Official Medicare Publications & Guides

Medicare & You - 2026 Edition from Medicare.gov

The official 2026 Medicare handbook covers eligibility, enrollment periods, Parts A through D, Medicare Advantage, Medigap, prescription drug coverage, preventive services, and costs. Essential reading for new enrollees and current beneficiaries.

Sep 30, 2025 · 4 min read

Credit: Medicare.gov

Who Should Read This

This handbook is essential reading for anyone enrolled in Medicare or preparing to enroll. If you're turning 65, recently retired, or helping a family member navigate Medicare, this is your primary reference guide. Caregivers and adult children assisting aging parents will find this particularly valuable as a comprehensive overview of all Medicare programs and benefits.

When This Applies

This edition of "Medicare & You" is applicable to the calendar year 2026. While the core Medicare structure remains consistent, specific costs, coverage details, and plan options are updated yearly. Always reference the current year's edition for accurate premium amounts, deductibles, and enrollment deadlines.

Quick Overview

"Medicare & You" is the official U.S. government Medicare handbook, published annually by the Centers for Medicare & Medicaid Services (CMS). This comprehensive 128 page guide covers everything from basic eligibility and enrollment to detailed explanations of Original Medicare, Medicare Advantage, and prescription drug coverage. It serves as the authoritative source for understanding your Medicare rights, benefits, and options.

Key Takeaways

Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage)
Initial Enrollment Period begins 3 months before you turn 65 and extends 3 months after your birthday month
Annual Enrollment Period (October 15 - December 7) is when you can change your Medicare coverage for the following year
2026 Medicare Part B standard premium is $202.90 per month and deductible is $283.00 for the calendar year
2026 Medicare Part A standard premium is $0 and deductible is $1,736 for the calendar year
You can choose between Original Medicare with a supplement or a Medicare Advantage plan, but not both simultaneously
Preventive services like annual wellness visits, screenings, and vaccinations are typically covered at no cost
Late enrollment penalties apply if you don't sign up when first eligible and don't have other creditable coverage

Publication Summary

The 2026 "Medicare & You" handbook begins by explaining Medicare eligibility, covering who qualifies at age 65, younger individuals with disabilities, and those with End-Stage Renal Disease or ALS. The guide clarifies the critical difference between automatic enrollment (if you're already receiving Social Security) versus needing to actively sign up through the Social Security Administration.

The handbook provides detailed explanations of Original Medicare Parts A and B. Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes while working. Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment. The handbook provides current cost-sharing details including the annual deductible, coinsurance amounts, and when you might pay more based on income.

The publication dedicates substantial coverage to Medicare Advantage (Part C) plans, explaining how these private insurance plans provide all Part A and Part B benefits, usually include prescription drug coverage, and often offer additional benefits like dental, vision, or hearing. It outlines the trade-offs: typically lower monthly premiums but network restrictions and referral requirements. The guide helps readers understand when they might prefer Original Medicare's flexibility versus a Medicare Advantage plan's integrated approach.

Prescription drug coverage (Part D) receives thorough treatment, including how the coverage works through private plans, what the coverage gap ("donut hole") means, and strategies for comparing plans based on your specific medications. The handbook explains Extra Help programs for those with limited income and resources, potentially saving thousands in drug costs annually.

Medigap (Medicare Supplement Insurance) is explained as optional coverage that helps pay costs Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. The guide clarifies the best time to buy Medigap (during your 6-month Medigap Open Enrollment Period) and why timing matters for guaranteed issue rights.

The handbook provides extensive information on preventive services, emphasizing which screenings and tests Medicare covers at no cost when provided by participating providers. This includes cardiovascular screenings, diabetes tests, cancer screenings, and the all-important Annual Wellness Visit.

Special situations receive dedicated sections: what happens to Medicare when you're still working or have employer coverage, how Medicare coordinates with other insurance, coverage while traveling (including outside the U.S.), and rights and protections including appealing coverage decisions.

Frequently Asked Questions

When should I sign up for Medicare?
Your Initial Enrollment Period is a 7-month window that begins 3 months before the month you turn 65, includes your birthday month, and continues for 3 months after. Missing this window may result in late enrollment penalties and coverage gaps.

Do I need both Medicare and a Medicare Advantage plan?
No. Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits. You have Original Medicare (Parts A and B) OR a Medicare Advantage plan, not both. Medicare Advantage plans must cover everything Original Medicare covers, often with additional benefits.

What's the difference between Medigap and Medicare Advantage?
Medigap supplements Original Medicare by helping pay out-of-pocket costs like deductibles and coinsurance. Medicare Advantage replaces Original Medicare entirely with a private plan that typically includes prescription drug coverage and may have network restrictions.

How much will Medicare cost me in 2026?
Most people pay $0 for Part A. The standard Part B premium is $202.90 monthly (higher earners pay more). Part D and Medicare Advantage premiums vary by plan. Original Medicare also has deductibles and coinsurance you'll pay when using services.

Can I change my Medicare coverage if I'm not happy with it?
Yes. During the Annual Enrollment Period (October 15 - December 7), you can switch between Original Medicare and Medicare Advantage, add or drop drug coverage, or change plans. Some people also qualify for Special Enrollment Periods outside of the Annual Enrollment Period based on specific circumstances.