How does Medicare planning work in 2026?
Medicare & healthcare
Medicare has four parts: A (hospital, free for most), B (doctor, $185/mo+ in 2025, projected ~$206/mo in 2026), C (Advantage), and D (drugs). Enrollment windows are strict and missing them triggers permanent late penalties.
The four parts in plain English
Part A covers hospital, paid via payroll taxes during your working years. Part B covers doctors and outpatient, paid monthly. Part D covers prescriptions. Part C (Advantage) bundles A+B+often D into a private plan.
The enrollment windows that bite people
Initial Enrollment Period: 7 months around your 65th birthday. Miss it without creditable coverage and you face a 10% Part B penalty per year missed, for life. General Enrollment is January-March, with coverage starting the month after enrollment (rule updated in 2023).
Medigap vs Medicare Advantage
Medigap (Supplement) + Original Medicare + Part D: more flexibility, any doctor accepting Medicare, predictable costs, higher monthly premium. Medicare Advantage: lower or zero premium, but network restrictions and prior authorizations. Switching from Advantage back to Medigap can be denied for health reasons after the first year.
What people often get wrong
- Missing the 7-month initial enrollment window
- Choosing Medicare Advantage without checking if your doctors are in network
- Not realizing Part B premiums are income-based (IRMAA)
What to think about next
- Calendar your initial enrollment 3 months before your 65th birthday.
- Confirm whether your current insurance counts as 'creditable coverage' to avoid penalties.
- Compare 2 Medigap quotes against 2 Advantage plans before age 65.
When to consider working with a CFP®
Working with a CFP® can help when these decisions feel intertwined, taxes, investments, cash flow, and life goals tend to move together, and a planning relationship can offer structure, prioritization, and accountability over time.
Frequently Asked Questions
Do I need Medicare if I'm still working at 65?
If your employer plan is creditable (typically 20+ employees), you can defer. Smaller employers, you usually need to enroll on time.
Talk to a CFP® who works with high earners.
Connect with a CFP® to help you navigate this decision and build a comprehensive financial strategy.
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