Open enrollment for Medicare began on Oct. 15 and runs until Dec. 7. It not only allows 65-year-olds to enroll in Medicare but also allows both original Medicare and Medicare Advantage beneficiaries to review and change their coverage.
But Medicare rules and regulations can be confusing. How do you navigate through them? And what is the cost? Medicare is set to increase for 2026.
Medicare Open Enrollment
You are required to sign up for Medicare when you reach 65. According to the Social Security Administration (SSA), failure to do so may result in gaps in coverage or late penalties. According to Medicare, you’ll pay an extra 10 percent for each year you could have signed up for Part B but didn’t. A penalty stays with you for the rest of your life.
Even if you have retiree health insurance, you must enroll in Medicare. Retiree insurance can be used to fill the coverage gaps.
But if you are aged 65 and already receive Social Security, you will automatically be enrolled in Part A. You must sign up for Part B. Your coverage begins the month after you enroll.
According to Medicare, Part A is hospital insurance and Part B is medical insurance. It will pay medical costs once you pay a deductible and coinsurance. If you want Medicare Drug Part D, you’ll need to join a separate Medicare drug plan.
Medicare Costs and Increases
Although there is no fee for Part A, you must pay a premium for Part B. The premium is increasing 11.6 percent from $185 in 2025 for those earning $106,000 or less ($212,000 or less for those who file jointly) to $206.50 in 2026, according to the AARP. This premium is just for Medicare Part B and doesn’t include Medigap, drug, or Medicare Advantage plans.
‘Hold Harmless Provision’ to Soften the Blow
According to Medicare Interactive, a rule called the hold harmless provision protects your Social Security benefit from decreasing due to Medicare Part B’s premium increase.
So, you will receive a cost-of-living adjustment (COLA) from the SSA that is large enough to cover the full amount of your increased premium. You will be protected or held harmless.
The new COLA, however, has not been announced because of the federal government shutdown.
On Oct. 24, the Bureau of Labor Statistics will publish the September 2025 Consumer Price Index. This release allows the SSA to meet statutory deadlines necessary to ensure the accurate and timely payment of benefits.
Medicare, Medigap, and Medicare Advantage
Although Medicare covers hospital and medical, there’s a large divide as to what they pay for and your share of the cost. That’s where Medigap and Medicare Advantage come into play.
Medigap
Medigap is a private insurance company, but Medicare still pays your main bills. You stay in the original Medicare so you can go to any doctor you wish. But you will need to add a separate Part D (drug plan) for prescriptions.
Medicare pays its share of your healthcare bills first. Then Medigap pays the rest (depending on which plan letter you pick, such as Plan G or Plan N). You’ll pay a monthly premium for Medigap in addition to Medicare, but you’ll have very few surprise bills, and you’ll be able to choose your doctor.
According to Medicare, in 2025, deductibles for Medigap plans F and G were up to $2,870. For plans K and L, the deductible was $257. After the deductible is met, Medigap pays 100 percent. But Plan N pays 100 percent of costs, except for copayments for some office visits and emergency room visits.
Think of it like this: Medicare is handled by the government, but you buy a helper plan to cover what Medicare doesn’t.
Medigap Preexisting Conditions
According to KFF, federal requirements prohibit the use of medical underwriting by the insurer when issuing Medigap policies. These are known as guaranteed issue protections. But, unfortunately, these protections are limited. That means it may be hard or impossible for people with preexisting conditions like asthma or cancer to purchase a Medigap policy.
However, federal law requires Medigap insurers to issue polices without medical underwriting during a one-time six-month Medigap open enrollment period. This applies to applicants aged 65 and older when first enrolling in Medicare Part B and for certain qualifying events.
Medicare Advantage Plan
You receive Medicare benefits through the traditional Medicare program, which is administered by the federal government or through a private Medicare Advantage plan. The Medicare Advantage plan is an health maintenance organization (HMO) or preferred provider organization (PPO).
The government contracts private insurers to provide Medicare benefits to enrollees. Medicare still pays its portion of the bill, but the Medicare Advantage plan administers it. Many include Part D, for prescription drugs.
In 2025, according to KFF, 76 percent of individuals enrolled in Medicare Advantage plans with prescription drug coverage paid no premium other than the $185 to Medicare.
However, there were higher deductibles, coinsurance, and copays. The average out-of-pocket limit for Medicare Advantage enrollees is $5,320 for in-network services and $9,547 for both in-network and out-of-network services.
Think of it like this: original Medicare is your main dish, and Medigap is your side dish that fills you up and covers what’s missing. Medicare Advantage is like ordering a combo meal where everything is bundled together, but is only available at certain restaurants (i.e., networks).
How Healthy Are You?
If you are healthy, you might not mind a higher deductible from a Medicare Advantage plan. You may have little to no premium. But a surprise illness could leave you holding a large bill.
Although Medigap may offer choices, its restrictions on preexisting conditions may make it difficult for many individuals to take advantage of them.
The Epoch Times copyright © 2025. The views and opinions expressed are those of the authors. They are meant for general informational purposes only and should not be construed or interpreted as a recommendation or solicitation. The Epoch Times does not provide investment, tax, legal, financial planning, estate planning, or any other personal finance advice. The Epoch Times holds no liability for the accuracy or timeliness of the information provided.
