Annual Enrollment
Join, switch, or drop a Medicare Advantage or Part D plan. Changes generally start January 1.
Medicare education, without the maze
A clearer Medicare decision starts right here.
Understand your timing, compare the two main coverage paths, and leave with the exact questions to ask—at your pace and without pressure.
- Plain-language explanations
- No obligation to enroll
- Guide selections are not submitted
Two Waters Policy Services is not connected with or endorsed by the U.S. government or the federal Medicare program.
One local guideMichael Treadway, independent agent
Two coverage pathsCompared without oversimplifying
A useful next stepEven if you never become a client
Timing first
Find the enrollment window that applies to you.
Medicare timing depends on more than age. Your birthday, current job-based coverage, and the kind of change you want to make all matter.
Where the calendar stands today
No major yearly change window is open today. Next: Annual Enrollment begins October 15, 2026.
Your first Medicare window
Estimate the 7-month window around age 65
This is a planning estimate—not an enrollment determination. It does not apply to every person who qualifies before 65 due to disability, ALS, or End-Stage Renal Disease.
Your dates will appear here
Enter a birth month and year to see the three months before, eligibility month, and three months after.
Enrollment calendar
Medicare enrollment dates: yearly and special periods
These periods happen every year or after certain life events. What you can change—and whether you qualify—depends on the window.
Medicare Advantage Open Enrollment
If you are already in Medicare Advantage, make one change or return to Original Medicare and add Part D.
Special Enrollment
Moving, losing certain coverage, or other events may open a limited window. The exact rule depends on the event.
Before leaving Medicare Advantage: returning to Original Medicare does not automatically guarantee that you can buy a Medigap policy. Check federal guaranteed-issue rights and West Virginia or Ohio rules before making the switch. If you missed an earlier enrollment window, a late-enrollment penalty may apply.
Understand the fork in the road
Two main ways to receive your Medicare benefits.
Neither route is automatically “best.” The right comparison starts with your doctors, prescriptions, budget, travel, and tolerance for plan rules.
Route 1Federal program + optional private coverage
Original Medicare
Part A + Part B + usually Part D + optionally Medigap
- Provider access: See any provider nationwide who accepts Medicare.
- Cost structure: Separate premiums may buy more predictable cost sharing.
- Drug coverage: Add a stand-alone Part D plan.
- Important: Original Medicare alone has no yearly out-of-pocket limit.
Watch closely: Medigap timing, underwriting outside protected periods, and separate dental/vision coverage.
Route 2Private plan approved by Medicare
Medicare Advantage
Part C bundles Part A + Part B + often Part D
- Provider access: Networks and service areas commonly apply.
- Cost structure: Plan copays and an annual limit for covered Part A/B services.
- Drug coverage: Often included; verify every prescription and pharmacy.
- Extras: Some plans add dental, vision, hearing, or other benefits.
Watch closely: Prior authorization, network changes, annual plan changes, and benefit limits.
Compare thisOriginal MedicareMedicare Advantage
Doctor choice
Any provider that accepts Medicare
Usually a plan network and service area
Yearly medical spending limit
None unless other coverage helps
Yes, for covered Part A and B services
Prescription coverage
Usually a separate Part D plan
Often included in the plan
Plan review
Part D should be reviewed yearly
Benefits, costs, and networks should be reviewed yearly
Make it personal
Build the questions that matter to you.
Select every priority that belongs in your Medicare conversation. This tool does not recommend a plan or collect your health information.
Nothing you select here is submitted to Two Waters.
What matters most?
Your conversation checklist3 questions ready
- Are my doctors, hospitals, prescriptions, and pharmacy covered?
- What are my likely costs in both a light-use and high-use year?
- Which enrollment deadline applies to my exact situation?
Two Waters does not offer every plan available in your area. Information Michael provides is limited to the plans he represents. Medicare.gov, 1-800-MEDICARE, and SHIP can provide information on all available options.
The foundation
The four parts, in plain English.
Think of A and B as Original Medicare, C as another way to receive A and B, and D as prescription drug coverage.
