NCOA Medicare & Healthcare Resources: Clear Guidance for Older Adults and Families

Medicare is the health insurance most Americans rely on after age 65, and for many younger people with disabilities. It covers hospital stays, doctor visits, preventive care, and prescription drugs, but the details can feel overwhelming. Premiums, deductibles, plan choices, enrollment deadlines, and extra help programs all change from year to year. NCOA has spent years creating straightforward resources, tools, and partnerships so older adults and their families can make sense of it without feeling lost.

This article focuses on the Medicare and healthcare side of NCOA’s work. You will find plain explanations of the main coverage options, 2026 cost numbers, the programs that lower those costs for people with limited income, where to get free unbiased counseling, and practical steps for open enrollment or special situations. Everything is written for everyday readers—no jargon, no sales pitch.

The Basics of Medicare Coverage

Medicare has several parts. Most people start with Original Medicare and then decide whether to add more.

• Part A is hospital insurance. It covers inpatient hospital care, skilled nursing facility care (with limits), hospice, and some home health. Most people pay no monthly premium for Part A because they or a spouse paid Medicare taxes while working.
• Part B is medical insurance. It covers doctor visits, outpatient care, preventive services, and durable medical equipment. There is a monthly premium and an annual deductible.
• Part D is prescription drug coverage. You get it through a standalone drug plan or as part of a Medicare Advantage plan.
• Medicare Advantage (Part C) is an alternative to Original Medicare. Private companies offer these plans. They must cover everything Original Medicare covers and often include extra benefits such as dental, vision, hearing, or fitness. Many include Part D drug coverage.

You can also buy Medigap (Medicare Supplement) policies to help pay the out-of-pocket costs that Original Medicare leaves behind. Medigap works only with Original Medicare, not with Medicare Advantage.

2026 Medicare Costs at a Glance

Costs rise most years. Here are the key figures for 2026:

Part A

• Most people pay $0 premium.
• If you buy Part A, the full premium is $565 per month; the reduced rate (for people with 30–39 quarters of coverage) is $311.
• Hospital deductible: $1,736 per benefit period.
• Daily coinsurance for hospital days 61–90: $434.
• Skilled nursing facility coinsurance (days 21–100): $217 per day.

Part B

• Standard monthly premium: $202.90.
• Annual deductible: $283.
• After the deductible, you generally pay 20% of the Medicare-approved amount for most services.
• Higher-income people pay more through an Income-Related Monthly Adjustment Amount (IRMAA).

Part D

• Average basic premium is expected around $34–$39 depending on the plan and whether it is a standalone or Medicare Advantage plan.
• Standard deductible: up to $615.
• Out-of-pocket spending is capped at $2,100 for the year (the “catastrophic” threshold). After that, coverage improves significantly.

These numbers come from official CMS announcements. Your actual costs depend on the specific plan you choose, your income, and whether you qualify for extra help.

Programs That Lower Medicare Costs

Many older adults pay far less than the standard amounts because of two key programs that NCOA actively promotes and helps people enroll in.

Medicare Savings Programs (MSPs)
These are state-run programs that help pay Medicare premiums and, in some cases, deductibles and coinsurance. There are three main levels:

• Qualified Medicare Beneficiary (QMB) – Usually covers Part A and Part B premiums plus deductibles, coinsurance, and copays. 2026 monthly income limit is about $1,350 for an individual and $1,824 for a couple. Resource limits are roughly $9,950 / $14,910.
• Specified Low-Income Medicare Beneficiary (SLMB) – Covers the Part B premium. Income limits are higher (around $1,616 / $2,184).
• Qualifying Individual (QI) – Also covers the Part B premium for people with still higher incomes (around $1,816 / $2,455). Funding is limited, so applying early in the year helps.

People who qualify for an MSP usually get Extra Help for drugs automatically. Limits are higher in Alaska and Hawaii, and some states are more generous than the federal minimums.

Extra Help (Low-Income Subsidy for Part D)

This reduces or eliminates Part D premiums, deductibles, and copays. For 2026, the income limit is roughly $23,940 for an individual and $32,460 for a married couple. Resource limits are about $18,090 / $36,100. Once approved, many people pay $0 premium and low copays (around $5 for generics and $12–13 for brand-name drugs, or even less if they also have Medicaid).

You can apply for Extra Help through Social Security. If you already have Medicaid, SSI, or an MSP, you often qualify automatically.

NCOA’s research shows that millions of eligible older adults still miss these programs. Participation rates for MSPs have hovered around 45–50% in recent years, leaving billions of dollars in help unclaimed.

Quick comparison table – 2026 cost-help programs

Program	Main help provided	Approx. individual monthly income limit	Approx. resource limit	Automatic Extra Help?
QMB	Premiums + deductibles + coinsurance	$1,350	$9,950	Yes
SLMB	Part B premium	$1,616	$9,950	Yes
QI	Part B premium	$1,816	$9,950	Yes
Extra Help only	Part D drug costs	~$1,995 (annual ~$23,940)	$18,090	N/A

Always verify the exact numbers for your state, because they can differ.

