2026 MEDICARE OVERVIEW
Understanding Medicare Parts A–D
Medicare is made up of four distinct parts. Knowing what each covers — and what it costs in 2026 — is the foundation of making the right choice.
Medical Insurance
Covers
Doctor & specialist visits
Outpatient hospital care
Lab tests & preventive services
Outpatient mental health
Durable medical equipment
Medicare Advantage
Covers
Everything in Parts A & B
Usually includes Part D
Often adds dental, vision & hearing
Plan types: HMO, PPO, SNP
Network restrictions apply
Prescription Drug Plan
Covers
Brand-name & generic drugs
Some vaccines
Phase 1: Deductible (you pay 100%)
Phase 2: 25% co-insurance
Phase 3: $0 after $2,100 OOP max
Part B not included in Part A: Original Medicare requires both Part A and Part B. Medicare Advantage (Part C) bundles both, but you must still pay your Part B premium
2026 OFFICIAL FIGURES
Key Medicare costs for 2026
Source: CMS Medicare Resource Guide 2026
$0
PART A PREMIUM
for most people (40+ quarters of Medicare taxes)
$1,736
PART A DEDUCTIBLE
per benefit period for hospital stays
$202.90
PART B DEDUCTIBLE
per month (standard; higher at upper incomes)
$283
PART D DEDUCTIBLE
annual; then Medicare pays 80%, you pay 20%
Up to $615
PART D DEDUCTIBLE
annual cap; then 25% until $2,100 OOP max
$2,100
PART D OOP MAX
after which you pay $0 for covered drugs
HEAD-TO-HEAD
Medicare Advantage vs. Supplement
The right choice depends on your health, budget, and lifestyle. We'll help you decide.
Plan Feature | Medicare Advantage | Medicare Supplement |
|---|---|---|
Best For | Low cost & extra benefits | Maximum flexibility & predictable costs |
Extra Benefits | Dental, vision, hearing, OTC, gym | Typically none |
How it Works | All-in-one bundled plan that replaces Original Medicare | Works with Original Medicare to cover gaps in cost |
Monthly Cost | Usually low or $0 premium (varies by plan) | Higher monthly premium |
Out-of-Pocket Costs | copays, deductibles, coinsurance as you go | Very low out-of-pocket costs; some plans cover nearly all medical expenses |
Provider Access | Must use doctors in plan network (HMO/PPO) | Any doctor nationwide who accepts Medicare |
MEDICARE SUPPLEMENT
How to pick the right
Medigap plan
Medigap fills the "gaps" in Original Medicare — deductibles, co-insurance, and co-pays. Plans are standardized by the government (same benefits regardless of insurer) but premiums vary. The best window to buy is within 6 months of enrolling in Part B — after that, insurers can charge more or deny you based on health history.​​
Important: Medigap cannot be used alongside a Medicare Advantage plan. If you switch to Advantage and later want to return to Medigap, there's no guarantee you can get coverage.
-
Think about your current and future health needs — which plan covers the costs that matter most to you?
-
Find which insurance companies sell Medigap in California. Plans are standardized but premiums vary.
-
Call those companies, ask your questions, and compare costs for the same plan type.
-
Ask for a clearly worded summary of the plan and the start date before you commit.
-
Buy the plan that fits — ideally within your 6-month Medigap Open Enrollment window.
PART D IN 2026
How Part D drug coverage works
Part D prescription coverage moves through three phases in 2026. Understanding these phases helps you plan for drug costs throughout the year.
Phase 1
Deductible Up to $615
You pay 100% of drug costs until you meet the annual deductible.
Phase 2
Standard Benefit - 25% co-insurance
After the deductible, you pay 25% of drug costs while your plan pays 75%.
Phase 3
Catastrophic Coverage - $0 after $2,100 OOP
Once you've paid $2,100 out-of-pocket, you pay $0 for covered drugs for the rest of the year.
Common Questions
Answers based on the 2026 Medicare Resource Guide. Still have questions? We're happy to help in person or over the phone.
When Should I enroll in Medicare?
Most people enroll at 65. Your Initial Enrollment Period is a 7-month window starting 3 months before your birthday. If you have employer coverage for a company with 20+ employees, you may delay Part B without a penalty — but talk to us first.
What is Medicare Advantage (Part C)?
​Medicare Advantage is an all-in-one alternative to Original Medicare offered by private, Medicare-approved insurers. It bundles Part A and Part B — and almost 90% of plans include Part D drug coverage. Many add dental, vision, and hearing benefits. However, you're limited to the plan's network (typically under 50% of US doctors) and many services require prior authorization.
Will my current doctor accept Medicare?
​With Original Medicare (Parts A & B), you can see virtually any doctor in the country — about 99% of US physicians accept Medicare. With Medicare Advantage, you're limited to the plan's network, which covers less than 50% of US doctors on average.
What does Medicare Part B actually cost in 2026?
The standard Part B premium is $202.90/month in 2026. If your income exceeds certain thresholds, you'll pay more. The annual Part B deductible is $283, after which Medicare pays 80% and you pay 20%.
What is Medigap and when should I buy it?
Medigap (Medicare Supplement Insurance) is private insurance that pays the costs Original Medicare leaves behind — deductibles, co-insurance, and co-pays. You must have Part A and Part B to buy it, and the best time is within 6 months of enrolling in Part B. After that window, insurers can charge more or deny coverage based on your health history. Medigap cannot be used alongside a Medicare Advantage plan.
Is working with Surf City Insurance free?
Yes — completely free. We are compensated by the insurance carriers, so our guidance costs you nothing. You get expert, independent Medicare advice at no cost.