Medicare Questions, Answered in Plain English

The insurance company pays us, not you. When you enroll in a plan through a licensed agent, the company that issues the plan pays the agent a commission, which is regulated by CMS for Medicare Advantage and Part D plans.

Your premium is the same whether you buy the plan through us, directly from the company, or on Medicare.gov. Plan prices are filed with the state or approved by Medicare, so using an agent never adds to your cost. That is why there is no cost for our help, before or after you enroll, including help with claims, billing problems and your yearly review.

The standard Part B deductible for 2026 is $283 a year (CMS). You pay that amount for Part B services, such as doctor visits, outpatient care and lab work, before Medicare starts paying its share. After that, you usually pay 20% of the Medicare-approved amount.

Many preventive services, such as your yearly wellness visit, do not count toward the deductible because you pay nothing for them. If you have Medigap Plan G, the Part B deductible is the main bill the plan leaves to you. CMS announces the 2027 amount around November 2026.

Read more: Medicare costs in 2026

The standard Part B premium for 2026 is $202.90 a month (CMS). Most people pay it straight out of their Social Security check. If you are not getting Social Security yet, Medicare sends you a bill.

You pay more than the standard amount if your income is above the IRMAA limits, and you can pay more for life if you signed up late without other qualifying coverage. You still pay the Part B premium if you join a Medicare Advantage plan. CMS sets the 2027 premium around November 2026, and we update our figures when it does.

Read more: Part B penalty calculator

IRMAA is an extra amount added to your Part B and Part D premiums when your income is higher. For 2026, it starts when your modified adjusted gross income is above $109,000 for a single filer or $218,000 for a married couple filing jointly (CMS). At that first level, your Part B premium is $284.10 a month plus $14.50 on top of your Part D premium. The top level is $689.90 for Part B.

Social Security uses your tax return from two years earlier. If your income has dropped because you retired or another life-changing event happened, you can ask Social Security to use a more recent year.

Read more: IRMAA calculator

Yes, you can buy Part A, and the price depends on how long you worked. Part A is premium-free if you or your spouse worked and paid Medicare taxes for at least 40 quarters, about 10 years. In 2026, if you have 30 to 39 quarters, Part A costs $311 a month. With fewer than 30 quarters, it costs $565 a month (CMS).

A spouse's work record can make Part A premium-free for you, including in some cases a former or late spouse. If you have to buy Part A and wait to sign up, a late penalty can apply, so ask us to check your timing first.

Read more: Are you eligible for Medicare?

You are not required to take Medicare, but many veterans sign up for Part B anyway. VA care and Medicare work separately: the VA generally pays only for care from VA facilities or care the VA authorizes, and Medicare pays only for care outside the VA. With both, you can choose either door.

VA coverage does not count as employer coverage, so if you skip Part B and want it later, you can face a late penalty and wait for the General Enrollment Period. VA drug coverage is creditable, so you can usually delay Part D without a penalty. If you have TRICARE, the rules are different: TRICARE For Life requires Part B.

Read more: Medicare with VA, TRICARE and CHAMPVA

Medigap, also called Medicare Supplement insurance, is a private policy that helps pay costs Original Medicare leaves to you, such as deductibles, coinsurance and copays. Medicare pays first, then your Medigap plan pays its share.

The plans are standardized by letter, so a Plan G from one company covers the same benefits as a Plan G from another; only the price and service differ. Medigap works only with Original Medicare, you need Parts A and B, and it covers one person. It does not include drug coverage, so most people add a Part D plan. You can see any doctor in the country who accepts Medicare.

Read more: Compare Medigap plans

These are the three ways a company can set your Medigap premium. With attained-age pricing, the premium is based on your current age, so it goes up as you get older. It is often lower at 65 and higher later.

With issue-age pricing, the premium is based on your age when you buy the policy, so getting older does not raise it. With community-rated pricing, everyone pays the same premium regardless of age.

Under all three, premiums can still rise because of inflation and rising health care costs. When you compare quotes, ask which method the company uses, so a low first-year price does not surprise you later.

Medicare SELECT is a Medigap policy that asks you to use specific hospitals, and in some cases specific doctors, to get full benefits. In exchange, the premium is often lower than the same lettered plan without a network.

In an emergency, you can go to any hospital. If you use a provider outside the network for non-emergency care, the SELECT policy may not pay its share, although Medicare still pays its part. SELECT can fit well if the network hospitals are the ones you already use and you do not travel much. Not every company offers SELECT plans in every area.

Plan F covers all the standard gaps in Original Medicare: the Part A deductible, the Part B deductible, coinsurance, Part B excess charges and emergency care abroad, within plan limits. With Medicare paying first, you pay little or nothing for covered care.

You can buy Plan F only if you were eligible for Medicare before January 1, 2020. If you became eligible on or after that date, Plan F is not available to you. Plan G covers the same benefits except the Part B deductible, and is the usual choice for people new to Medicare. If you already have Plan F, you can keep it.

Read more: Compare Medigap plans

No. Plan G is a Medicare Supplement (Medigap) plan. It works alongside Original Medicare: Medicare pays first, then Plan G pays most of what is left.