How NCOA Helps with Medicare

NCOA does not sell insurance or run Medicare plans. Its role is education, tools, and connecting people to free counseling.

BenefitsCheckUp

The same free online tool used for food and utility benefits also screens for Medicare Savings Programs and Extra Help. Enter your ZIP code and answer questions about income and resources. You get a personalized list of programs you may qualify for and clear next steps.

MIPPA Resource Center

NCOA operates the national resource center funded under the Medicare Improvements for Patients and Providers Act (MIPPA). This center supports State Health Insurance Assistance Programs (SHIPs), Area Agencies on Aging, and other local groups that do outreach and enrollment help for low-income Medicare beneficiaries. The center provides training, data tools, eligibility charts, and best practices so local counselors can help more people.

Benefits Enrollment Centers
These local organizations (about 90 across 40 states and territories in the current cycle) use BenefitsCheckUp and provide one-on-one help applying for MSPs, Extra Help, and related benefits. They are especially useful if forms feel confusing or if you prefer talking to a person.

State Health Insurance Assistance Programs (SHIPs)

Every state has a SHIP that offers free, unbiased, one-on-one Medicare counseling. Counselors help with plan comparisons, enrollment, appeals, and questions about Original Medicare versus Medicare Advantage. NCOA strongly encourages people to use SHIPs rather than relying only on plan sales materials. You can find your local SHIP by calling 877-839-2675 or visiting shiptacenter.org.

NCOA also publishes plain-language guides, open enrollment toolkits for professionals, cost-sharing charts, and articles that walk through common situations such as missing an enrollment deadline or switching plans after a move.

Open Enrollment and Other Important Dates

The main Medicare Open Enrollment period runs from October 15 to December 7 each year. During this window you can:

• Switch from Original Medicare to a Medicare Advantage plan (or the reverse)
• Change Medicare Advantage plans
• Join, switch, or drop a Part D drug plan

Coverage starts January 1 of the following year. NCOA reminds people every year to review their current plan because formularies, provider networks, and costs can change. A plan that worked well last year may no longer cover your medications or doctors at the same cost.

There are also Special Enrollment Periods for life events such as moving, losing other coverage, or qualifying for Extra Help. NCOA publishes calendars and guides that list these windows so people do not miss opportunities.

Choosing Between Original Medicare and Medicare Advantage

There is no single “best” choice. It depends on your health needs, preferred doctors, medications, and budget.

Original Medicare + Medigap + Part D

• You can usually see any doctor or hospital that accepts Medicare.
• No referrals needed for specialists in most cases.
• Medigap helps with the 20% coinsurance and deductibles.
• You pay separate premiums for Medigap and Part D.

Medicare Advantage

• Often lower or $0 extra premium beyond Part B.
• May include dental, vision, hearing, or gym memberships.
• Usually requires using doctors and hospitals in the plan’s network.
• Prior authorization is more common.
• Out-of-pocket maximums apply (a protection Original Medicare does not have on its own).

NCOA resources stress looking at the full picture—your doctors, your drugs, your expected care needs—rather than focusing only on the monthly premium. Free SHIP counseling is the best place to compare options side by side with someone who is not paid to sell a particular plan.

Practical Steps You Can Take This Year

1. Check whether you qualify for an MSP or Extra Help using BenefitsCheckUp.org or by calling the helpline.
2. Contact your local SHIP for free counseling before open enrollment or whenever you have questions.
3. Review your current plan’s Annual Notice of Change (you should receive it in the fall).
4. Make a list of your doctors, pharmacies, and medications. Use that list when comparing plans on Medicare.gov or with a counselor.
5. If money is tight, apply for the savings programs even if you are not sure you qualify. Many people are surprised by the result.
6. Keep copies of everything—applications, approval letters, plan documents.

Why This Matters for Health and Finances

High out-of-pocket costs lead some people to skip needed care or medications. Programs like MSPs and Extra Help exist to prevent that. NCOA’s work on the MIPPA Resource Center and Benefits Enrollment Centers is aimed at closing the gap between people who are eligible and people who are actually enrolled. Recent data still shows millions of older adults missing out, which is why the organization keeps pushing outreach, simpler tools, and stable funding for counseling services.

Medicare will never be completely simple, but good information and free local help make a real difference. Start with BenefitsCheckUp if you want to see cost-saving programs, call your SHIP for plan advice, and use NCOA’s guides when you need clear explanations of the rules. The goal is the same one NCOA has carried for decades: help people age with better health and less financial stress.

All figures and program details are based on official 2026 announcements from CMS, Medicare.gov, and NCOA materials current as of early-to-mid 2026. Income and resource limits can be updated, and state rules vary, so confirm the latest numbers for your situation before applying.