$2,100→$2,400
Yearly limit on drug costs
After you spend $2,400 on covered drugs, you pay $0 for the rest of the year.
Your 2027 Medicare guide
Medicare, without the 128‑page book.
Simple pictures and plain English. Start with the one that fits you:
New to MedicareI’m turning 65 soonWhen to sign up, and how to avoid penalties.Start here →Already enrolledI already have MedicareCheck your costs, your options, and what’s new for 2027.Start here →Ready when you areI’m ready to enrollHave your Medicare card? Compare plans and sign up yourself.Enroll ↗
An independent guide from Finspire Solutions, not connected with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Currently we represent 8 organizations which offer 141 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Time to review or change plansOct 15 to Dec 7Open now
Most you’ll pay for covered drugs$2,400For all of 2027. Up from $2,100.
Highest drug-plan deductible$700Many plans charge less, or nothing.
Part B monthly premiumComing in NovemberIt’s $202.90 in 2026.
1
The basics
What the parts of Medicare are, and the one big choice everyone makes.
About 4 minutes · 4 topics
The parts
Medicare has four parts. Each one has a letter.
You don’t need to memorize them. Just know which letter covers what.
A
HospitalHospital stays, skilled nursing after a hospital stay, hospice, some home care.B
DoctorsDoctor visits, outpatient care, tests, equipment, most preventive care.C
Medicare AdvantageA private plan that bundles A, B and usually D into one card.D
DrugsPrescription drug coverage from a private plan.The big choice
There are two ways to get Medicare. You pick one.
Original Medicare is run by the government. Medicare Advantage is a private plan approved by Medicare.
Way 1
Original Medicare
Part Ahospital+Part Bdoctors
You can addPart Da drug planMedigappays most of your 20%
- Any doctor in the U.S. that takes Medicare
- Rarely needs approval first
- No yearly limit on your costs, unless you add Medigap
Way 2
Medicare Advantage
One plan, one cardA + B + usually D, plus extras
Often includesDentalvision · hearing
- A yearly limit on what you pay
- Usually a network of doctors
- Some care needs approval first
Medigap doesn’t work with Medicare Advantage. It only fills the gaps in Original Medicare.
Tell me more
| Original Medicare | Medicare Advantage | |
|---|---|---|
| Doctors | Any doctor in the U.S. that takes Medicare. Usually no referral. | Usually the plan’s network. May need a referral for specialists. |
| Your share | Usually 20% after the Part B deductible. | Copays set by the plan. |
| Yearly limit | None, unless you add Medigap or other coverage. | Yes. After it, you pay $0 for covered care. |
| Drugs | Join a separate drug plan. | Most plans include drug coverage. |
| Travel abroad | Generally not covered. Some Medigap plans cover emergencies. | Generally not covered. Some plans add emergency coverage. |
Both ways still charge the monthly Part B premium.
How a bill works
Who pays a $1,000 doctor bill?
On Original Medicare you pay the deductible first, then 20% of the rest. Medicare pays the other 80%.
$283You: the deductible
$143.40You: 20%
$573.60Medicare: 80%
You pay $426.40. Your next bill this year skips the deductible, so you’d pay just the 20%. Based on 2026 amounts, for the first bill of the year, from a doctor who accepts Medicare’s price.
Words you’ll see on every bill
- Premium
- The monthly fee to have coverage, even if you never use it.
- Deductible
- What you pay first, before the plan starts paying.
- Coinsurance
- Your percentage of each bill after the deductible. Often 20%.
- Copay
- A flat fee for a visit or prescription, like $20.
- Out-of-pocket limit
- The most you’ll pay in a year for covered care.
- Creditable coverage
- Drug coverage at least as good as Medicare’s. It protects you from a late penalty.
A bad year
The same bad year, three ways.
Imagine one 5-day hospital stay plus $20,000 of doctor and outpatient bills. Here’s roughly what you’d owe.