AHospital insuranceInpatient hospital, skilled nursing, hospice, and some home health care
Part A helps pay when you are formally admitted as an inpatient. It also covers limited skilled nursing, hospice, and home health services when Medicare’s requirements are met. It is not long-term care insurance.
- Hospital stays: Covers a semiprivate room, nursing, medicines, and other inpatient services. Observation status is usually outpatient care under Part B, even if you stay overnight.
- Skilled nursing: Under Original Medicare, short-term skilled care generally follows a qualifying 3-day inpatient hospital stay. It does not cover long-term custodial care.
- Hospice and home health: Covers hospice for a terminal illness and certain home health services when the eligibility rules are met.
Worth checking
Part A uses benefit periods rather than a once-a-year deductible. A new benefit period can mean another deductible in the same calendar year.
2026 snapshot$1,736 inpatient hospital deductible per benefit period in 2026.
BMedical insuranceDoctors, outpatient care, durable equipment, and preventive services
Part B helps pay for medically necessary and preventive care you receive outside an inpatient hospital stay. It generally has a monthly premium, a yearly deductible, and cost sharing.
- Doctors and outpatient care: Includes office visits, outpatient surgery, therapy, mental health care, ambulance services, and many diagnostic tests.
- Prevention and equipment: Includes many screenings and vaccines, durable medical equipment, and certain home health services. Some preventive services cost $0 when the rules are met.
- Your share: For many covered services, you usually pay 20% of the Medicare-approved amount after the deductible when the provider accepts assignment. Other services can use different cost sharing.
Worth checking
Original Medicare has no annual out-of-pocket maximum. Ask whether a provider takes Medicare and accepts assignment, because those are different questions.
2026 snapshot$202.90 standard monthly premium and $283 annual deductible in 2026.
CMedicare AdvantageA private-plan way to receive Part A and Part B benefits
Medicare Advantage is a private-plan alternative for receiving Part A and Part B benefits. You remain in Medicare, must have Parts A and B, live in the plan’s service area, and generally keep paying the Part B premium.
- One plan, different rules: The plan provides your Part A and B coverage. Most plans include Part D, and some offer extra benefits, but the details vary by plan and county.
- Networks and approvals: Provider networks, referrals, and prior authorization may apply. Verify doctors, hospitals, prescriptions, and pharmacies directly before enrolling.
- Medical spending limit: Every plan has an annual limit for covered Part A and B services. Premiums, Part D drugs, and noncovered extras do not count toward that medical limit.
Worth checking
Plans can change costs, benefits, drug lists, and provider networks each year. Leaving Medicare Advantage does not automatically guarantee that you can buy any Medigap policy you want.
2026 snapshotCosts, networks, drug coverage, and extra benefits vary by plan and county.
DPrescription drug coveragePrivate coverage for Medicare-covered outpatient prescriptions
Part D is private insurance for Medicare-covered outpatient prescriptions. With Original Medicare it is usually a separate plan; most Medicare Advantage plans include it.
- Exact medication matters: Coverage depends on the drug name, dosage, form, and the plan’s formulary tier. Some outpatient medicines are covered by Part B instead, depending on the drug and setting.
- Pharmacy matters: Costs can change between preferred, standard, mail-order, and out-of-network pharmacies. Compare the full year—not the premium alone.
- Plan rules matter: Prior authorization, step therapy, and quantity limits may apply. Going 63 days or more without Part D or other creditable drug coverage can trigger a late penalty.
Worth checking
Drug lists, pharmacies, restrictions, and prices can change each year. Recheck every prescription during fall Open Enrollment even if the plan name stays the same.
2026 snapshot$615 maximum deductible and $2,100 annual out-of-pocket cap for covered Part D drugs in 2026.
Current numbers
The Medicare costs worth knowing this year.
These are federal baseline figures. Medicare Advantage, Medigap, and Part D premiums and cost sharing vary by plan and location.
Hospital insurance
What you may pay for inpatient hospital and skilled nursing care under Original Medicare.
