Medicare Benefits: What Parts A, B, C and D Cover, What They Cost, and How to Get Help Paying

Who can get Medicare benefits

Most people qualify for Medicare benefits at age 65 if they are U.S. citizens or have been lawful permanent residents for at least five years in a row. You do not need to be retired. Younger people can also qualify:

• Disability: after receiving Social Security Disability Insurance or certain Railroad Retirement disability benefits for 24 months.
• ALS (Lou Gehrig’s disease): Medicare starts the same month disability benefits begin, with no 24-month wait.
• End-stage renal disease: permanent kidney failure that needs dialysis or a transplant.

If you already get Social Security retirement or disability checks, you are usually signed up for Parts A and B automatically and your card arrives in the mail. If you are not getting Social Security yet, you sign up yourself through Social Security, online or by phone. Medicare and Medicaid are different programs; our guide on Medicare vs. Medicaid explains how they work together for people who qualify for both.

The four parts of Medicare

Each part of Medicare pays for a different kind of care. Knowing which part does what makes your bills and plan choices easier to understand.

Parts A and B together are called Original Medicare. People on Original Medicare usually add a separate Part D drug plan, and many also buy a Medigap policy to fill cost gaps.

Medicare costs in 2026

These are the standard 2026 amounts published by Medicare and the Centers for Medicare & Medicaid Services. Your costs can differ if you have a Medicare Advantage plan, a Medigap policy, or help from Medicaid.

A benefit period starts the day you are admitted to a hospital and ends after you have gone 60 days in a row without inpatient or skilled nursing care. That means you can pay the Part A deductible more than once in a year. Higher-income people pay an extra amount for Part B and Part D, based on the tax return Social Security has on file from two years earlier. The 2027 Part A and B amounts are usually announced in the fall; check the CMS fact sheet and Medicare.gov costs page for the latest figures.

Prescription drug coverage and the yearly cap

Part D plans are sold by private insurers. Each plan has its own list of covered drugs, called a formulary, its own premium, and its own pharmacy network. In 2026, according to Medicare.gov, you pay up to the plan’s deductible (no more than $615), then 25% coinsurance until your out-of-pocket spending on covered drugs reaches $2,100. After that, you pay nothing for covered drugs for the rest of the calendar year. For 2027, Medicare lists a deductible of up to $700 and a cap of $2,400.

If large drug bills hit early in the year, you can join the Medicare Prescription Payment Plan, which spreads your out-of-pocket costs into monthly payments. It does not lower what you owe, but it can make bills easier to manage. Ask your drug plan to sign you up.

Compare drug plans every fall. Plans change their premiums and covered drugs each year, and the plan that was cheapest last year may not be this year. The Medicare Plan Finder on Medicare.gov lets you enter your exact drugs and pharmacies.

Original Medicare or Medicare Advantage

This is the biggest choice you make with your Medicare benefits. Both options must cover everything Original Medicare covers, but they work differently.

You still pay your Part B premium with most Medicare Advantage plans. For a closer look at the tradeoffs, read our guide to Medigap vs. Medicare Advantage.

Medigap supplement policies

Medigap, also called Medicare Supplement Insurance, is a private policy that helps pay what Original Medicare leaves behind, such as the 20% Part B coinsurance and the Part A deductible. You need Parts A and B to buy one, and you can only use Medigap with Original Medicare, not with a Medicare Advantage plan.

Most states offer 10 standardized Medigap plans named by letter, such as Plan G and Plan N. Plans with the same letter have the same basic benefits no matter which company sells them, so price and service are the main differences. Massachusetts, Minnesota, and Wisconsin standardize plans their own way.

Timing matters. Medicare.gov explains that you get a one-time, six-month Medigap Open Enrollment Period that starts the first month you have Part B and are 65 or older. During that window, insurers cannot turn you down or charge more because of health problems. After it ends, you may be denied or charged more in many states.

