Reviewed by Joseph Sacco, MD, ABFM, ACQ-HPM.
Dr. Joseph Sacco is a board-certified hospice and palliative medicine physician with over 40 years of experience. Currently serving as Chief Medical Officer at The Connecticut Hospice and as an assistant professor at the Yale School of Medicine, he has published in Health Affairs, AJHPM, and The New York Times and authored three books.
If you’re approaching 65, you’ve probably already received a stack of letters inviting you to free “educational” dinners at local restaurants (steak, or salmon?) hosted by local fee-based retirement and Medicare planners.
This blog will help you make these decisions yourself—no entrée required.
Here’s the honest truth about Medicare before we go any further: it’s complicated, it’s not free, and it doesn’t cover everything. Understanding the basics now, before you’re staring down an enrollment deadline, can save you from some very unpleasant surprises down the road.
Important Takeaways
- Medicare is not comprehensive coverage, and uninformed beneficiaries can face steep out-of-pocket costs.
- Most people turning 65 qualify for free Part A and pay roughly $203/month for Part B, but your income may change that.
- Understanding eligibility, premiums, and what each part covers is the foundation for making smart Medicare decisions.
First: Why Health Insurance Is Non-Negotiable
Before diving into Medicare specifically, it’s worth saying plainly: health insurance, whether it’s a comprehensive employment-based plan or a bare-bones policy purchased on the ACA marketplace, is a must.
Going without health insurance at any age is a serious financial risk. While it’s true that commercial premiums, deductibles, and out-of-pocket maximums can add up to $20,000 or more per year, consider that a single hospitalization or routine treatments for an ongoing condition like cancer can cost ten to twenty times that amount, leaving people with debt that follows them for life.
Medicare, for all its complexity, exists to help protect you from that exposure.
What Medicare Is (And What It Isn’t)
Medicare is a federal health insurance program that covers hospitalization, medical services, skilled nursing and rehabilitation, doctor visits, and other services. It is not a single comprehensive plan that takes care of everything. It’s a framework with different parts, each covering different services, and each with its own costs.
Those parts, in brief:
- Part A covers hospital stays, skilled nursing facilities, hospice care, inpatient rehabilitation, and some home health services.
- Part B covers outpatient and medical services, including doctor visits.
- Part C (Medicare Advantage) is an alternative way to receive Parts A and B through a private insurer.
- Part D covers prescription drugs.
- Medigap is supplemental private insurance designed to cover costs that Medicare doesn’t cover.
This blog focuses on eligibility and premiums for Parts A and B, the foundation that everything else builds on. Other blogs in this series will cover in more detail what Part A actually pays for, Part B benefits, Medicare Advantage, prescription coverage, and Medigap.
Medicare Eligibility Requirements: Who Qualifies?
Medicare is available to:
- U.S. citizens age 65 and older
- Permanent legal residents 65+ who have lived in the U.S. for at least five consecutive years (the legal residency itself doesn’t need to be five years; the physical presence does)
- People receiving Social Security Disability Insurance (SSDI) for at least 24 months, regardless of age
- People with ALS (amyotrophic lateral sclerosis): Coverage begins the same month SSDI benefits start, with no 24-month waiting period
- People with end-stage renal disease (ESRD), or permanent kidney failure requiring dialysis or transplant: Coverage potentially begins before 24 months, depending on treatment type
People qualifying through SSDI, ALS, or ESRD must be lawful U.S. residents, but are not required to have five consecutive years of residence.
What Does Medicare Cost?
The Common Case: What Most People Pay
If you’ve worked and paid Medicare taxes for at least 10 years (40 quarters, or “work credits”), here’s the short version:
- Part A: Free. Roughly 99% of Medicare beneficiaries have 40 work credits and pay no Part A premium.
- Part B: $202.90/month in 2026 for most people. This is deducted directly from your Social Security or Railroad Retirement payments.
That’s the baseline. Now for the fine print.
Part A Premiums: What If You Don’t Have 40 Work Credits?
