Tim Berry Financial Services is a private, independent agency and is not connected with or endorsed by the U.S. government, the federal Medicare program, or CMS. This guide is educational and does not offer or recommend any specific plan. We do not offer every plan available in your area — to see all your options, contact Medicare.gov, call 1-800-MEDICARE, or reach your State Health Insurance Assistance Program (SHIP).
Where Medicare enrollment stands in 2026
If you're approaching 65 — or already on Medicare and rethinking your coverage — you'll quickly hit the biggest fork in the road: Medicare Advantage or Original Medicare. It's the single decision that shapes what you pay, which doctors you can see, and how much paperwork stands between you and your care. And unlike most retirement choices, it's one you can revisit every single year.
The honest answer up front: neither option is universally better. They're two very different ways of structuring the same government benefit. Medicare Advantage trades some freedom for lower monthly cost and bundled extras. Original Medicare paired with a supplement trades a higher monthly premium for near-total freedom and predictability. The right choice depends on your health, your budget, your doctors, and how you like to handle risk.
The last two decades tell a clear story: a steady, dramatic shift toward private plans. In 2007, only about 19% of eligible beneficiaries chose a Medicare Advantage plan. For 2026, KFF reports roughly 35.2 million people — about 55% of the 64.2 million eligible beneficiaries — are enrolled in Medicare Advantage, and the Congressional Budget Office projects the share will keep climbing toward 63% by 2034. But growth has slowed to about 3% into 2026 as insurers pull back from unprofitable markets, and the market is concentrated: UnitedHealth Group (26%) and Humana (20%) together cover nearly half of all Advantage enrollees.
What Medicare Advantage actually is
A Medicare Advantage plan (also called Part C) is private insurance that Medicare pays to deliver your Part A and Part B benefits, usually with prescription drug coverage folded in. When you enroll, the insurer becomes your point of contact — you use their network, their rules, and their customer service instead of dealing with Original Medicare directly.
The appeal is real. For 2026, KFF reports that about 75% of enrollees pay no premium beyond the standard Part B premium, and the average Medicare Advantage premium across all enrollees is roughly $14 a month. Most plans bundle extras Original Medicare never covers — vision, dental, hearing, and a fitness benefit — plus, crucially, an annual out-of-pocket maximum that Original Medicare lacks on its own. Once you hit that cap (about $5,421 in-network on average for 2026), the plan covers 100% of the rest of your in-network Part A and B costs for the year.
In exchange, Advantage plans use tools to manage cost. You're generally limited to a network of doctors and hospitals; HMOs (about 57% of plans) usually require referrals; and most plans use prior authorization, meaning the plan must approve certain services before it pays. Nearly all 2026 enrollees are in a plan that requires prior authorization for at least some services.
Medicare Advantage plans use provider networks and prior authorization to manage costs. Original Medicare does not.
Original Medicare + Medigap explained
Original Medicare is the traditional program run directly by the federal government. Part A covers inpatient hospital care; Part B covers doctor visits, outpatient care, and preventive services. You can see any doctor or hospital in the country that accepts Medicare — and the overwhelming majority do — with no networks and no referrals.
The catch: Original Medicare, by itself, has no annual out-of-pocket limit. Part B generally pays 80% of covered costs, leaving you responsible for the other 20% with no ceiling. That's where a Medigap (Medicare Supplement) policy comes in. Sold by private insurers but standardized by the government, a Medigap plan pays some or all of the deductibles, copays, and coinsurance Original Medicare leaves behind.
There are 10 standardized Medigap plans, labeled A through N. Because they're standardized, a Plan G from one insurer covers exactly the same benefits as a Plan G from another — only the price and service differ. Plan G is the most popular, covering virtually all of your Medicare cost-sharing except the annual Part B deductible ($283 in 2026). About 12.5 million people carried a Medigap policy in 2023, and the average Plan G premium for a 65-year-old in 2026 is roughly $220 a month — though the identical plan can cost about $115 in one state and $350+ in another. You then add a standalone Part D drug plan to complete your coverage.