Based on 2026 amounts. Not counted: monthly premiums (Part B for everyone, plus the Medigap or plan premium) and drug costs. Every Advantage plan sets its own yearly limit, so check the plan’s number.
2
Signing up
When you can sign up, when you can switch, and how to avoid a penalty that lasts for life.
About 4 minutes · 4 topics
Turning 65
You have a 7-month window to sign up.
It opens 3 months before your 65th birthday month and closes 3 months after. Pick a birthday to see the exact months.
Example shown. Change it to yours.
Sign up here: coverage starts on timeYour birthday monthLater: coverage starts the month after
Tell me more
Already getting Social Security? Parts A and B start automatically, and your card arrives about 3 months before your birthday.
Birthday on the 1st of the month? Everything moves one month earlier.
Medicare Supplement (Medigap) has its own best time to buy: the 6 months starting when your Part B begins, at 65 or older.
Still working?
Can I wait to sign up for Part B?
Only health coverage from a current job lets you wait. Yours or your spouse’s.
Do you have health coverage from a current job?Your own job, or your spouse’s
NoSign up for Part B in your 7-month window.
COBRA, retiree plans, VA and Marketplace plans don’t count as a current job.
Yes · 20 or more employeesYour job plan pays first. You can wait.
When the job or coverage ends, you have 8 months to sign up with no penalty.
Yes · fewer than 20Medicare pays first. Get Part B.
Without it, your bills may go unpaid.
Tell me more
Have a Health Savings Account (HSA)? Stop adding money the month before Part A starts. Part A can start up to 6 months back from when you sign up.
Under 65 with a disability, the cutoff is 100 employees instead of 20. Ask your employer’s benefits office how their plan works with Medicare.
The calendar
Each year, there’s a set time to change plans.
October 15 to December 7 is Open Enrollment. Anyone can join, switch or drop a plan. Changes start January 1.
- Oct 15 to Dec 7Open Enrollment. Anyone can join, switch or drop a plan.
- Jan 1Your new plan starts.
- Jan 1 to Mar 31If you’re in a Medicare Advantage plan, you get one more change.
- Jan 1 to Mar 31Missed Part B? You can sign up now. A penalty may apply.
- Dec 8 to Nov 30Switch once into a plan rated 5 stars, if there’s one near you.
Tell me more
Some life events let you change plans at other times. Examples: you move, you lose other coverage, or you get Medicaid or Extra Help.
Before December 7, read the “Annual Notice of Change” letter your plan mails each fall. It lists what’s changing for next year.
Late penalties
Signing up late can cost you for life.
Move the sliders to see how a late penalty grows.
20%
$12.00
How the penalties work
Part B: your premium goes up 10% for every full 12 months you could have had Part B but didn’t.
Drug coverage: 1% of a national base amount ($41.33 in 2027) for every month you went without, once a gap reaches 63 days in a row. Rounded to the nearest 10 cents.
How to avoid it: have drug coverage from a job, union, TRICARE or the VA that’s at least as good as Medicare’s. Keep the yearly letter that says so. People with Extra Help don’t pay this penalty.
3
Costs
What’s new for 2027, what a hospital stay costs, how drug costs work, and help if money is tight.
About 4 minutes · 5 topics
What’s new
What’s changing in 2027.
The drug numbers are final. Hospital and doctor costs for 2027 come out in November.
$615→$700
Highest drug deductible
The most a drug plan can charge before it starts paying. Many charge less.
+15 drugs
Lower negotiated prices
15 more drugs get Medicare-negotiated prices from January 1, 2027.
See every change
- Who can get MedicareYou must be a U.S. citizen or national, a green card holder, or lawfully present in certain other categories.
- Telehealth from homeAvailable anywhere in the U.S. through December 31, 2027.
- Faster approvalsAdvantage plans may handle approval requests online from January 1, 2027.
- GLP-1 BridgeCertain weight-loss drugs for $50 a month, if you have drug coverage and qualify.
- New ways to log inMedicare.gov now works with ID.me, CLEAR and Login.gov.
