Medicare in plain English

Medicare is the federal health insurance program built mainly for people who are 65 or older. (Some people under 65 qualify because of certain disabilities or conditions.) If you live in Charlotte or anywhere in North Carolina, the federal Medicare rules and cost figures are the same as they are everywhere in the country, though the specific plans available to you depend on your county.

The most important thing to understand up front is that Medicare is not one single plan. It is built from separate "parts," and you put those parts together into coverage that fits your health, your budget, and the doctors you want to keep. This is where a lot of people approaching 65 feel overwhelmed, and it is exactly the kind of decision worth thinking through carefully several months before your birthday.

The parts of Medicare, one at a time

Part A — Hospital Insurance

Part A covers medically necessary inpatient hospital stays, and under certain conditions it also helps with limited skilled nursing facility care, some home health care, and hospice. Most people pay $0 per month for Part A in 2026, because they or a spouse paid Medicare taxes while working for at least about 10 years. If you do not have enough work history, in 2026 you would pay $311/month (with 30–39 quarters) or $565/month (with fewer than 30 quarters).

Part A does not work like a simple copay. In 2026, there is a $1,736 inpatient hospital deductible per benefit period. After that, days 1–60 have no daily coinsurance; days 61–90 cost $434 per day; and lifetime reserve days beyond day 90 cost $868 per day in 2026.

Part B — Medical Insurance

Part B covers doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. In 2026, the standard Part B premium is $202.90 per month, and the annual deductible is $283. After you meet the deductible, you generally pay 20% of the Medicare-approved amount for most covered services. Higher-income enrollees pay more through IRMAA (explained below).

Part D — Prescription Drug Coverage

Part D helps pay for prescription medications. It is sold by private insurers, either as a standalone plan or built into a Medicare Advantage plan. A big improvement worth knowing: in 2026, once your out-of-pocket spending on covered Part D drugs reaches $2,100, you hit catastrophic coverage and pay $0 for covered Part D drugs the rest of the calendar year.

Original Medicare vs. Medicare Advantage

After you have Part A and Part B (together called Original Medicare), you generally choose one of two directions.

Original Medicare, often with a Medicare Supplement

With Original Medicare you can see any doctor or hospital in the country that accepts Medicare, with no networks. But Original Medicare on its own has no yearly cap on what you pay out of pocket, and it does not include drug coverage. Many people close that gap with a Medicare Supplement (Medigap) policy, which helps pay Original Medicare's deductibles and coinsurance, plus a separate Part D drug plan.

  • Medigap plans are standardized and named by letters (A through N), so a given letter offers the same core benefits from every company — companies mainly compete on price and service.
  • Plan G, a common choice for people newly eligible, covers essentially all of Original Medicare's gaps except the Part B deductible ($283 in 2026).
  • Your one-time Medigap Open Enrollment Period lasts 6 months and starts the first month you have Part B and are 65 or older. During that window you have guaranteed issue rights — no health questions can be used to deny you or charge you more. After it closes, insurers generally can use medical underwriting, which is why timing matters.

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers approved by Medicare and act as an all-in-one alternative to Original Medicare. They typically use provider networks (HMO or PPO), so which doctors and hospitals you can use — and referral rules — matter. Every Medicare Advantage plan must include a yearly out-of-pocket maximum for covered Part A and Part B services, which Original Medicare does not have on its own. Most bundle Part D drug coverage and often add extras like dental, vision, and hearing. You still pay your Part B premium. Neither path is universally "best" — the right choice depends on your doctors, your medications, and how you like to manage care.

When you sign up: the turning-65 timeline

Your Initial Enrollment Period (IEP) is a 7-month window: the 3 months before your birthday month, your birthday month, and the 3 months after. Signing up in those first 3 months is what lets coverage start the first day of your birthday month — so it is worth starting your research and paperwork about 3 months early rather than waiting.

  • Annual Enrollment Period (AEP): October 15 to December 7 every year, when anyone with Medicare can join, drop, or switch Medicare Advantage or Part D plans, with changes taking effect January 1.
  • General Enrollment Period: January 1 to March 31, a fallback if you missed your IEP.
  • Special Enrollment Periods: for life events like working past 65 with employer coverage (you generally get up to 8 months to sign up for Part B after that coverage ends), moving, or losing other coverage.

Costs beyond the premium: IRMAA and late penalties

Higher earners pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of the standard Part B and Part D premiums. It is based on your income from two years prior — 2026 IRMAA uses your 2024 tax return. In 2026, IRMAA begins when MAGI is above $109,000 (individual) or $218,000 (married filing jointly). At or below those numbers you pay no IRMAA; in the first bracket above them, the 2026 add-on is about $284.10 for Part B and $14.50 for Part D.

Late-enrollment penalties are the other reason timing matters. Miss Part B when first eligible without a Special Enrollment Period, and your premium goes up 10% for each full 12 months you could have had it — for as long as you have Medicare. Go 63+ days without creditable drug coverage after your IEP, and a Part D penalty is added to your premium for life. Enrolling on time is the simplest way to avoid both.

How The Jordan Insurance Agency helps

The Jordan Insurance Agency is an independent, full-time, licensed insurance agency based in Charlotte, North Carolina, serving clients across the state. Because we are independent, we represent multiple carriers rather than one — so we can compare Original Medicare with a Medicare Supplement, Medicare Advantage plans, and Part D options side by side and explain the honest trade-offs for your situation.

An experienced, full-time agent who completes annual AHIP and carrier certifications, carries errors-and-omissions coverage, and uses real enrollment technology can save you from costly timing mistakes — like missing your Medigap window or triggering a lifelong late penalty. Working with a licensed agent costs you nothing; the carrier pays the agent, and your premium is the same whether you enroll on your own or with our help. We also review your plan every year at renewal, because drug formularies, networks, and plans change annually. For any current-year figure not shown here, you can always confirm at Medicare.gov or by calling 1-800-MEDICARE. When you are ready, reach out to The Jordan Insurance Agency and we will walk you through it calmly, one part at a time.

Plan availability & disclaimer

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. The Jordan Insurance Agency is not connected with or endorsed by the United States government or the federal Medicare program.