Head-to-head: the real 2026 costs
Everyone on Medicare pays the Part B premium — $202.90 a month in 2026, per CMS — no matter which path you choose. The difference is what you add on top and what you pay when you actually use care.
With Medicare Advantage, most people add little or nothing in monthly premium, but they pay copays and coinsurance as they go until they hit the plan's out-of-pocket maximum. With Original Medicare + Medigap + Part D, you pay a higher, predictable monthly premium (roughly $220 for a Plan G plus a Part D premium), and in return most of your cost-sharing disappears. In a heavy-care year, that predictability can be worth far more than the extra premium.
| Cost / feature (2026) | Medicare Advantage | Original Medicare + Medigap |
|---|---|---|
| Part B premium (everyone) | $202.90/mo | $202.90/mo |
| Added monthly premium | Often $0 (≈75% pay $0) | ≈$220 Plan G + Part D |
| Doctor & hospital choice | Plan network | Any provider taking Medicare |
| Out-of-pocket cap | ≈$5,421 avg in-network | Very low with Plan G |
| Referrals / prior authorization | Common | None |
| Bundled extras | Dental, vision, hearing often included | Not included |
A worked example: what a year actually costs
Numbers make the trade-off concrete. Picture two healthy 66-year-olds, each paying the same $202.90 Part B premium. Pat chooses a $0-premium Medicare Advantage plan; Sam chooses Original Medicare with a $220 Plan G supplement and a $40 Part D drug plan.
In a healthy year — a couple of check-ups and one minor procedure — Pat pays only a few small copays and comes out several hundred dollars ahead, because Sam spent roughly $3,120 in extra annual premium ($260 a month × 12) on coverage they barely used. Medicare Advantage tends to win the quiet years, and for many healthy retirees most years are quiet.
Now give both a hard year: a hospital stay, a specialist course of treatment, imaging, and rehab. Pat pays copays and coinsurance climbing toward the plan's out-of-pocket maximum — often north of $5,000 in-network, and more if any care slips out of network. Sam's Plan G absorbs almost all of it, so their total extra cost stays close to the $3,120 in premium they already budgeted. In the years that hurt, predictability wins. Which scenario is more likely for you is the real question — and it's one worth working through before you're in it, with a clear look at the numbers.
IRMAA: why some people pay more for the same Medicare
One cost surprise catches higher-income retirees off guard: IRMAA, the Income-Related Monthly Adjustment Amount. If your modified adjusted gross income from two years earlier crosses certain thresholds, Social Security adds a surcharge on top of both your Part B and Part D premiums — the exact same coverage, at a higher price. It's tiered, so a single dollar over a threshold can bump you up an entire bracket.
This is precisely where Medicare planning meets the rest of your financial plan. The timing of retirement-account withdrawals, Roth conversions, and capital gains — both two years before you enroll and every year after — can push you over an IRMAA line or keep you comfortably under it. Coordinating those moves is part of the whole-picture planning we do across insurance, investments, and tax, and it's a strong reason not to treat Medicare as a standalone decision.
Networks, referrals, and provider freedom
This is where the two paths differ most in daily life. With Original Medicare, if a specialist across the country takes Medicare, you can see them — no referral, no network check. With Medicare Advantage, your care generally has to stay inside the plan's network, and a plan can change that network (or exit your county entirely) from one year to the next.
That's not a reason to avoid Advantage — for many people the network covers every doctor they use, and the savings are real. But it is the reason to check your specific doctors and hospitals against the plan's network every year during Open Enrollment, and to read the Annual Notice of Change your plan mails each fall. The most common reason people ask us to help them switch is simple: a favorite doctor turned out to be out of network.
The right plan isn't the one with the best ad — it's the one your doctors actually take.
Drugs, travel, and extra benefits
Prescription drugs are where 2026 brings the biggest good news for everyone. Thanks to the Inflation Reduction Act, Part D now has a hard $2,100 annual out-of-pocket cap (up from $2,000 in 2025). Once your covered drug costs hit that limit, your plan pays 100% for the rest of the year — a genuine relief for anyone on expensive medications. The standard Part D deductible is capped at $615.