Medicare Advantage is a different path that replaces how Original Medicare pays your bills, usually with a network and copays. With Plan G, you can see any provider in the country that accepts Medicare, and the main cost left to you is the Part B deductible ($283 in 2026). Plan G does not include drug coverage, so you add a separate Part D plan. You cannot use a Medigap plan and a Medicare Advantage plan together.

Read more: Medicare Advantage vs Supplement

Both plans pay the Part A deductible and the coinsurance Original Medicare leaves, and both leave you the Part B deductible. The difference is what you pay after that.

With Plan G, once you meet the Part B deductible, you generally pay nothing more for covered care. With Plan N, you may owe a small copay for some office visits and emergency room visits, and Plan N does not pay Part B excess charges, which some doctors who do not accept assignment can bill. In return, Plan N usually has a lower monthly premium. If you see doctors often, Plan G can cost less overall.

Read more: Compare Medigap plans

High-deductible Plan G covers the same benefits as Plan G, but only after you pay a yearly deductible: $2,950 in 2026 and $3,050 in 2027 (CMS). Until you reach it, you pay what Original Medicare does not.

The trade is a much lower monthly premium. It can suit people who are healthy, rarely see a doctor, and have savings to cover a bad year. If you expect regular care, standard Plan G is often the steadier choice. We can run both side by side for you.

Read more: Medicare Supplement plans

You can apply to switch at any time of year, but outside your Medigap Open Enrollment Period, the company can usually ask health questions and turn you down or charge more. That is called medical underwriting.

Some states give people a yearly window to switch without health questions, often called a birthday rule. Arizona does not have one. There are also federal guaranteed issue rights in certain situations, such as when your Medicare Advantage plan leaves your area or employer coverage that paid after Medicare ends. When your company raises your rate, we check whether you qualify for a lower-cost plan with the same benefits.

Medicare Advantage (Part C) plans are offered by private companies approved by Medicare. They cover everything Parts A and B cover, and most include Part D drug coverage. Many add extras such as dental, vision or hearing benefits.

Most plans use a network of doctors and hospitals, and some need prior approval or referrals. You pay copays and coinsurance as you use care, up to a yearly out-of-pocket limit. You still pay your Part B premium. Original Medicare, by contrast, lets you see any provider that accepts Medicare nationwide, but has no yearly limit unless you add a Medigap plan.

Read more: Types of Medicare Advantage plans

It runs January 1 to March 31 each year, and it is only for people already in a Medicare Advantage plan. During it, you can make one change: switch to a different Medicare Advantage plan, or leave Medicare Advantage for Original Medicare and join a Part D plan.

If you are new to Medicare Advantage, you also get a one-time chance to change in your first three months in the plan. You cannot use this window to move from Original Medicare into Medicare Advantage. If you go back to Original Medicare, a Medigap plan may require health questions, so talk with us before you switch.

Read more: Medicare enrollment periods

No. A Medigap plan only pays alongside Original Medicare, so it would pay nothing while you are in a Medicare Advantage plan. It is against the law for a company to sell you a Medigap policy if they know you have Medicare Advantage, unless you are switching back to Original Medicare.

If you are moving from Medicare Advantage back to Original Medicare, apply for the Medigap plan first and make sure you are approved before you leave the Advantage plan. Outside a guaranteed issue situation, the Medigap company can ask health questions.

Read more: Medigap vs Advantage calculator

In 2026, the most you pay for covered Part D drugs in a year is $2,100 (CMS). Once your out-of-pocket drug costs reach that amount, you pay nothing more for covered drugs for the rest of the year. The cap applies to standalone Part D plans and to Medicare Advantage plans with drug coverage.

Your monthly premium does not count toward the cap, and neither do drugs your plan does not cover. If big costs early in the year are hard to pay, the Medicare Prescription Payment Plan lets you spread them into monthly payments. The cap is set again each year.

Read more: Medicare Part D explained

Extra Help is a federal program that lowers what you pay for Part D: your premium, deductible and copays. It is for people with limited income and savings, and the limits change each year.

If you have Medicaid (AHCCCS in Arizona), get Supplemental Security Income, or are in a Medicare Savings Program, you get Extra Help automatically. Otherwise, you can apply through Social Security, online or by phone, at no cost. If you qualify, you also get chances during the year to change your drug plan. We can help you check whether you are likely to qualify before you apply.

Read more: Extra Help in Arizona

In most cases, yes, it is worth enrolling when you are first eligible. If you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, you can owe a late enrollment penalty added to your premium for as long as you have Part D.

Creditable coverage is drug coverage at least as good as Medicare's, such as many employer plans or VA coverage. If you have no coverage like that, a low-premium Part D plan protects you from the penalty and from a sudden new prescription. We can find plans that fit your situation.

Read more: Part D penalty calculator

Original Medicare covers a test, surgery or therapy when it is medically necessary, meaning it is needed to diagnose or treat your condition and meets accepted standards of care. Part A covers care when you are formally admitted to a hospital. Part B covers doctors, outpatient surgery, lab work and therapy.