Enrollment periods and deadlines

Medicare has set times to sign up and make changes. Missing one can mean waiting months for coverage or paying a penalty.

If you or your spouse are still working and covered by an employer group plan, you can usually delay Part B without a penalty. You then get an eight-month Special Enrollment Period after the job or coverage ends, whichever comes first. Details are on Medicare.gov’s page about when coverage starts.

Late enrollment penalties to avoid

Medicare charges lifelong penalties in some cases if you sign up late without other qualifying coverage. According to Medicare.gov:

• Part B: 10% added to your premium for each full 12-month period you could have had Part B but did not, for as long as you have Part B.
• Part D: 1% of the national base premium for each month without creditable drug coverage, if you go 63 days or more without it after you first become eligible.
• Part A (if you must buy it): up to 10% higher premium, for twice the number of years you delayed.

Before you skip any part, ask your employer or plan in writing whether your current coverage counts as creditable. People who get Extra Help do not pay the Part D penalty.

Help paying Medicare costs on a low income

Several free programs lower Medicare costs for people with limited income and savings. Many eligible people never apply, so it is worth checking even if you think you earn too much. Many states use higher limits than the federal minimums below.

Medicare Savings Programs

State Medicaid offices run Medicare Savings Programs. They can pay your Part B premium, and the QMB level also covers Part A and B deductibles, coinsurance, and copays. Joining one also qualifies you automatically for Extra Help.

Extra Help with drug costs

Extra Help, also called the Low-Income Subsidy, lowers Part D premiums, deductibles, and copays. Medicare.gov lists 2026 limits of $23,940 in yearly income and $18,090 in resources for one person, or $32,460 and $36,100 for a married couple. You qualify automatically if you have full Medicaid, a Medicare Savings Program, or SSI. Otherwise, apply through Social Security.

Medicaid for people with Medicare

If your income is very low, you may qualify for full Medicaid as well as Medicare. Medicaid can then cover costs Medicare does not, including long-term care in many states. See our grants to help the elderly guide for food, energy, and home repair help that pairs well with these programs.

What does Medicare not cover?

Original Medicare generally does not pay for routine dental care, dentures, routine eye exams, eyeglasses, hearing aids, or long-term custodial care, such as help bathing and dressing in a nursing home or at home. It also does not usually cover care outside the U.S. Some Medicare Advantage plans include limited dental, vision, or hearing benefits, and Medicaid may cover some of these for people who qualify for both. Read our guide to whether Medicare covers hearing aids for one common example.

Free counseling from your SHIP

Every state has a State Health Insurance Assistance Program, or SHIP. Trained counselors give unbiased, one-on-one help with Medicare choices, plan comparisons, bills, appeals, and applications for Medicare Savings Programs and Extra Help. According to SHIPhelp.org, the counseling comes at no cost to you, and counselors do not sell insurance. Use the “Find Your SHIP” tool on that site to get your state’s phone number. You can also call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day except some federal holidays.

How to get started, step by step

1. Mark your Initial Enrollment Period on a calendar, starting three months before your 65th birthday month.
2. Check whether you will be enrolled automatically through Social Security, or sign up yourself.
3. Decide between Original Medicare and Medicare Advantage, using the Medicare Plan Finder and a SHIP counselor.
4. Add drug coverage on time to avoid the Part D penalty, unless you have other creditable coverage.
5. Consider Medigap during your six-month Medigap Open Enrollment if you choose Original Medicare.
6. Apply for a Medicare Savings Program and Extra Help if your income and savings are limited.
7. Review your plan every fall during Open Enrollment, October 15 to December 7.

Related guides

• Medigap vs. Medicare Advantage
• Medicare vs. Medicaid
• Grants to help the elderly
• Free government assistance for seniors living at home

Frequently asked questions

This guide is general information, not insurance advice. Costs and plan rules change each year. National Relief Program is an independent website and is not affiliated with Medicare, CMS, or any insurance company.