As of 2026-10-15
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| Original Medicare (A + B) + Medigap + Part D | Medicare Advantage (Part C) | |
|---|---|---|
| Doctors | Any doctor or hospital in the U.S. that takes Medicare | Usually a network; going outside may cost more or not be covered |
| Monthly cost | Part B premium + Medigap premium + Part D premium | Part B premium + plan premium (some plans $0) |
| Costs when you get care | Low and predictable with Medigap | Copays per visit; yearly out-of-pocket limit |
| Approval before care | Rarely needed | Often needed for some services |
| Extras (dental, vision, hearing) | Not usually included | Often included |
| Switching later | Medigap may ask health questions after your first window | Can change each year Oct 15–Dec 7 |
Plain rule of thumb: If you want freedom to see any doctor and predictable bills, and can afford the Medigap premium, Original Medicare + Medigap + Part D fits. If you want a low monthly premium and extras, and your doctors are in the network, Medicare Advantage fits. Buy Medigap in your first 6-month window if there's any chance you'll want it.
| Part | What it covers | 2026 cost (2027 not yet published by CMS for A and B) |
|---|---|---|
| A Hospital | Inpatient hospital, skilled nursing facility, hospice, some home health | Most people pay $0 premium. Deductible $1,736 per benefit period; $434/day for days 61–90; skilled nursing $217/day for days 21–100. Premium if you don't qualify free: up to $565/month |
| B Medical | Doctors, outpatient care, tests, preventive care, equipment | Premium $202.90/month (higher with IRMAA). Deductible $283/year, then usually 20% |
| C Medicare Advantage | Private plan that replaces A and B; most include D | Plan premium varies (some $0) plus your Part B premium; yearly out-of-pocket limit |
| D Drugs | Prescription drugs, through a private plan | 2027: deductible no more than $700 and out-of-pocket cap $2,400 (2026: $615 and $2,100). After the cap you pay $0 for covered drugs that year |
Sources: CMS 2026 Parts A & B fact sheet (Nov 14, 2025), Medicare.gov 2026 Medicare Costs, Medicare.gov Part D costs (2027 limits). CMS usually announces next year's Part A and B amounts in mid-November.
Based on your 2024 tax return. Most people (about 92%) pay the standard premium.
| Single filer income (2024) | Joint filer income (2024) | Part B per month | Part D extra per month |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | $0 |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 | +$14.50 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 | +$37.50 |
| $171,001–$205,000 | $342,001–$410,000 | $527.50 | +$60.40 |
| $205,001–$499,999 | $410,001–$749,999 | $649.20 | +$83.30 |
| $500,000 or more | $750,000 or more | $689.90 | +$91.00 |
Sources: SSA Medicare premiums 2026, CMS fact sheet. If your income dropped (retirement, divorce, death of a spouse), you can ask Social Security to use newer income with form SSA-44.
| Period | When | What you can do |
|---|---|---|
| Initial Enrollment (IEP) | 7 months around your 65th birthday: 3 months before, your birthday month, 3 months after | Sign up for A, B and D |
| Open Enrollment (Annual) | October 15 – December 7 each year | Join, switch or drop Advantage and drug plans; changes start Jan 1 |
| Medicare Advantage Open Enrollment | January 1 – March 31 | If you're in Advantage: switch to another Advantage plan or go back to Original Medicare (+ a drug plan), once |
| General Enrollment (GEP) | January 1 – March 31 | Sign up for A or B if you missed your window; coverage starts the next month; penalties may apply |
| Special Enrollment (SEP) | Usually 8 months after job-based coverage ends (Part B); other events like moving or losing coverage | Sign up or change without waiting for open enrollment |
| Medigap Open Enrollment | 6 months starting the month you're 65+ and have Part B | Buy any Medigap policy with no health questions. One time only |
Sources: Medicare.gov: when coverage starts, Medicare.gov: joining a plan.
Source: Medicare.gov: avoid penalties.
Sources: Medicare.gov guaranteed issue rights, Tennessee Dept. of Commerce & Insurance bulletin, NAIC birthday-rule chart (May 11, 2026).
Source: Medicare.gov: help with drug costs.
October 15 to December 7, 2026. Changes you make start January 1, 2027. If you're in a Medicare Advantage plan, you also get one change from January 1 to March 31.
The standard Part B premium is $202.90 a month in 2026, with a $283 yearly deductible (CMS). CMS usually announces the 2027 amount in mid-November.
Medicare.gov says no drug plan may have a deductible over $700 in 2027, and out-of-pocket costs for covered drugs are capped at $2,400 in 2027 (up from $615 and $2,100 in 2026).
For 2026, people whose 2024 modified adjusted gross income was above $109,000 (single) or $218,000 (joint) pay more for Part B and Part D. Social Security decides and you can ask for a review if your income dropped.
No. As of NAIC's May 2026 chart, Tennessee has no birthday rule. Your guaranteed window is the 6 months after you're 65 and have Part B, plus certain events. Tennessee also requires Medigap offers to people under 65 on Medicare due to disability or ESRD.
TN SHIP, the State Health Insurance Assistance Program: 1-877-801-0044 or dda.ship@tn.gov. SHIP counselors do not sell insurance.
Facts, not insurance advice. We don't sell insurance or provide quotes; confirm coverage and requirements with the insurer, an agent or your state insurance department.