- Monthly premiumMost people qualify for premium-free Part A
- $0for most people
- Hospital deductibleCan apply more than once in a year
- $1,736per benefit period
- Hospital days 61–90Coinsurance after the first 60 days
- $434per day
- Lifetime reserve daysLimited to 60 days over your lifetime
- $868per day
- Skilled nursing days 21–100When Medicare’s coverage requirements are met
- $217per day
Medical insurance
What you may pay for doctors, outpatient care, equipment, and other Part B services.
- Standard premiumSome people pay more based on income
- $202.90per month
- Annual deductiblePaid before cost sharing for many services
- $283per year
- Most covered servicesOf the Medicare-approved amount after the deductible when the provider accepts assignment; some services differ
- Usually 20%your share
- Higher-income adjustmentIRMAA begins above $109,000 MAGI for individual filers or $218,000 for joint filers; generally based on 2024 tax information. Other filing statuses differ.
- Variesadded to premium
- Many preventive servicesWhen you meet the service’s rules and the provider accepts assignment
- $0you pay nothing
Part D
Prescription drug costs
Plan premiums and drug prices vary; these are the 2026 federal limits for covered Part D drugs.
Maximum deductible$615Plans may charge less or no deductible
Annual out-of-pocket cap$2,100For covered Part D drugs; premiums and noncovered drugs do not count
Verified July 21, 2026.
Part A and B amounts come from CMS. Part D amounts are the 2026 federal benefit parameters; actual plan design and covered-drug spending can differ.
Want free, unbiased help? Medicare and your State Health Insurance Assistance Program can explain all options, whether or not Two Waters represents them.
Plain English
Translate the words Medicare keeps using.
Search a term from a letter, plan document, or conversation.
Showing 12 common terms. Search all 36.
Browse official Medicare basics ↗- Assignment
- A provider agrees to accept Medicare’s approved amount as full payment for a covered service.
- Benefit period
- Part A’s clock for inpatient hospital and skilled nursing costs. It ends after 60 consecutive days without inpatient hospital care or skilled SNF care.
- Coinsurance
- A percentage of a covered cost you pay after a deductible, such as 20%.
- Copayment
- A fixed dollar amount you pay for a covered service or prescription.
- Creditable drug coverage
- Prescription coverage expected to pay, on average, at least as much as standard Medicare drug coverage.
- Deductible
- The amount you pay for covered care before Medicare or a plan begins paying its share.
- Formulary
- A drug plan’s list of covered prescriptions, including tiers and coverage rules.
- IRMAA
- An income-related amount added to Part B and Part D costs for some higher-income beneficiaries, generally using tax information from two years earlier.
- Medigap
- Private Medicare Supplement insurance that works only with Original Medicare and can help pay some costs Parts A and B leave behind.
- Network
- The doctors, hospitals, pharmacies, or other providers contracted with a private plan.
- Out-of-pocket maximum
- A plan’s limit on certain covered costs. A Medicare Advantage medical limit does not include premiums or Part D drug spending.
- Prior authorization
- A plan’s requirement to approve certain services or drugs before it will cover them.
Common questions
A few answers people need before they call.
“You made it painless. You are so genuine and caring, and your honesty is so appreciated.”— Debbie Yoho, Two Waters client
Does Two Waters represent every Medicare plan?
No. Two Waters does not offer every plan available in every area. Information Michael provides is limited to the plans he represents. Medicare.gov, 1-800-MEDICARE, and SHIP can provide information on all available options.
Will I be expected to enroll on the first call?
No. The first conversation is educational and focused on your situation, questions, and a sensible next step. There is no obligation to purchase coverage.
What should I have ready?
If available, bring your Medicare card dates, current plan notice, a medication list, preferred pharmacy, and the names of important doctors. Do not send Social Security numbers or detailed medical records through an ordinary website form.
Can Michael help outside Point Pleasant?
Two Waters serves clients across West Virginia and Ohio, with phone and video conversations available statewide. Plan availability varies by county and eligibility.
Ready when you are
Leave with a clearer next step.
Michael Treadway is a licensed independent insurance agent serving West Virginia and Ohio. Bring the checklist you built here and talk through the parts that still feel uncertain.
Request a Medicare reviewCall Michael304-220-0011
No pressure. No obligation. Only share what is needed to begin.