THE ABCD OF MEDICARE

Every letter, in plain English, before the deadline arrives

The mail starts about six months before your 65th birthday.

Envelopes from companies you have never heard of, all of them urgent, all of them certain you are about to make a terrible mistake. Every one of them speaks in letters. Part A. Part B. Plan G. Part C, which is also somehow called Advantage. And here is the thing about that pile: not one envelope in it was sent to educate you. Every single one was sent to sell you something. By the third envelope you are not reading anymore. You are sorting mail into a pile you tell yourself you will deal with later, and the pile is really a question you cannot yet ask out loud: what do these letters actually spell?

Here is the answer, in plain English, the way I wish someone had said it to me at my own kitchen table.

First, one thing nobody in that pile of mail says clearly. Unless you are already collecting Social Security at 65, nothing happens automatically. Nobody enrolls you. Nobody calls. You have a seven month window wrapped around your 65th birthday, three months before, your birthday month, and three months after, and inside that window the signing up is your job. If you are already receiving Social Security, Parts A and B start on their own and a card arrives in the mail. Everyone else has to knock.

And do not let Social Security’s age confuse you. That program lets you wait until 67 or even 70. Medicare does not wait with you. The Medicare clock rings at 65 no matter what you decided about the other one, and waiting for the Social Security age to enroll in Medicare is one of the most expensive misunderstandings in retirement.

Now the letters.

Part A is the hospital. If you are admitted overnight, if you need skilled nursing care after a hospital stay, if you ever need hospice, that is Part A. For most people it costs nothing in premiums, because you already paid for it. Every paycheck of your working life, or your husband’s working life, bought this letter in advance. It is the only one that arrives prepaid.

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Part B is everything that happens while you are awake and dressed. Doctor visits. Specialists. Lab work. Outpatient surgery. The scan, the follow up, the physical therapy after. Part B has a monthly premium, $202.90 in 2026, and a small annual deductible of $283 that resets every January. After that, Medicare pays 80 percent of the approved cost and you pay 20 percent. Hold on to that number. We are coming back to it.

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Part D is the pharmacy. Prescription drugs, sold by private insurance companies, not the government, which is why the plan your neighbor loves may not cover the one medication you actually take. Every Part D plan has a list of covered drugs, and drugs not on the list are simply not covered. The good news is recent and real: your yearly out of pocket cost for covered drugs is now capped, $2,100 in 2026, and once you reach it you pay nothing more at the pharmacy for the rest of the year.

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Earlier in this series I asked you to write down your medications, your doctors, your pharmacies, and how you travel. This is the first moment that list earns its keep. Go to Medicare.gov, open the plan finder, and type in your exact medications and your pharmacy. It will show you what each plan actually costs you for the drugs you actually take. It is the single most useful twenty minutes in this entire process.

So the letters spell something simple. A is the hospital bed. B is the doctor’s office. D is the pharmacy counter.

Now the part the letters do not spell. The part that explains almost everything else in that pile of mail.

The hospital deductible under Part A is $1,736. That is not a once a year number. It applies to each benefit period, and a benefit period ends only after you have been out of the hospital and skilled nursing care for 60 straight days. Two separate hospital stays in one year can mean paying it twice. It does not reset on January first, because it was never annual to begin with.

And that 20 percent under Part B has no ceiling. None.

Most insurance you have ever had came with an out of pocket maximum, a worst case number where the bleeding stops. Original Medicare does not have one. Twenty percent of a $50,000 surgery is $10,000. Twenty percent of a serious cancer year is a number I am not going to type. There is no cap because the system was designed on the assumption that something else would catch you.

That something else is the supplement, sold as Medigap. It is a private policy that works alongside Original Medicare and exists for one purpose, to pay what the letters leave behind. The 20 percent. The hospital deductible, every benefit period. The exposure with no ceiling. With the most complete plans, a catastrophic year costs you little more than the $283 Part B deductible, no matter what that year holds.