- Discount couponsDrug coupons can be cheaper, but what you pay doesn’t count toward your drug limit.
A hospital stay
Part A charges by the stay, not by the year.
Each stay starts a “benefit period”. It ends after you’ve been out for 60 days in a row. You can have more than one in a year.
In the hospital2026 amounts
$1,736 oncedays 1 to 60
$434 a daydays 61 to 90
$868 a daydays 91 to 150
All
Day 16090150151+
In a skilled nursing facility, after a hospital stay2026 amounts
$0days 1 to 20
$217 a daydays 21 to 100
All
Day 120100101+
Ask every day: “Am I an inpatient or an outpatient?” A night “under observation” counts as outpatient. Skilled nursing is only covered after 3 days as an inpatient.
Prescriptions
Your drug costs stop at $2,400 a year.
Here’s one example year for someone on an expensive brand-name drug.
$2,400 limit
$0 for covered drugs, June to December
$700
$2,400
JanFebMarAprMayJunJulAugSepOctNovDec
Step 1Deductible
You pay full price up to $700. Some plans have no deductible.
Step 2Copays
You pay a copay or a percentage. The plan pays the rest.
Step 3$0
Once you’ve paid $2,400, covered drugs cost nothing until January.
Tell me more
Insulin: no more than $35 for a month’s supply, with no deductible.
Every plan covers different drugs. Check that your drugs are on the plan’s list before you join.
Prefer smaller monthly bills? The Medicare Prescription Payment Plan spreads your costs over the year. It doesn’t lower the total.
Watch out
What Original Medicare doesn’t pay for.
These are the most common surprise bills. Some Advantage plans cover part of them as extras.
Long-term care
Help with daily living in a nursing home or at home.
Most dental
Cleanings, fillings, extractions and dentures.
Eyes and ears
Eye exams for glasses, and hearing aids.
Routine physicals
The yearly “Wellness” visit is covered. A full physical isn’t.
Care abroad
Generally not covered outside the U.S.
Cosmetic care
Cosmetic surgery, massage and concierge fees.
If money is tight
Help exists, and many people who qualify never apply.
Even if you’re not sure you qualify, it’s worth asking.
Extra Help
Lowers drug costs. In 2027, generally no more than $5.80 for a generic and $14.40 for a brand-name drug. Apply at SSA.gov/extrahelp.
Medicare Savings Programs
Your state can help pay your Part B premium, and sometimes your deductibles and copays. Ask your state Medicaid office.
Who usually qualifies
| Extra Help, 2026 limits | Yearly income under | Savings under |
|---|---|---|
| Single | $23,940 | $18,090 |
| Married, living together | $32,460 | $36,100 |
Savings means bank accounts, stocks, bonds and IRAs. Your home, car, burial plot and life insurance don’t count. If you have Medicaid or SSI, you get Extra Help automatically.
4
Extra coverage
How Medicare Supplement (Medigap) works, and the kinds of Medicare Advantage plans.
About 2 minutes · 2 topics
Medicare Supplement (Medigap)
Same letter, same benefits, any company.
A Plan G from one company covers exactly what a Plan G from another covers. Only the price is different.
The best time to buy: your first 6 months
Starting the month your Part B begins, at 65 or older. No health questions during these months.
1month
2months
3months
4months
5months
6months
After that, a company may ask health questions and can say no or charge more.
