Medicare is not written for the people who use it. Here is the official wording, and
underneath it, the version we would say to you on the phone.
How the handbook says it
Part A
Hospital Insurance helps cover inpatient hospital care, skilled nursing facility care, hospice care and some home health care. An inpatient deductible applies per benefit period, and coinsurance applies to days 61 through 90 and to lifetime reserve days.
Part B
Medical Insurance helps cover medically necessary services including physicians’ services, outpatient care, durable medical equipment and many preventive services. After the annual deductible you generally pay 20% coinsurance of the Medicare-approved amount.
Part D
Prescription Drug Coverage is offered through private plans approved by Medicare. Cost sharing varies by formulary tier and by pharmacy status. Once your true out-of-pocket costs reach the annual maximum you enter catastrophic coverage.
How we would say it
Part A
Part A is the hospital half. If you are admitted overnight, this is the part that pays. Most people pay nothing for it each month, because they already paid through payroll taxes while they worked.
Part B
Part B is the doctor half. Office visits, blood tests, scans, a walker, a wheelchair. You pay the first $283 each year, then Medicare pays 80% and you pay the other 20%. Nothing caps that 20%, which is the reason most people add a second plan.
Part D
Part D is the pill half. You buy it from a private company and each company covers a different list of drugs. In 2026, once you have paid $2,100 of your own money for covered drugs, you pay nothing more for the rest of the year.
Move your mouse over the panel, or press and drag on a touch screen, to read it in plain
English through the window. Keyboard: focus the panel and use the arrow keys.
January 1 – March 31
The year turns, and the numbers change
Every figure below took effect on January 1. Whatever you chose in the fall is what you
are living with now, and for most people these are the only Medicare numbers that
matter all year.
Medicare costs for 2026
What
Who pays it
2026
Part A monthly premium
Most people, nothing
$0
Part A hospital deductible
You, each benefit period
about $1,736
Part B monthly premium
You, usually from your Social Security payment
$202.90
Part B yearly deductible
You
$283
Part B coinsurance
You, after the deductible
20%, with no ceiling
Part D drug spending cap
Your plan, once you reach it
$2,100
Households with higher incomes pay more for Parts B and D. That surcharge is called
IRMAA and it is based on your tax return from two years ago.
See every cost explained.
Two windows share these three months
If you were in a Medicare Advantage plan on January 1, you get one switch
before March 31. And if you missed your first window entirely, January 1 to March 31 is
the General Enrollment Period. Which one applies to you.
April – September
The quiet months, and the window that is only yours
Nothing on the national calendar happens between April and September. The only window
that can be open in these months is your own: the seven around your 65th birthday. It
opens three months before your birthday month and closes three months after it, and it
is the one people miss.
Sign up for Part A and Part B now and your coverage starts on the first day of your birthday month. Nothing you do later gets you an earlier start date.
You apply through Social Security, not through Medicare and not through us. It takes about fifteen minutes online, or you can do it on the phone.
One exception worth knowing: if your birthday is on the first of the month, Medicare treats you as turning 65 the month before, and everything shifts back by one month.
If you or your spouse still work somewhere with 20 or more employees and you are covered there, you can usually delay Part B with no penalty, and pick it up later through a Special Enrollment Period.
If the employer has fewer than 20 employees, Medicare usually needs to be your primary coverage from 65. Delaying can leave claims unpaid, and nobody will warn you until a bill arrives.
Most people still take Part A at 65 because it is free. One caution: you cannot contribute to a health savings account once any part of Medicare starts.
Sign up during your birthday month and coverage starts on the first day of the following month. That is a rule change from 2023, and it replaced a much worse one that could leave people waiting until July.
Nothing is broken. You have simply given up the neatest possible start date.
Original Medicare pays about 80% of Part B services and puts no ceiling on your share of the rest. You close that gap in one of two ways, and you cannot easily have both.
Original Medicare plus a Medigap policy plus a drug plan. Any doctor in the country who takes Medicare. No referrals, no prior approvals. Higher monthly cost, very few surprises.
A Medicare Advantage plan. Usually lower monthly cost, drugs and extras often included, a network to stay inside, and a yearly ceiling on what you can be charged.
Neither is the right answer for everyone. It depends on your doctors, your prescriptions, whether you travel, and how much uncertainty you can live with.
This one is separate from the seven-month window and it matters more than almost anything else on this page.
For six months, any Medigap company must sell you any plan they offer, at their standard rate, whatever your health history. They cannot ask health questions and they cannot say no.
After those six months, in most states they can ask, and they can decline. People who plan to “try Medicare Advantage for a year and switch to a supplement later” are often surprised to learn that later is not guaranteed.
Sign up in this stretch and coverage still starts the first of the month after you apply. Once it ends, if you have no other reason to delay, your next chance is the General Enrollment Period, January 1 to March 31, and a late-enrollment penalty is likely.
Before you accept a penalty, call us. Plenty of people qualify for a Special Enrollment Period they did not know existed.
Between late September and December 7 your mailbox fills up. Nearly all of it is
advertising. The two pieces that are not are the ones people throw away.
