What is Medicare
What is Medicare, and what is Medigap? These are two of the most common questions we are asked daily, so we dedicated an entire page to answering them. While both Medicare and Medigap are in-depth topics, this page gives you a broad understanding of how to tell one from the other and whether they apply to you. You can always call us with questions at (888) 918-0518. We’re here to help!
The government provides Medicare Part A and Part B, together known as Original Medicare. Most people pay no premium for Part A because they or a spouse paid Medicare taxes for at least 40 quarters (about 10 years) while working. Part B has a monthly premium once you enroll. The standard Part B premium is $202.90 per month in 2026, and people with higher incomes pay more. Parts A and B on their own leave gaps in coverage, such as deductibles and the 20% coinsurance on most Part B services, with no yearly limit on what you can spend.
So, what is Medigap? A Medigap plan helps fill those gaps in Part A and Part B. Plan F fills all of the standard gaps (prescriptions aside, which is Part D, below), but it is only available to people who were eligible for Medicare before January 1, 2020. For people new to Medicare, Plan G covers everything Plan F does except the Part B deductible, and around here, we are big fans of Plan G. Premiums vary by insurance company, age, and where you live.
Medicare is health insurance for people 65 or older, people under 65 with certain disabilities, and people of any age with End-Stage Renal Disease (ESRD), which is permanent kidney failure requiring dialysis or a kidney transplant.
The Different Parts of Medicare
Part A helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care.
Usually, you don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working. This is sometimes called premium-free Part A. If you aren’t eligible for premium-free Part A, you may be able to buy Part A and pay a premium. In 2026, the Part A hospital deductible is $1,736 for each benefit period.
Part B helps cover services from doctors and other health care providers, hospital outpatient care, durable medical equipment, home health care, and preventive services that help maintain your health and keep certain illnesses from getting worse.
Most people pay the standard monthly Part B premium. In 2026, the Part B deductible is $283, and after you meet it you typically pay 20% of the Medicare-approved amount for most services. You may want coverage that fills these gaps, such as a Medicare Supplement Insurance (Medigap) policy from a private company.
Medicare Advantage plans are run by Medicare-approved private insurance companies and include all of the benefits and services covered under Part A and Part B. Most plans also include Medicare prescription drug coverage (Part D), and many offer extra benefits Original Medicare doesn’t cover, such as vision, hearing, or dental. Plans usually have networks of doctors and hospitals, along with their own costs and rules.
We have a great article about Medicare Advantage vs. Medigap and how to choose.
Part D helps cover the cost of outpatient prescription drugs. It is run by Medicare-approved private insurance companies, and it can help lower your prescription drug costs and protect against higher prices in the future.
If you have limited income and resources, you may qualify for help paying for your health care and prescription drug costs. For more information, visit socialsecurity.gov, call Social Security at 1-800-772-1213, or contact your local State Medical Assistance (Medicaid) office.
Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid may also cover services not usually covered by Medicare, like long-term supports and services and personal care services. Each state has different rules about eligibility and applying for Medicaid. If you qualify for Medicaid in your state, you automatically qualify for Extra Help paying for your Medicare prescription drug coverage (Part D).
You may be eligible for Medicaid if you have limited income and are 65 or older, a child under 19, pregnant, living with a disability, a parent or adult caring for a child, an adult without dependent children (in certain states), or an eligible immigrant. In many states, more parents and other adults can get coverage now. If you were turned down in the past, you can try again and may qualify now.
When you enroll, you can get the health care benefits you need, like doctor visits, hospital stays, long-term services and supports, preventive care (including immunizations, mammograms, and colonoscopies), prenatal and maternity care, mental health care, necessary medications, and vision and dental care for children.
You should apply for Medicaid if you or someone in your family needs health care. If you aren’t sure whether you qualify, a qualified caseworker in your state can look at your situation. Contact your local or state Medicaid office to see if you are eligible and apply. To get information about your state’s Medicaid program, visit HealthCare.gov/do-i-qualify-for-medicaid.
Dual Eligibility
People who qualify for both Medicare and Medicaid are called “dual eligibles.” If you have Medicare and full Medicaid coverage, most of your health care costs are likely covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan (like an HMO or PPO). If you have Medicare and full Medicaid, Medicare covers your Part D prescription drugs, and Medicaid may still cover some drugs and other care that Medicare doesn’t.
When to Enroll in Medicare
Your Initial Enrollment Period is a 7-month window around your 65th birthday. It starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after. If you are already getting Social Security benefits, you are usually enrolled in Parts A and B automatically.
If you miss your Initial Enrollment Period and don’t have other qualifying coverage, such as a group health plan through current employment, you can sign up during the General Enrollment Period from January 1 to March 31 each year. You may also owe a late enrollment penalty. In most cases, your Part B premium goes up 10% for each full 12-month period you could have had Part B but didn’t, and you pay that penalty for as long as you have Part B.
Each fall, the Medicare Open Enrollment Period runs from October 15 to December 7. During this time you can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or join, switch, or drop a Part D plan. Changes take effect January 1.
Original Medicare vs. Medicare Advantage
With Original Medicare, you can see any doctor or hospital in the country that accepts Medicare. Adding a Medigap plan and a Part D plan gives you predictable costs and drug coverage, with a separate premium for each. Medicare Advantage combines your coverage into one plan, often with a low or $0 plan premium (you still pay your Part B premium), but you typically use a network of providers and pay copays as you go, up to a yearly out-of-pocket limit.
Neither option is right for everyone. A licensed iHealthBrokers advisor can compare both side by side with the plans available in your area, at no cost to you.