Medigap has no network. Any doctor, any hospital, any state, as long as they accept Medicare, and the overwhelming majority do. No referrals. No asking permission. If the diagnosis is serious and the best program in the country is a thousand miles away, Medigap walks in the front door with you.

And here is the mercy hidden inside the second alphabet: Medigap plans are standardized by federal law. Plan G from one company is identical in coverage to Plan G from every other company. The brochure cannot make it better. The brand cannot make it better. The only real difference is the price, which means shopping for Medigap is one of the few times in insurance where you can compare on premium alone and lose nothing. Plan G is the most complete option for new enrollees. Plan N runs cheaper in exchange for small copays. Expect somewhere between $130 and $250 a month depending on your state and your age, and remember Medigap does not include drugs, so it pairs with a Part D plan.

What Medigap does have is a clock, one protected chance to buy it without the insurance company examining your health history. That clock, and what happens to the women who miss it, is the next post, and it is the one I most need you to read.

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Then there is C.

Part C does not join the other letters. It offers to take them off your hands. To join a Part C plan, sold as Medicare Advantage, you must first be enrolled in A and B, and you keep paying the Part B premium. Then the plan takes over delivering your benefits. A and B become your ticket. Advantage becomes the venue. Inside that venue, the private insurer’s rules replace the government’s: its network of doctors, its approvals, its copays, and, to be fair, its yearly spending cap, which Original Medicare never gives you. Often the premium is zero and drug coverage is built in. That is why the commercials never stop.

So the letters are not a sequence. They are a fork. Path one: A plus B plus D, with Medigap covering the gaps. Path two: C, delivered by one private company, instead of all of it. More than half of everyone on Medicare has now taken the second path, which means the option still labeled the alternative quietly became the default. Which path is right depends on the list you made, your doctors, your medications, your travel, and one timing rule almost nobody explains at the door.

A practical note about where all of this is sold, because it catches almost everyone. Part D, Medicare Advantage, and Medigap are all sold by private insurance companies through licensed agents, and selling Medicare products requires its own license and its own certification every single year. The agent who has handled your auto and home insurance for twenty years almost certainly does not carry it. You will call him, because he is the insurance person you trust, and he will not be able to help you. That is not a bad sign about him. It is a sign that this is a different industry wearing a familiar word.

One more thing, because this is the part that fooled me. I helped my husband pick his Medicare supplement and his plans. This year I picked my own. And here is my confession: I never really understood Medicare fully until I started researching this whole topic to write about it. I sat down with my own enrollment materials, thirty years of financial documents behind me, and still had to make myself a chart, because Medicare has two alphabets. The Parts, A through D, come from the government. The supplement plans, Plan A through Plan N, come from private insurers and use the same letters to mean entirely different things. Part A and Plan A are strangers. (Whoever designed this naming system has clearly never had to explain it to anyone at a kitchen table.) When someone on the phone says a letter, your first question is always the same: is that a Part or a Plan? Two alphabets. One question sorts them.

Part A and Plan A are strangers.

A word to the woman whose husband always handled the insurance paperwork. This alphabet is yours now, or it will be, and there is no version of the next thirty years where someone else can hold it for you. You do not need to master it today. You need five sentences. A is the hospital. B is the doctor. D is the pharmacy. C is a different path entirely. And the 20 percent has no ceiling until you put one there. If you can say those five sentences, you know more than most people walking into that deadline, and nobody on the phone can fog you with letters again.

You were never bad at this. Nobody sat you down and translated it, and the industry that profits from the confusion was never going to volunteer.

I do not sell any of these letters. The one thing I do sell is the worksheet itself, because building it took real time, and I would rather hand it to you finished than have you build it alone at your own kitchen table. I went through this alphabet myself, recently enough that the frustration is still fresh, and translating it plainly is the entire point.

The letters were never the decision. The path is.

I have a worksheet that breaks all of this down for you in one page, every 2026 number and every enrollment window. It is available to my paid subscribers:

MEDICARE COST SHEET LINK

If one woman came to mind while you read this, send it to her before you close the tab.