On extra benefits, Medicare Advantage has a clear edge: most plans bundle dental, vision, hearing, and fitness that Original Medicare simply doesn't cover. On travel, Original Medicare wins — it works anywhere in the U.S. that accepts Medicare, while Advantage networks are usually local, which matters for snowbirds and frequent travelers.
| Extra benefit | Share of 2026 MA plans offering it |
|---|---|
| Vision | 99% |
| Dental | 98% |
| Hearing | 95% |
| Fitness / gym | 91% |
What's changing in 2026
Three shifts make reviewing your coverage this year more important than usual. First, the $2,100 Part D cap above, which reshapes the math for anyone with high drug costs. Second, the Part B premium rose to $202.90 and the deductible to $283. Third — and most practical — plan counts fell about 9% and several large insurers are exiting counties, so the exact plan you have in 2025 may look different, cost more, or disappear in 2026.
None of this is cause for alarm; KFF notes that most beneficiaries affected by plan terminations still have robust options. But it's a strong argument for treating Medicare as an annual decision, not a set-it-and-forget-it one. Fifteen minutes reviewing your plan each fall can save a lot more than fifteen minutes' worth of money.
It's also worth watching plan star ratings. Medicare rates every Advantage and Part D plan from 1 to 5 stars on quality and service, and those ratings feed the bonus payments that help fund extra benefits — Medicare will spend more than $13 billion on Advantage quality bonuses in 2026 alone. A 5-star plan even carries its own special enrollment right to switch to it almost any time of year, while a plan that slips from 4 stars to 3 can quietly trim the extras you signed up for.
Switching rules and the Medigap trap
Here's a rule that catches people off guard. Switching from Medicare Advantage back to Original Medicare is easy — you can do it during the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31) or the Annual Enrollment Period (Oct 15–Dec 7). But buying a Medigap policy later can be hard. Outside your initial Medigap open-enrollment window, most states let insurers medically underwrite you — meaning they can charge more, or decline you, based on your health.
That asymmetry is the single most important thing to understand before you choose Advantage: it's the easy door to walk through, but the door back to a fully supplemented Original Medicare may have a health questionnaire on it. It doesn't mean don't choose Advantage — it means choose it with eyes open, and revisit the decision while you're still healthy enough to have options.
Beyond the standard windows, you may also qualify for a Special Enrollment Period — for moving out of a plan's service area, losing other creditable coverage, qualifying for Medicaid or Extra Help, or when a plan leaves your county. And first-time Advantage enrollees get a one-time 12-month trial right to return to Original Medicare with a guaranteed-issue path to a Medigap policy. These exceptions are easy to miss and run on your own personal calendar, not the year's — which is exactly why a quick review with someone who does this every day tends to pay for itself.
How to decide which fits you
There's no universal winner, but the decision usually comes down to a few honest questions. Lean toward Original Medicare + Medigap if you value seeing any doctor without referrals, you travel or split time between states, you'd rather pay a fixed premium than face surprises, or you have chronic conditions that make predictability priceless. Lean toward Medicare Advantage if a $0 or low premium matters, your doctors are in-network, you want bundled dental/vision/hearing, and you're comfortable working within a network and its rules.
Whichever way you lean, the coordination with the rest of your retirement plan matters — how your Social Security claiming age, your income (which can raise your Part B premium through IRMAA), and your retirement income sources interact. That whole-picture view is what we do. As an independent agency we're not tied to one carrier, so our only job is matching you to the plan that fits.
- Make a list of your must-keep doctors and check them against each plan's network
- Add up your regular prescriptions and price them under each plan's formulary
- Decide how much predictability is worth to you versus a lower monthly premium
- Factor in travel — Original Medicare travels; most Advantage networks don't
- Review your plan every fall; the Annual Notice of Change tells you what's different
The 10 standardized Medigap plans, compared
If you lean toward Original Medicare plus a supplement, the next question is which supplement. In most states, Medigap policies are standardized by federal law into ten lettered plans (A, B, C, D, F, G, K, L, M, and N). "Standardized" is the important word here: a Plan G from one insurer covers exactly the same gaps as a Plan G from any other insurer. The letter defines the benefits, so the only things that change from company to company are the monthly premium, the customer service, and the rate history. That makes Medigap one of the few corners of Medicare where you can shop almost purely on price for identical coverage.