The surest way to know is to ask your doctor or the facility before the procedure, and to check that they accept Medicare. If your provider thinks Medicare may not pay, they should give you an Advance Beneficiary Notice (ABN) to sign. That form means you may owe the whole bill, so read it before you agree. If you have a Medicare Advantage plan, ask the plan whether it needs prior approval.

Read more: Medicare 101: Parts A, B, C and D

The Welcome to Medicare preventive visit is a one-time checkup you can have within the first 12 months you have Part B. Your doctor reviews your medical and family history, checks your height, weight, blood pressure and vision, talks through recommended screenings, and can help you plan an advance directive if you want one.

After you have had Part B for more than 12 months, you can have a yearly wellness visit once every 12 months to update your prevention plan. You pay nothing for either visit when your doctor accepts assignment. Neither is a full physical exam, so extra tests or treatment during the same appointment can bring a separate charge.

Read more: Turning 65 checklist

Medicare Part B covers screening colonoscopies, and you pay nothing for the screening itself when your doctor accepts assignment. If you are not at high risk, Medicare covers one every 10 years (or 4 years after a flexible sigmoidoscopy). If you are at high risk, it covers one every 2 years.

One thing surprises people: if your doctor finds and removes a polyp or takes a biopsy during the screening, you can owe a coinsurance for that part, and you may also owe a facility charge. The Part B deductible does not apply. A Medigap plan generally picks up that coinsurance; with Medicare Advantage, check your plan's cost sharing.

Generally no. Original Medicare pays for care outside the United States only in a few rare cases, such as certain situations near the Canadian border. If you travel, plan for this before you go.

Several Medigap plans, including Plans G and N, cover emergency care abroad: they pay 80% of the cost after a yearly deductible, up to a lifetime limit. Some Medicare Advantage plans include emergency or urgent care abroad, so read your plan's Evidence of Coverage. For longer trips or more protection, a travel medical policy can fill the gap, and we can help you find one.

Read more: Travel insurance

Original Medicare does not cover most routine dental care, such as cleanings, fillings and dentures. It also does not cover routine eye exams for glasses, eyeglasses, hearing aids or exams to fit them. It does cover some care tied to a medical problem, such as cataract surgery and one pair of glasses afterward.

Many Medicare Advantage plans include some dental, vision and hearing benefits, with limits that vary by plan. If you choose Original Medicare with a Medigap plan, you can add a separate dental or vision policy. We can compare the options with you.

Read more: Dental insurance

Medicare does not pay for long-term custodial care, which is help with daily activities like bathing, dressing and eating, whether at home or in a nursing home. That is the care most people mean when they say "long-term care."

Medicare does cover a limited stay in a skilled nursing facility for rehab after a qualifying hospital stay of at least three days as an inpatient, and some part-time skilled care at home. Long-term custodial care is usually paid for out of savings, by Medicaid (AHCCCS in Arizona) for those who qualify, or by long-term care insurance planned ahead of time.

Read more: What is long-term care insurance?

It depends mainly on the size of your employer. If you have group health coverage through your own or your spouse's current job and the employer has 20 or more employees, that plan pays first, and you can usually delay Part B without a penalty.

If the employer has fewer than 20 employees, Medicare usually pays first, so you generally need Part A and Part B when you turn 65 or your claims may not be paid. When the job or the coverage ends, you have 8 months to sign up for Part B without a penalty. COBRA and retiree coverage do not count as current employment. If you have an HSA, stop contributions before Medicare starts.

Read more: Working past 65 and Medicare

Your Medigap Open Enrollment Period is a one-time, 6-month window. It starts the first month you are both 65 or older and enrolled in Part B. During those 6 months, a company cannot turn you down or charge you more because of your health.

It does not repeat, and you cannot pause it once your Part B begins. If you delay Part B because you are still working, the window waits until your Part B starts. After it ends, companies can usually ask health questions, and Arizona has no yearly birthday rule to switch. For many people, this is the most important deadline in Medicare.

Read more: Medicare enrollment date calculator

It runs October 15 to December 7 every year, and the changes you make start January 1. The current window, for 2027 plans, is October 15 to December 7, 2026. During it, you can join, switch or drop a Medicare Advantage plan or a Part D drug plan, or move between Medicare Advantage and Original Medicare.

Plans change their premiums, drug lists and networks each year, and your plan mails an Annual Notice of Change in the fall. This is the time to check that your doctors and prescriptions still fit. We review your plan and prescriptions with you every year during this window.

Read more: Annual Medicare review checklist

Your Initial Enrollment Period is 7 months long: the 3 months before the month you turn 65, your birthday month, and the 3 months after. Signing up in the months before your birthday month means coverage starts on time.

If you already get Social Security or Railroad Retirement benefits, you are enrolled in Parts A and B automatically, and your card arrives in the mail. Otherwise, you sign up through Social Security. If you miss your window and have no qualifying employer coverage, you may have to wait for the General Enrollment Period and pay a late penalty.

Read more: Medicare enrollment date calculator