Your Annual Notice of Change
It arrives by the end of September from your current plan and lists everything changing
on January 1: the premium, the copays, the drug list, the network. Read the drug list
and the network sections. Skip the rest.
Nobody from Medicare will knock
Medicare does not cold-call, does not door-knock, and will never ask for your bank
details over the phone. Neither will we. If someone pressures you to decide today,
that is the tell.
There is no form to fill in first, no quote engine, no follow-up campaign. A licensed
agent picks up, you describe your situation, and you get an answer. Plenty of people
qualify for a window they had never heard of. If you do not need us, we will say so.
Set here as they arrive: one at a time, in the post. These correspondents are invented for
this demonstration, like the agency itself — there are no star ratings on this site
and no claim that anybody consented to anything, because neither would be true.
SylvaniaFEB 2026
Sylvania, Ohio14 February 2026
Dear Plainspoken,
I turn 65 in April and four different companies rang me in one week. Not one of them would tell me plainly whether they were Medicare or selling something. I had begun to think that was my fault for not understanding.
You told me in the first minute that Medicare never telephones people, and then you asked me one question — am I still working — and everything after that followed from the answer. My window opened in January and closes at the end of July. Hospital and doctor parts first. The drug plan the week after.
That is the first thing anyone has said to me about this that I understood.
My plan sent me fourteen pages in September. Somewhere inside it, it said my cardiologist would not be in the network from January, but it did not say it in a way a person could find.
I sent you the first two pages and his name on a Tuesday morning. You rang me back the same afternoon: he is out from the first, two other plans in Lucas County still have him, and one of those keeps my pharmacy as well.
Fourteen pages, and you got it down to two sentences. My wife wants you to know she has told four people at church.
I bought a supplement two years ago and wanted a different one, and I assumed I could simply switch, the way you switch anything else.
You explained that outside my first six months on Part B a company is allowed to ask health questions and turn me down, and that I should find out whether I would be accepted before I cancelled anything. Nobody told me that the first time.
I am cross that I did not know, and grateful that you said it before I did something I could not undo.
I called about my husband, who has eleven prescriptions and no patience for any of this. You did not ask me what plan we wanted. You asked me to read out the eleven bottles.
The plan with the cheapest monthly price came out third once you added the year up, and you showed me the arithmetic rather than telling me to trust you.
We changed before the seventh of December, which I now know is the date that matters.
I am 67 and still working, with coverage through the plant. Everyone at work had a different theory about whether I had to sign up.
You went through it once, slowly: whose insurance it is, how many people the employer covers, and what that means for the penalty. Then you said I did not need you yet and to ring back three months before I finish.
I have never had anybody in insurance tell me they were not needed. That is why I am writing.
Letter 1 of 5. These correspondents are invented for this demonstration.
Questions people ask us most
I turn 65 soon. What is the very first thing I should do?
Work out whether you will still have health coverage from a job, yours or a spouse’s, after you turn 65. That single answer changes everything else.
If you will not, your seven-month Initial Enrollment Period starts three months before your birthday month, and signing up early means coverage starts on the first day of your birthday month. If you will, you may be able to delay Part B without penalty. Call us and we will tell you which one you are in, in about four minutes.
Do I get Medicare automatically?
Only if you are already receiving Social Security or Railroad Retirement benefits at least four months before you turn 65. Then Parts A and B arrive in the mail and start on their own.
Everybody else has to apply, through Social Security, online or by phone. Nobody sends you a reminder.
What is the actual difference between Medicare Advantage and a Medigap plan?
A Medigap policy sits behind Original Medicare and pays the bills Medicare leaves you. You keep the freedom to see any doctor in the country who takes Medicare, and you pay a monthly premium for that.
A Medicare Advantage plan replaces Original Medicare with a private plan. It usually costs less each month and often includes drugs, dental and vision, but you use a network, you may need referrals, and some services need approval in advance.
Neither is better. They are different trades, and which one fits depends on your doctors, your travel, your prescriptions and how you feel about surprises.
I am still working at 65. Do I have to take Medicare?
If your employer has 20 or more employees and you have coverage through that job, you can usually delay Part B without penalty and pick it up later through a Special Enrollment Period.
If the employer has fewer than 20 employees, Medicare usually needs to be primary and delaying can leave you with unpaid claims. Ask your benefits office to put the answer in writing, then call us before you decide.
What does your help cost me?
Nothing. If you enroll in a plan through us, the insurance company pays us a commission that it sets. Your premium is exactly the same as it would be if you enrolled directly or through anyone else.
Plainspoken Medicare has been in Toledo since 2011. We are licensed in Ohio, Michigan and Indiana. We are small on purpose: the person who helps you choose is the person who picks up
when something goes wrong in March.
We are paid a commission by the insurance company when you enroll, at a rate the company
sets. It costs you nothing and it does not change your premium.
This demonstration is printed in two inks on one stock. Pick a different pair and the
whole site is re-run in it — the masthead, the rules, the buttons, the icons, the folios,
the gradients and the ink that blooms under your pointer.
Each pair was measured before it was offered. Body text holds at least 7:1 in both the day
and the night press, and the regulatory notices are frozen so they read the same under
every one of them.
The pair on the press is written into the address bar, so a link to this page carries it
with you.