Two plans dominate new enrollment today: Plan G and Plan N. Plan G covers essentially everything Original Medicare leaves behind except the annual Part B deductible ($283 in 2026). Plan N covers slightly less in exchange for a lower premium: you pay small copays of up to $20 for some office visits and up to $50 for an emergency room visit that does not lead to admission, and Plan N does not cover "Part B excess charges" (the extra amount a provider who does not accept Medicare assignment may bill). There is also a High-Deductible Plan G, where you pay a much lower premium but cover the first $2,950 of costs yourself in 2026 before the policy pays.
Plan F, once the most popular option because it covered the Part B deductible too, is closed to anyone who became eligible for Medicare on or after January 1, 2020. If you were eligible before that date you can often still buy or keep it, but for most new enrollees the practical choice is G versus N versus High-Deductible G. Our team can pull side-by-side premium quotes for your ZIP code, since the same lettered plan can vary by hundreds of dollars a year between carriers.
| Cost or benefit | Plan G | Plan N | High-Deductible G |
|---|---|---|---|
| Part A deductible & hospital costs | Covered | Covered | Covered after deductible |
| Part B deductible ($283) | You pay | You pay | You pay (counts toward deductible) |
| Part B coinsurance (20%) | Covered | Covered, minus small copays | Covered after deductible |
| Office/ER copays | None | Up to $20 / $50 | None after deductible |
| Part B excess charges | Covered | Not covered | Covered after deductible |
| Annual deductible you pay first | $0 | $0 | $2,950 |
| Typical monthly premium | Higher | Lower | Lowest |
Every Plan G is the same Plan G. Once you pick a letter, you are shopping on price and service, not coverage.
Special Needs Plans: the quiet engine of 2026 Medicare Advantage growth
When you read that Medicare Advantage grew again this year, most of that growth came from a specific niche you may never have heard of: Special Needs Plans, or SNPs. These are Medicare Advantage plans that restrict enrollment to people who meet certain conditions, which lets them tailor their networks, drug formularies, and extra benefits to that group. According to KFF, nearly 8.2 million people were enrolled in SNPs in 2026, about 23% of all Medicare Advantage enrollees, and SNPs accounted for roughly 85% of the net increase in Medicare Advantage enrollment over the past year.
There are three flavors. D-SNPs serve people who have both Medicare and Medicaid ("dual eligibles") and increasingly coordinate the two programs into one experience. C-SNPs serve people with specific chronic conditions such as diabetes, heart disease, or chronic lung conditions, and were the fastest-growing type this year, up about 45% between 2025 and 2026. I-SNPs serve people living in an institution such as a nursing home, or the equivalent level of care at home.
SNPs can be a genuinely good fit if you qualify, because the extra benefits are aimed at your actual situation rather than marketed at everyone. But the same cautions from the rest of this article still apply: networks, prior authorization, and referral rules do not disappear just because a plan is a SNP. And eligibility is conditional, so if you no longer meet the criteria, your enrollment can be affected. If you think you might qualify as a dual eligible or through a chronic condition, it is worth a careful conversation before enrolling rather than after.
- D-SNP — for people with both Medicare and Medicaid; the largest SNP category.
- C-SNP — for people with qualifying chronic conditions; the fastest-growing in 2026.
- I-SNP — for people in a nursing facility or receiving that level of care at home.
Extra Help and Medicare Savings Programs: real relief for lower incomes
Two programs can dramatically cut Medicare costs for people with modest income and savings, and both are underused simply because people do not know they exist. The first is Extra Help (also called the Part D Low-Income Subsidy, or LIS), which helps with prescription drug costs. Since the Inflation Reduction Act simplified it, there is now a single full-benefit level: it covers your Part D premium up to a regional benchmark, wipes out the drug deductible, and caps your copays at $5.10 for generics and $12.65 for brand-name drugs in 2026. To qualify, a single person generally needs income below roughly 150% of the federal poverty level (in the low-$20,000s per year) and resources under $18,090 (about $36,100 for a married couple), excluding your home, one car, and certain burial funds.