Compare the plan letters
| What the plan pays | A | B | C | D | F | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Hospital coinsurance, extra days | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% |
| Part B 20% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | 50% | 75% | Pays 100% | Pays 100%* |
| Hospice coinsurance | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | 50% | 75% | Pays 100% | Pays 100% |
| Skilled nursing coinsurance | Not covered | Not covered | Pays 100% | Pays 100% | Pays 100% | Pays 100% | 50% | 75% | Pays 100% | Pays 100% |
| Part A deductible | Not covered | Pays 100% | Pays 100% | Pays 100% | Pays 100% | Pays 100% | 50% | 75% | 50% | Pays 100% |
| Part B deductible | Not covered | Not covered | Pays 100% | Not covered | Pays 100% | Not covered | Not covered | Not covered | Not covered | Not covered |
| Part B excess charges | Not covered | Not covered | Not covered | Not covered | Pays 100% | Pays 100% | Not covered | Not covered | Not covered | Not covered |
| Emergency care abroad | Not covered | Not covered | 80% | 80% | 80% | 80% | Not covered | Not covered | 80% | 80% |
Dot = pays 100%. * Plan N: you may pay up to $20 for some office visits and $50 for some ER visits. Plans C and F are only for people eligible for Medicare before January 1, 2020. For everyone newer, Plan G covers the most. Medigap doesn’t cover drugs, dental, vision or hearing aids.
Trying Medicare Advantage first?
If you join Medicare Advantage when you first get Medicare at 65, you can switch to Original Medicare within 12 months and still buy certain Medigap policies with no health questions.
If you drop a Medigap policy to try Advantage for the first time, you have 12 months to get the same policy back, if the company still sells it.
Medicare Advantage
The main kinds of Advantage plans.
The biggest difference is how much freedom you have to choose your doctors.
HMO
Use the plan’s doctors. You usually pick a main doctor and need referrals to see specialists.
PPO
Use any doctor, but doctors in the plan’s network cost you less.
Special Needs Plan
For people with Medicaid, certain long-term conditions, or nursing-home care.
Tell me more
Two less common types: Private Fee-for-Service plans set their own payment terms with doctors, and Medical Savings Account plans pair a high deductible with money deposited for your care.
Watch out: if you join an HMO or PPO that doesn’t include drug coverage, you can’t add a separate drug plan.
5
Staying safe
How to spot scam calls, the choices that are hard to undo, and where to get free help.
About 2 minutes · 3 topics
Scam calls
Only a few people are allowed to call you about Medicare.
Never give your Medicare number to someone who calls you out of the blue.
Allowed to call you
- Your current plan
- The agent who helped you join
- 1-800-MEDICARE, if you asked them to call back
Report anyone who
- Asks for your personal information by phone or email
- Calls to sign you up
- Shows up at your door uninvited
Think twice
Five choices that are hard to undo.
Take your time with these. Once made, you may not be able to go back.
- Dropping a Medigap policyAfter your first 12 months, you may not get it back, or may pay more.
- Leaving Advantage for Medigap later onOutside your protected windows, a company can say no based on your health.
- Waiting on Part B without coverage from a current jobThe late penalty lasts for as long as you have Part B.
- Going 63 days or more without drug coverageThe late penalty is added to your drug premium for life.
- Dropping job, union or retiree coverage to join a planYou may not get it back, and your spouse may lose it too. Ask the benefits office first.
Free help
Numbers worth saving.
| Medicare Questions about your coverage, 24 hours a day | 1-800-633-4227 |
| Senior Medicare Patrol Report scams and billing errors | 1-877-808-2468 |
| Your state’s SHIP Free, unbiased Medicare counseling | shiphelp.org |
Hi, I’m Pranav.
I’m a licensed, independent insurance agent in metro Atlanta. I help people turning 65, and people already on Medicare, understand their choices in plain English.
- Talking with me costs nothing
- You pay the same premium with or without an agent
- I’ll look at your doctors and prescriptions with you
Reading this guide asks nothing of you. I’ll never call you unless you ask.
Ask me a questionPick a time for a callCall meCalls are recorded, as Medicare requiresCompare plans and enroll yourselfOpens my secure enrollment siteYou’ll see plans from the companies I work with. I’m still your agent if you need help, at no extra cost.
Phone (912) 453-7782
Email pranav@finspire.me
We do not offer every plan available in your area. Currently we represent 8 organizations which offer 141 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Counts shown are for Georgia. I help people in Georgia. Elsewhere, contact Medicare.gov, 1-800-MEDICARE or your state’s free SHIP counselors.