Medicare & Insurance FAQ 2026

Medicare Part A covers inpatient hospital stays, skilled nursing facilities, hospice, and some home health care. Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment (DME). In 2026, the standard Part B premium is $202.90/month and the annual Part B deductible is $283. Part D now caps annual out-of-pocket drug costs at $2,100 — after that, your covered medications are free for the rest of the year.

Original Medicare (Part A + Part B) is run by the federal government and accepted by most doctors nationwide. Medicare Advantage (Part C) is offered through private insurers that bundle Part A, Part B, and usually Part D into one plan. Advantage plans often include extra benefits — dental, vision, hearing, fitness memberships, and sometimes medical alert systems — but you must use in-network providers. Original Medicare gives more flexibility; Advantage plans can lower out-of-pocket costs if you stay in-network.

Original Medicare (Parts A and B) does not cover medical alert systems. However, many Medicare Advantage plans include personal emergency response systems (PERS) as a supplemental benefit. Coverage varies widely by plan and insurer. Call your plan's member services number and ask specifically whether PERS or medical alert devices are covered as a supplemental benefit — many enrollees don't realize this coverage is available.

Medicare Part B covers durable medical equipment (DME) — including walkers, canes, rollators, and wheelchairs — if your doctor certifies medical necessity and you use a Medicare-approved supplier. Medicare pays 80% after the annual deductible; you pay the remaining 20% (or your Medigap plan covers it). Grab bars and most home modifications are generally not covered by original Medicare, though some Medicare Advantage plans offer home safety modification benefits.

In 2026, the Medicare Part A inpatient hospital deductible is $1,736 per benefit period. Days 1–60 in the hospital: $0 coinsurance. Days 61–90: $433/day. Days 91+: $866/day (lifetime reserve days). For skilled nursing facilities: days 1–20 are fully covered; days 21–100 cost $216.50/day; after day 100, Medicare pays nothing. Medigap (supplemental insurance) policies can cover many of these gaps.

Medigap is private supplemental insurance sold alongside original Medicare to cover cost-sharing gaps — deductibles, coinsurance, and copays. Plans are standardized (labeled A through N) and must cover the same benefits regardless of insurer, though premiums vary. The best time to buy Medigap is during your 6-month open enrollment window when you first sign up for Part B — insurers cannot reject you or charge more due to health conditions during this window.

Original Medicare does not cover routine dental care, dentures, eye exams for glasses, hearing aids, or hearing exams for fitting hearing aids. These are among the biggest coverage gaps for seniors. Many Medicare Advantage plans include dental, vision, and hearing benefits — often with annual allowances for exams, glasses, and hearing aids. If you have original Medicare, standalone dental and vision plans are available from private insurers.

Medicare is a federal health insurance program primarily for adults 65+ and for younger people with disabilities. Eligibility is based on work history, not income. Medicaid is a joint federal-state program for people with low income, covering health care, long-term care, and nursing home costs. Seniors who qualify for both programs are called 'dual eligible' — Medicaid often covers premiums, deductibles, and long-term care costs that Medicare doesn't.

If you're receiving Social Security at 65, you're automatically enrolled in Parts A and B. If not, you must enroll during your Initial Enrollment Period (IEP) — the 7-month window around your 65th birthday. Missing this window can result in a permanent 10% premium penalty for each 12-month period you delay Part B enrollment. For Part D, the penalty is 1% per month of delayed enrollment. If you have creditable employer coverage, you can delay without penalty.

Starting January 1, 2026, Medicare began using newly negotiated drug prices for a set of high-cost medications under the Inflation Reduction Act. If you take one of these drugs, you may see significantly lower costs at the pharmacy. The $2,100 annual out-of-pocket cap on Part D drugs is also now fully in effect. Additionally, insulin is capped at $35/month for Medicare beneficiaries.