If you (or your spouse) haven’t accumulated 40 work credits, you can still enroll in Part A, but you’ll pay a monthly premium. If cost is a barrier, Medicare Savings Programs (MSPs), run by individual states, may cover some or all of your Medicare costs. Check your state’s guidelines for specifics.
Part B Premiums: How Income Affects What You Pay
Part B premiums aren’t one-size-fits-all. If your modified adjusted gross income (MAGI)—as determined by the IRS, based on your income from two years prior—exceeds certain thresholds, you’ll pay more. This adjustment, called IRMAA (income-related monthly adjustment amount), is factored into your total monthly premium.
Here’s how Medicare Part B premiums break down for 2026:
Individual MAGI | Total Monthly Part B Premium |
Up to $109,000 | $202.90 |
$109,001 – $137,000 | $284.10 |
$137,001 – $171,000 | $405.80 |
$171,001 – $205,000 | $527.50 |
$205,001 – $499,999 | $649.20 |
$500,000+ | $689.90 |
Married filing jointly thresholds are approximately double the individual amounts. The maximum premium of $689.90 applies to married filers with MAGI of $750,000+.
If you have no income in the two years prior to eligibility, you’ll be charged the standard premium of $202.90. And as with Part A, Medicare Savings Programs may help low-income beneficiaries with Part B premium costs.
Worth noting: Medicare looks at your income from two years ago. If your income has dropped significantly since then (for example, due to retirement), you can request a review using a more recent tax year.
How to Apply for Medicare
There are a few different paths to Medicare enrollment, depending on your circumstances.
- If you’re already receiving Social Security or Railroad Retirement benefits when you turn 65, you’ll be automatically enrolled in Parts A and B starting the month you turn 65 with no action needed.
- If you apply for Social Security 3 months before turning 65 or later, you can sign up for Medicare at the same time you apply for Social Security.
- If you’re still working at 65 and not ready to collect Social Security, you’ll need to sign up yourself, either online through SSA.gov, by phone, or in person at a Social Security office.
Whichever scenario applies to you, mark your calendar: the Initial Enrollment Period gives you a 7-month window (three months before you turn 65, your birth month itself, and three months after). Missing this window can mean a late enrollment penalty, so it’s worth confirming your Medicare Part A eligibility and enrollment timeline before turning 65.
Once you’ve confirmed you meet Medicare eligibility requirements, applying is generally the easy part. The harder part (and the reason this series exists) is understanding what you’re actually signing up for.
What to Expect After You Enroll
Enrollment isn’t the finish line; it’s the start of a few things worth knowing about upfront.
A Medicare card arrives first. Roughly a month before your coverage starts, you’ll receive your card in the mail. Keep it somewhere safe; you’ll need it for nearly every medical visit going forward.
- You’ll likely get a flood of mail (and calls). Once you’re enrolled, private insurers offering Medicare Advantage, Part D, and Medigap plans will have access to the fact that you’re newly eligible, and they will let you know. None of this is required reading, but it’s worth knowing it’s coming, so it doesn’t feel urgent or official just because it looks that way.
- You’ll need to make a few more decisions. Parts A and B are just the foundation. Most people also choose between Original Medicare with a Medigap policy or a Medicare Advantage plan, plus separate prescription drug coverage, if needed. None of this needs to be decided on day one, but it’s worth knowing it’s the next step.
We’ll cover each of those choices—Medicare Advantage, Part D, and Medigap—later in this series, so you can make them with a clear head (instead of over a steak dinner).
Next in the Series
Medicare premiums are just the starting point. What Medicare Part A and Part B actually cover (and what you’ll owe when you use them) is where things get more granular, and where people are often caught off guard.
The next blog in this series covers Part A benefits in detail: hospitalization costs, skilled nursing facility rules, inpatient rehabilitation, and home health care. We’ll focus on the practical specifics: what’s covered, what you’ll pay, and the “gotchas” that blindside people most often.
The Connecticut Hospice is a Medicare-certified hospice provider serving patients and families across Connecticut. For questions about how Medicare covers hospice care specifically, read our blog on Medicare hospice benefits.