The second is the family of Medicare Savings Programs (MSPs), run through your state Medicaid office, which help with Medicare's own premiums and cost-sharing. The Qualified Medicare Beneficiary (QMB) program pays your Part B premium and can cover deductibles and coinsurance; the SLMB and QI programs pay the Part B premium for slightly higher incomes. As a bonus, qualifying for any MSP automatically enrolls you in Extra Help. The 2026 monthly income ceilings are roughly $1,350 (single) for QMB, $1,616 for SLMB, and $1,816 for QI, with higher limits for couples and in several states that use more generous rules.
Because these thresholds change yearly and vary by state, treat the numbers here as a starting point, not a verdict. It is common to assume you earn "too much" and never apply, only to discover you qualified all along. You can apply for Extra Help through the Social Security Administration and for an MSP through your state, and we are glad to help you figure out whether a full application is worth your time.
| Program | What it helps pay | Single (monthly) | Couple (monthly) |
|---|---|---|---|
| QMB | Part B premium + deductibles & coinsurance | About $1,350 | About $1,824 |
| SLMB | Part B premium | About $1,616 | About $2,184 |
| QI | Part B premium (first come, first served) | About $1,816 | About $2,455 |
The Part D late-enrollment penalty, with real numbers
One of the most avoidable Medicare mistakes is triggering the Part D late-enrollment penalty. Here is the rule: if you go 63 or more days in a row without either Medicare drug coverage or other "creditable" drug coverage (coverage at least as good as Part D, such as many employer plans) after your Initial Enrollment Period ends, you can owe a permanent penalty once you finally sign up. "Permanent" is not an exaggeration. In most cases you pay it for as long as you have Part D.
The math is simple but unforgiving. The penalty equals 1% of the national base beneficiary premium for every full month you went without creditable coverage. For 2026 that base premium is $38.99. So if you delayed for 30 months, the penalty is 30% of $38.99, which is $11.70 (rounded to the nearest 10 cents), added to your drug premium every single month. Wait 43 months and the penalty is about $16.80 a month, or roughly $200 a year on top of your regular premium, effectively forever. And because the base premium tends to rise over time, the dollar amount of your penalty can actually grow year to year.
The good news is that avoiding it is usually easy. If you have creditable coverage through an employer, union, or the VA, keep the annual notice they send you as proof and you owe nothing. If you do not have drug coverage, enrolling in even a low-cost Part D plan when you first become eligible stops the clock entirely, even if you take no medications yet. Think of that minimum plan as cheap insurance against a lifelong surcharge.
A few months of "I don't take any pills, why bother?" can become a surcharge you pay for the rest of your life.
Still working at 65? Slow down before you enroll
Turning 65 does not force you onto Medicare if you are still working and covered by a solid employer plan, and moving too fast can cost you real money. Whether you should delay Part B depends mostly on your employer's size. If the company has 20 or more employees, its group plan generally stays your primary coverage and you can safely delay Part B without a late penalty, then enroll later through a Special Enrollment Period when you retire. If the company has fewer than 20 employees, Medicare usually becomes primary at 65, and delaying Part B can leave dangerous gaps, so most people in that situation should enroll on time.
Health Savings Accounts add a wrinkle that trips up a lot of people. You cannot contribute to an HSA for any month you are enrolled in any part of Medicare, including premium-free Part A. Worse, when you eventually enroll after 65, Part A coverage is backdated up to six months (never before the month you turned 65). Any HSA contributions you made during that retroactive window become excess contributions that can face a 6% excise tax. The practical takeaway: if you want to keep funding an HSA past 65 (the 2026 limits are $4,400 self-only or $8,750 family, plus a $1,000 catch-up at 55+), you generally must delay all of Medicare, and then stop HSA contributions at least six months before you plan to enroll.
