Frequently Asked Questions

Stand-alone Medicare Prescription Drug Plans (Part D)  

• Medicare Prescription Drug Plan (PDP) — A stand-alone drug plan that adds prescription drug  coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private  Fee-For-Service Plans, and Medicare Medical Savings Account Plans.  

Medicare Advantage Plans (Part C) and Cost Plans  

• Medicare Health Maintenance Organization (HMO) — A Medicare Advantage Plan that provides all  Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug  coverage. In most HMOs, you can only get your care from doctors or hospitals in the plan’s network  (except in emergencies). 

• Medicare HMO Point-of-Service (HMO-POS) — A Medicare Advantage Plan that provides all  Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug  coverage. HMO-POS plans may allow you to get some services out of network for a higher copayment or  coinsurance.  

• Medicare Preferred Provider Organization (PPO) Plan — A Medicare Advantage Plan that provides  all Original Medicare Part A and Part B health coverage and sometimes covers Part D prescription drug  coverage. PPOs have network doctors, providers and hospitals but you can also use out-of-network  providers, usually at a higher cost.  

• Medicare Private Fee-For-Service (PFFS) Plan — A Medicare Advantage Plan in which you may go to  any Medicare-approved doctor, hospital and provider that accepts the plan’s payment, terms and conditions  and agrees to treat you — not all providers will. If you join a PFFS Plan that has a network, you can see  any of the network providers who have agreed to always treat plan members. You will usually pay more to  see out-of-network providers.  

• Medicare Special Needs Plan (SNP) — A Medicare Advantage Plan that has a benefit package designed  for people with special health care needs. Examples of the specific groups served include people who  have both Medicare and Medicaid, people who reside in nursing homes, and people who have certain  chronic medical conditions.  

• Medicare Medical Savings Account (MSA) Plan — MSA Plans combine a high deductible health plan  with a bank account. The plan deposits money from Medicare into the account. You can use it to pay  your medical expenses until your deductible is met.  

• Medicare Cost Plan — In a Medicare Cost Plan, you can go to providers both in and out of network. If  you get services outside of the plan’s network, your Medicare-covered services will be paid for under  Original Medicare but you will be responsible for Medicare coinsurance and deductibles.  

Other Health-Related Products  

• Dental/Vision/Hearing Products — Plans offering additional benefits for consumers who are looking to  cover needs for dental, vision, or hearing. These plans are not affiliated or connected to Medicare.  

• Hospital Indemnity Products— Plans offering additional benefits; payable to consumers based upon  their medical utilization; sometimes used to defray copays/coinsurance. These plans are not affiliated or  connected to Medicare. 

• Medicare Supplement (Medigap) Products— Insurance plans that help pay some of the  out-of-pocket costs not paid by Original Medicare (Parts A and B) such as deductibles and co-insurance  amounts for Medicare approved services. 

For most people the Medicare Part B Premium is $202.90/mo in 2026. However, if you fall into higher tax brackets, it can be higher. (Income is based on your IRS tax returns from 2 years prior.) If your income is:

Individuals: Greater than $109,000 and less than or equal to $137,000: $284.10

Couples Filing Jointly: Greater than $218,000 and less than or equal to $274,000: $284.10

Individuals: Greater than $137,000 and less than or equal to $171,000: $405.80

Couples Filing Jointly: Greater than $274,000 and less than or equal to $342,000: $405.80

Individuals: Greater than $171,000 and less than or equal to $205,000: $527.50

Couples Filing Jointly: Greater than $342,000 and less than or equal to $410,000: $527.50

Individuals: Greater than $205,000 and less than $500,000: $649.20

Couples Filing Jointly: Greater than $410,000 and less than $750,000: $649.20

Individuals: Greater than or equal to $500,000: $689.90

Couples Filing Jointly: Greater than or equal to $750,000: $689.90

The same concept applies to Part D of Medicare as it does with your Part B. You will have your base premium decided by the plan you choose to enroll in, but may have a higher premium based on your income from your IRS tax returns from 2 years prior.  If your income is:

Individuals: Greater than $109,000 and less than or equal to $137,000: $14.50 + Your Plan Premium

Couples Filing Jointly: Greater than $218,000 and less than or equal to $274,000: $14.50 + Your Plan Premium

Individuals: Greater than $137,000 and less than or equal to $171,000: $37.50 + Your Plan Premium

Couples Filing Jointly: Greater than $274,000 and less than or equal to $342,000: $37.50 + Your Plan Premium

Individuals: Greater than $171,000 and less than or equal to $205,000: $60.40 + Your Plan Premium

Couples Filing Jointly: Greater than $342,000 and less than or equal to $410,000: $60.40 + Your Plan Premium

Individuals: Greater than $205,000 and less than $500,000: $83.30 + Your Plan Premium

Couples Filing Jointly: Greater than $410,000 and less than $750,000: $83.30 + Your Plan Premium

Individuals: Greater than or equal to $500,000: $91.00 + Your Plan Premium

Couples Filing Jointly: Greater than or equal to $750,000: $91.00 + Your Plan Premium