Medicare has four parts and several ways to put them together. Here's what each piece actually covers, what your real options are, and what it costs — in plain English.
Every Medicare plan you'll ever hear about is built from these four pieces.
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people pay $0 monthly premium for Part A because they paid Medicare taxes while working.
Covers doctor visits, outpatient care, preventive services, and durable medical equipment. Has a monthly premium ($202.90 in 2026) and an annual deductible ($283). After the deductible, Medicare pays 80%.
An alternative to Original Medicare — a private plan that bundles Parts A and B, often with drug coverage, dental, vision, hearing, and fitness benefits. Usually includes a provider network.
Covers prescription medications through private, Medicare-approved drug plans. Sold stand-alone alongside Original Medicare, or bundled into a Medicare Advantage plan. The 2026 out-of-pocket cap is $2,100.
Get oriented on the four parts and how they're typically combined.
See the trade-offs between Medigap, Medicare Advantage PPO, and Medicare Advantage HMO plans.
Know your timing, your costs, and what to watch out for before you sign up.
Most people on Medicare end up choosing one of these three paths. There's no single "best" answer — it depends on your health, your budget, and what trade-offs matter to you.
| How it works | Medicare + Medigap + Stand-Alone Part D | Medicare Advantage PPO (Part C) | Medicare Advantage HMO (Part C) |
|---|---|---|---|
| What it is | Parts A & B, plus a private Medigap (Supplement) plan that covers most leftover costs | Parts A & B benefits delivered through a private insurer, often with extra perks | Parts A & B benefits delivered through a private HMO — usually the lowest-cost option, with in-network-only care |
| Prescription drugs | Not included — needs a separate stand-alone Part D plan | Usually bundled in automatically (called an "MA-PD" plan) | Usually bundled in automatically |
| Monthly cost | Highest — Part B premium + Medigap premium + Part D premium | Often lowest — many plans have a $0 premium beyond Part B | Lowest — many $0-premium plans in California; pay copays per service |
| Out-of-pocket risk | Lowest — Medigap covers most coinsurance and deductibles | Capped, but can include copays for every visit and an annual max out-of-pocket | In-network MOOP applies; out-of-network care generally not covered |
| Doctor network | See any doctor who accepts Medicare, nationwide | Usually limited to a network; may need referrals | In-network providers only; no out-of-network coverage (emergencies excepted) |
| Extra benefits | Rarely included — purely fills cost gaps | Often includes dental, vision, hearing, gym memberships | Often includes dental, vision, hearing, gym memberships |
| Best fit for | People who want predictable costs and travel often | People comfortable with a network who want lower premiums | People with in-network local providers and who want the lowest possible monthly cost |
IRMAA brackets, late enrollment penalties (with a calculator), Part D rules, and what Medicare doesn't cover — all in one place.
These are the standard 2026 federal amounts. Want the full breakdown, including Medigap and Part D specifics? Visit our complete Medicare costs page.
Standard 2026 amount. Higher-income beneficiaries pay more (IRMAA surcharge). Deducted from Social Security for most people.
You pay this once per year before Part B starts sharing costs. After the deductible, Medicare covers 80% of approved services.
Covers the first 60 days of a hospital stay — and can apply more than once a year if you're re-admitted after 60 days at home.
No drug plan can charge more than this in 2026. The annual out-of-pocket cap for covered drugs is $2,100 — after that, you pay $0 for the rest of the year.
A 7-month window around your 65th birthday to sign up for the first time without a penalty.
Switch Medicare Advantage or Part D plans, or move between Medicare Advantage and Original Medicare.
If you're already in a Medicare Advantage plan, you get one more chance to switch plans or return to Original Medicare.
Life events like losing employer coverage or moving can open a special window outside the usual dates.
Browse and enroll directly in a Blue Shield Medicare Advantage or Medicare Supplement plan through their consumer enrollment portal.
If your income is limited, you may qualify for both Medicare and Medi-Cal — making you "dual eligible." This is one of the most valuable combinations in California healthcare. Medi-Cal can cover what Medicare doesn't, including long-term care and your Medicare premiums themselves.
Income: Most senior Medi-Cal programs require income under 100%–138% FPL (~$1,304–$1,836/month for individuals). The 250% Working Disabled Program extends to ~$3,345/month.
Assets: As of January 1, 2026, Medi-Cal reinstated asset limits for seniors. Countable assets must be under $130,000 for an individual and $195,000 for a couple. Your primary home, one vehicle, and personal property are generally not counted.
How to apply: Apply through your local county Medi-Cal office or through Covered California. If you already have Medicare, ask specifically about Medicare Savings Programs and the Low-Income Subsidy for Part D.
Full Medi-Cal for Seniors guide →Pulled automatically from KFF Health News and the Medicare Rights Center, two trusted nonpartisan sources for Medicare policy and news.
Not always. If you have qualifying employer coverage through a large employer, you may be able to delay Part B without a penalty. It depends on the size of your employer and your specific plan — this is exactly the kind of thing worth a quick call before you decide.
A Medicare Supplement (Medigap) works alongside Original Medicare to cover leftover costs like coinsurance and deductibles — you keep Original Medicare and can see any doctor who accepts it. Medicare Advantage replaces Original Medicare with a private plan, usually with a network, often at a lower monthly cost and with extra benefits.
Generally yes, if you go 63 days or more without "creditable" drug coverage after you're first eligible. The penalty is added to your premium for as long as you have Part D, so it's worth enrolling even if you're not currently taking medications — unless you have other creditable coverage.
Yes. The Annual Enrollment Period (October 15 – December 7) lets you switch Medicare Advantage or Part D plans for the following year. For Medigap, California has a special advantage most states don't: the Birthday Rule. Every year, you get 60 days starting on your birthday to switch to any Medigap plan with equal or lesser benefits — from any insurance company — with no health questions and no medical underwriting. Since Medigap benefits are standardized by letter, this means you can shop for a lower premium on the exact same coverage every single year.
No. Plans cost the same whether you enroll through an agent or directly — insurance carriers pay agent commissions, not you. There's no fee for our help.
