I dedicate this month’s article to those of you who will be newly eligible for Medicare in 2026. I hope you find it helpful!
If you’ve been anticipating your own transition to the Medicare program, you may have already noticed that there are a lot of moving parts, and figuring out what to do can be confusing. So let’s break it down.
First of all, you want to know about your initial enrollment period. Assuming you are not intending to remain on your employer’s group plan and you’re not already collecting Social Security benefits, beginning three months before your birth month when you turn 65, you can enroll for Medicare Parts A and B through the Social Security Administration. These days, this is best accomplished online at ssa.gov. Technically, you can wait as long as three months past your 65th birthday to enroll without penalty, but get it done early.
If you’ve worked at least 40 quarters in your lifetime, you’re automatically provided Medicare. This includes two parts(Medicare Parts A and B). Medicare Part A has no premium and covers hospital-related fees with various deductibles. Medicare Part B covers 80% of physicians and other outpatient fees, and it is offered with a monthly premium. For most people, in 2026, the Part B premium is $202.90, which will be automatically deducted from SSA benefits if you collect them, or paid directly by you if you are not. For those with higher incomes based on a two-year look back, the Part B premium will vary and can be as high as $689.90 (and $91.00 for Part D prescription coverage) per month. This is known as the Income Related Monthly Adjustment Amount, or IRMAA.
Step two, you’re going to decide whether you’d prefer to stick with Traditional Medicare (Parts A and B) and then add a Medicare Supplement Plan and a Prescription Drug Plan (Part D) to help offset the rest, or switch to a Medicare Advantage Plan, which is a commercial health plan designed specifically for Medicare beneficiaries.
Original Medicare with an added Supplement Plan (Medigap) will be your strongest insurance option. During your initial enrollment into Medicare, you have guaranteed issuance into a Supplement Plan within the first six months of enrolling in Part B. This means that you do not need to pass underwriting before purchasing a Supplement Plan. If you decide after those six months to purchase a Supplement Plan, you will need to pass medical underwriting to be accepted. A Supplement Plan will allow you to see any provider in the country that accepts Medicare, and most of the costs that Original Medicare does not cover will be covered by your Supplement Plan. The reason many choose a Supplement Plan over an Advantage Plan is the flexibility to see more providers, without the concern of needing prior authorization or having an insurance company deny a claim. However, Supplement Plans have an extra premium between $100 and $225 per month, depending on which plan and carrier you choose, and they do not include a Prescription Drug Plan. You will need to add a PDP along with it. If you don’t, you will be charged a lifetime penalty when you later decide to add an Advantage Plan or PDP. This penalty is 1% for every month you did not have a PDP after starting your Medicare Part B.
If you choose an Advantage Plan, the government essentially pays your Medicare benefits to the insurance company to manage your health care, and in turn, the Advantage Plan is required to offer benefits that meet a minimum standard. Historically, many have offered extra perks as well, including a Prescription Drug Plan. Advantage Plans work very much like an employer’s group insurance. You will need to decide if you want an HMO or a PPO and will need to stay within your plan’s network. This is the most affordable option as they usually have $0 premiums, and many even include a Part B Giveback, which will actually pay back a portion of your Medicare Part B premium. Different carriers will have different provider networks and PDP drug formularies, so it is important to choose the right plan according to your needs.
What most influences people when it comes to choosing which Supplement and PDP plan or Advantage plan will work best is typically a combination of one’s anticipated health care needs, doctor network flexibility or preferences, and budget. Talk to your local broker to get more details and see which plan may work best for you.
Everyone is different and has individualized needs, so getting a free consultation from a certified Medicare broker is valuable. Reach out anytime! Email Christian@evergreenhealthins.com or call (850) 687 7606.