None of this is intuitive, and the penalties for guessing wrong are steep and often permanent. This is one of those decisions where a short conversation before your 65th birthday can save years of regret. It also pairs closely with your Social Security timing, which we cover in our guide on when to claim benefits at 62, 67, or 70, and with how your broader retirement income plan fits together.
- Employer with 20+ employees: you can usually delay Part B safely and enroll later.
- Employer with fewer than 20: Medicare is often primary; enrolling on time is usually wise.
- Want to keep contributing to an HSA? You generally must delay all of Medicare, then stop contributions six months before enrolling.
Star ratings and the Annual Notice of Change: your yearly checkup
A Medicare Advantage or Part D plan is not a "set it and forget it" purchase. Every fall, your plan mails you an Annual Notice of Change (ANOC), a document that spells out exactly what will be different next year: premium, drug copays, which medications are covered, provider network, and extra benefits. It usually arrives in September, and it is the single most important piece of mail you will get from your plan all year. The plan you loved this year can quietly become a poor fit next year, and the ANOC is where that shows up in black and white, in time to switch during Open Enrollment (October 15 to December 7).
CMS also publishes star ratings from 1 to 5 that grade plans on quality and member experience across roughly 40 measures. They are a useful sanity check, not gospel. For 2026, only about 40% of Medicare Advantage contracts earned 4 stars or higher, though roughly 64% of enrollees are in a 4-plus star plan, since larger plans tend to score better. A consistently low-rated plan is a yellow flag worth a second look; a 5-star plan even offers a special enrollment period that lets you switch to it outside the normal windows. But a high rating does not guarantee that a plan covers your doctors or your drugs, which is why the ANOC still matters more for your specific situation.
Build a simple habit: when the ANOC lands, spend twenty minutes checking three things against next year's plan. Are your prescriptions still covered at a price you can afford? Are your doctors and preferred hospital still in network? Did the out-of-pocket maximum or key copays jump? You can verify all of this on the official Medicare Plan Finder, and our planning tools can help you weigh the trade-offs. If anything looks off, that is your cue to reach out before December 7 rather than after.
The Annual Notice of Change is the most important mail your plan sends all year. Do not let it go in the recycling unopened.
Frequently asked questions
Is Medicare Advantage better than Original Medicare in 2026?
Neither is universally better. Medicare Advantage usually costs less per month (about 75% of enrollees pay $0 beyond the Part B premium) and bundles extras, but limits you to a network with referrals and prior authorization. Original Medicare plus a Medigap policy costs more monthly but lets you see any doctor who takes Medicare, with highly predictable bills. The right choice depends on your doctors, budget, prescriptions, and travel.
How much does Medicare cost in 2026?
Everyone pays the Part B premium of $202.90 a month and a $283 annual deductible in 2026, per CMS. Medicare Advantage often adds little or no premium; Original Medicare + a Plan G Medigap policy adds roughly $220 a month plus a Part D drug plan, in exchange for much lower cost-sharing.
What is the 2026 Part D out-of-pocket cap?
$2,100. Thanks to the Inflation Reduction Act, once your covered prescription-drug out-of-pocket costs reach $2,100 in 2026, your Part D plan pays 100% of covered drugs for the rest of the year. The standard Part D deductible is capped at $615.
Can I switch from Medicare Advantage back to Original Medicare?
Yes — during the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31) or the Annual Enrollment Period (Oct 15–Dec 7). The catch is that buying a Medigap policy afterward may require medical underwriting in most states, so it's easier to leave Advantage than to fully supplement Original Medicare later.
Do I have to review my Medicare plan every year?
It's strongly recommended. For 2026, plan counts fell about 9% and some insurers exited counties, so premiums, networks, and drug coverage can change. Your plan's Annual Notice of Change (mailed each fall) lists what's different — a 15-minute review during Open Enrollment can prevent expensive surprises.
Is Tim Berry Financial Services affiliated with Medicare?
No. We are a private, independent agency and are not connected with or endorsed by the U.S. government, Medicare, or CMS. We don't offer every plan available in your area — for all your options, contact Medicare.gov, call 1-800-MEDICARE, or reach your State Health Insurance Assistance Program (SHIP).