New to Medicare? Start Here.
Medicare doesn't have to be confusing. Here's a straightforward overview of how it works, what the parts are, what they cover, and what you need to do when you turn 65.
The Four Parts of Medicare
Part A, Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people don't pay a premium for Part A if they (or their spouse) worked and paid Medicare taxes for at least 10 years.
2026 Part A costs: $1,736 deductible per benefit period. Coinsurance applies for longer hospital stays.
Part B, Medical Insurance
Pays for doctor visits, checkups, and care you get without staying overnight. Part B has a monthly premium. The standard amount in 2026 is approximately $202.90/month, though it can be higher based on income (IRMAA).
2026 Part B costs: ~$202.90/month premium, $283 annual deductible, then 20% coinsurance for most services.
Part C, Medicare Advantage
Another way to get Medicare, run by private insurers. It covers what Parts A and B cover. It usually adds Part D drug coverage, and often includes dental, vision, and hearing. You must be enrolled in Parts A and B to join a Medicare Advantage plan.
Part D, Prescription Drugs
Standalone prescription drug coverage for people on Original Medicare. Offered by private insurance companies approved by Medicare. Plans vary by which drugs they cover and what you pay. The out-of-pocket cap for 2026 is $2,100.
The Two Coverage Paths
When you first enroll in Medicare, you'll choose one of two coverage paths:
Path 1: Original Medicare + Medigap + Part D
- ✓ Use any Medicare provider nationwide
- ✓ No referrals needed
- ✓ Predictable costs with Medigap
- ✗ Higher monthly premiums
- ✗ No dental/vision/hearing included
Path 2: Medicare Advantage (Part C)
- ✓ Often $0 or low premiums
- ✓ Usually includes drug, dental, vision
- ✓ Out-of-pocket maximum
- ✗ Network restrictions
- ✗ Plans change annually
When Do You Need to Enroll?
Your Initial Enrollment Period (IEP) is a 7-month window: the 3 months before your birthday month, your birthday month, and the 3 months after. Missing this window can mean late enrollment penalties and gaps in coverage.
Still working at 65 with health coverage from your job? You may be able to put off Medicare without a penalty, but the rules are specific. Get advice before assuming you can wait.
What You Should Do Before You Turn 65
- Sign up for Medicare Parts A and B through Social Security (at ssa.gov or by calling 1-800-772-1213)
- Gather your list of current medications and the doctors you want to keep
- Speak with a licensed Medicare agent (like us) to compare plan options in your county
- Enroll in your chosen coverage before your IEP window closes
⚠️ Idaho residents: Check your state programs Idaho has several programs (QMB, SLMB, QI) that can help lower-income residents pay for Medicare costs. Idaho SHIP (Senior Health Insurance Benefits Advisors) also offers free, unbiased counseling. Call Idaho SHIP at 1-800-247-4422.
Turning 65 Soon?
Start the conversation 3–6 months before your birthday month. Plans need time to process enrollment.
Schedule Free Review (208) 207-4508By calling you will be connected to a licensed insurance agent.
Ready to Find the Right Medicare Plan?
Medicare enrollment windows have strict deadlines. Speak with a licensed Idaho agent today, it's completely free.