Once you've enrolled in Medicare, there's more to know. From reviewing your annual plan documents to understanding preventive services, here's what you should consider to get the most from your Medicare coverage.
Enrolling in Medicare is just the first step. Once you're covered, understanding how your benefits work—and how they may change from year to year—helps you make informed decisions about your healthcare. Here's what you should know.
You only need to apply for Medicare once. Enrollment is handled through the Social Security Administration, either online at ssa.gov, by phone, or in person at your local Social Security office.
After enrolling, you have a choice: stay with Original Medicare (Parts A and B) or enroll in a Medicare Advantage plan. Original Medicare provides broad access to any doctor or hospital that accepts Medicare. At the same time, private insurers offer Medicare Advantage plans and often include additional benefits like dental, vision, and hearing coverage.
Cost | 2025 | 2026 |
Part B Monthly Premium (standard) | $185.00 | $202.90 |
Part B Annual Deductible | $257 | $283 |
Part A Hospital Deductible | $1,676 | $1,736 |
Part D Max Out-of-Pocket | $2,000 | $2,100 |
Part D Max Deductible | $590 | $615 |
MA Max Out-of-Pocket (in-network) | $9,350 | $9,250 |
Note: Higher-income beneficiaries pay more for Part B and Part D. These income-related monthly adjustment amounts (IRMAA) are based on your tax return from two years prior.
Medicare Advantage: All Medicare Advantage plans include an out-of-pocket maximum. Once you reach this limit, your plan covers 100% of eligible medical expenses for the rest of the year. In 2026, the federal maximum is $9,250 for in-network services (down from $9,350 in 2025), though many plans set their limits lower. The national median out-of-pocket maximum is approximately $5,900.
Original Medicare: Parts A and B do not have an out-of-pocket maximum. Your costs could continue to accumulate without a cap. This is one reason many people with Original Medicare purchase a Medigap (Medicare Supplement) policy.
Prescription Drug Coverage: All Part D plans now include a $2,100 annual cap on out-of-pocket drug costs for 2026 (up from $2,000 in 2025). Once you reach this limit, you pay nothing for covered Part D prescriptions for the rest of the year. This cap was introduced in 2025 as part of the Inflation Reduction Act and replaces the old "donut hole" coverage gap.
Evidence of Coverage (EOC): Your Medicare plan will send an Evidence of Coverage document, typically in September. The EOC details what your plan covers, how much you'll pay for services, and any rules or restrictions. Review your EOC carefully to make sure your current plan continues to meet your needs, especially if your health situation has changed.
Annual Notice of Change (ANOC): Also arriving in September, the ANOC explains any upcoming changes in costs and coverage for the following year. Changes take effect January 1. Comparing your ANOC to your current coverage helps you decide whether to keep your plan or switch during the Medicare Open Enrollment Period (October 15 – December 7).
Original Medicare (Parts A and B): Automatically renews every year as long as you continue paying your Part B premium (Part A is premium-free for most beneficiaries). No action required to maintain coverage.
Medicare Advantage and Part D: Your plan automatically renews, but benefits, costs, and drug formularies may change each year. Review your ANOC and EOC to understand what's different.
Medicare Prescription Payment Plan: If you enrolled in the Medicare Prescription Payment Plan (which spreads out-of-pocket drug costs into monthly payments), you'll be automatically re-enrolled in 2026 unless you opt out or change plans.
Medicare covers a wide range of preventive services at no cost when you see a provider who accepts Medicare assignment. These services help detect health problems early and keep you healthy.
Wellness Visits:
"Welcome to Medicare" Preventive Visit: Available once within your first 12 months of Part B coverage. Includes a review of your health history, screenings, referrals, and a written prevention plan.
Annual Wellness Visit: Available every 12 months after your Welcome to Medicare visit (or 12 months after Part B starts). Develops or updates your personalized prevention plan based on current health and risk factors. Not a physical exam.
Covered Screenings and Services:
Cardiovascular disease screenings (cholesterol, lipid, and triglyceride levels)
Diabetes screenings (for people at risk)
Flu shots, pneumonia vaccines, COVID-19 vaccines, and Hepatitis B shots
Colorectal cancer screenings (colonoscopy, stool tests)
Mammograms and cervical/vaginal cancer screenings
Bone mass measurements
Glaucoma tests
Depression screenings
Medical nutrition therapy (for diabetes or kidney disease)
Alcohol misuse screening and counseling
Tobacco cessation counseling
Important: You pay nothing for most preventive services if your provider accepts Medicare assignment. However, if additional tests or services are performed during the same visit that aren't covered under the preventive benefit, you may owe a copay or coinsurance.
To be eligible for Medicare Advantage, you must be enrolled in both Medicare Parts A and B. Many Medicare Advantage plans offer $0 premiums (beyond your Part B premium) and include benefits not covered by Original Medicare, such as:
Dental, vision, and hearing coverage (offered by 98-99% of plans)
Prescription drug coverage (most plans include Part D)
Fitness programs like SilverSneakers
Over-the-counter allowances (provided by 66% of plans in 2026)
Transportation to medical appointments (24% of plans)
Important tradeoffs to consider:
Network restrictions: Unlike Original Medicare, most Medicare Advantage plans require you to use in-network providers (except in emergencies). HMO plans typically require referrals to see specialists.
No Medigap eligibility: When you enroll in Medicare Advantage, you are no longer eligible to purchase or use a Medigap policy. If you later switch back to Original Medicare, you may face medical underwriting for Medigap.
Prior authorization: Some Medicare Advantage plans require prior approval for certain procedures or specialist visits.
Medicare Open Enrollment Period (October 15 – December 7): The main opportunity to switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or join, switch, or drop a Part D prescription drug plan. Changes take effect January 1.
Medicare Advantage Open Enrollment Period (January 1 – March 31): If you're already in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or return to Original Medicare (and join a Part D plan). One change allowed; effective the first of the following month.
Special Enrollment Periods: Certain life events (moving, losing other coverage, qualifying for Medicaid) may trigger a Special Enrollment Period outside the regular windows.
New for 2026: If you enrolled in a Medicare Advantage plan and discover during your first three months that your doctors are not actually in-network (despite information on Medicare Plan Finder), you may qualify for a special enrollment period to switch plans or return to Original Medicare.
Medicare is not a "set it and forget it" program. Review your Evidence of Coverage and Annual Notice of Change every fall to ensure your plan still meets your needs. Take advantage of covered preventive services to stay healthy. And if your current coverage isn't working for you, the Medicare Open Enrollment Period (October 15 – December 7) is your opportunity to make a change for the coming year.
Questions about Medicare? Contact a licensed insurance agent who can help you compare plans and find the coverage that fits your healthcare needs and budget.