What Is Medicare?
The Complete Reference Guide
Medicare is the federal health insurance program that covers more than 67 million Americans. This guide covers everything — the history, every part, all enrollment rules, 2026 costs, official forms, key laws, and the 30 most important questions — in one place.
Table of Contents
The History of Medicare
Medicare didn't appear overnight. It was the product of decades of political debate, failed proposals, and ultimately a historic moment of legislative will. Understanding where Medicare came from helps explain why it works the way it does today — and why it continues to evolve.
Social Security Act — The Foundation
President Franklin D. Roosevelt signs the Social Security Act on August 14, 1935. The act establishes old-age benefits but does not include health insurance. Roosevelt considered including health coverage but dropped it to avoid opposition from the American Medical Association (AMA), which feared "socialized medicine."
Truman's National Health Insurance Proposal
President Harry S. Truman proposes a national health insurance program for all Americans. The AMA launches a massive lobbying campaign calling it "socialized medicine." The proposal fails in Congress, but Truman's advocacy plants the seed for future Medicare legislation.
Forand Bill — First Medicare Proposal
Representative Aime Forand (D-RI) introduces the first bill specifically proposing hospital insurance for Social Security beneficiaries. The bill fails but generates significant public debate and establishes the framework for what will become Medicare.
Kerr-Mills Act — A Partial Step
Congress passes the Kerr-Mills Act, providing federal grants to states for medical assistance to low-income elderly. The program is voluntary and unevenly implemented — only 28 states participate by 1963. Critics argue it is inadequate and call for a universal federal program.
Kennedy Pushes for Medicare
President John F. Kennedy makes Medicare a top legislative priority. He holds a rally at Madison Square Garden in May 1962 to build public support. The AMA responds with a counter-campaign featuring Ronald Reagan warning against "socialized medicine." Kennedy's Medicare bill fails in the Senate by two votes.
Landslide Election Changes Everything
President Lyndon B. Johnson wins a landslide election, and Democrats gain 37 House seats and 2 Senate seats. The new Congress has the votes to pass Medicare. Ways and Means Committee Chairman Wilbur Mills, previously a Medicare skeptic, becomes a key architect of the legislation.
Medicare and Medicaid Signed Into Law
On July 30, 1965, President Johnson signs the Social Security Amendments of 1965 (Public Law 89-97) in Independence, Missouri — Harry Truman's hometown — with Truman at his side. The law creates Medicare (Title XVIII) and Medicaid (Title XIX). Former President Truman and his wife Bess become the first Medicare enrollees.
Medicare Launches — 19 Million Enroll
Medicare officially begins on July 1, 1966. Nearly 19 million Americans age 65 and older enroll in the first year. Hospitals scramble to comply with the new program's civil rights requirements — Medicare is one of the most powerful tools used to desegregate Southern hospitals.
Medicare Expands to Disabled and ESRD
The Social Security Amendments of 1972 expand Medicare to cover people under 65 with long-term disabilities (after 24 months of Social Security Disability Insurance) and people with End-Stage Renal Disease (ESRD) requiring dialysis or kidney transplant.
Medigap Standardization Begins
The Baucus Amendment to the Social Security Act begins the process of standardizing Medigap (Medicare Supplement) insurance, requiring minimum benefit standards and loss ratios. This is the first federal regulation of the private Medigap market.
Prospective Payment System — DRGs
Congress enacts the Prospective Payment System for hospital inpatient services, replacing cost-based reimbursement with fixed payments based on Diagnosis Related Groups (DRGs). This fundamentally changes how hospitals are paid and is one of the most significant Medicare cost-control measures in history.
Catastrophic Coverage Act — and Repeal
Congress passes the Medicare Catastrophic Coverage Act, the largest expansion of Medicare since 1965, adding a cap on out-of-pocket costs and prescription drug coverage. But the law is funded by a surtax on higher-income Medicare beneficiaries — who revolt. Congress repeals the law in 1989, just 16 months after passage.
Balanced Budget Act — Medicare+Choice
The Balanced Budget Act of 1997 creates Medicare+Choice (later renamed Medicare Advantage), allowing private insurance companies to offer Medicare coverage as an alternative to Original Medicare. The act also creates the State Children's Health Insurance Program (SCHIP) and makes significant Medicare payment reductions.
Medicare Modernization Act — Part D
President George W. Bush signs the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) on December 8, 2003. The law creates Medicare Part D (prescription drug coverage), renames Medicare+Choice to Medicare Advantage, and adds the Health Savings Account (HSA). Part D launches January 1, 2006.
Affordable Care Act — Closing the Donut Hole
The Affordable Care Act (ACA) makes significant changes to Medicare, including gradually closing the Part D "donut hole" coverage gap, adding free preventive services, creating the Center for Medicare and Medicaid Innovation (CMMI), and establishing the Independent Payment Advisory Board (later repealed).
Inflation Reduction Act — Drug Price Negotiation
The Inflation Reduction Act gives Medicare the authority to negotiate drug prices directly with pharmaceutical manufacturers for the first time in the program's history. The law also caps Medicare Part D out-of-pocket costs at $2,000 starting in 2025 and caps insulin at $35/month.
Medicare Today — 67 Million Beneficiaries
Medicare covers more than 67 million Americans — 57 million age 65 and older and 10 million with disabilities. Total Medicare spending exceeds $1 trillion annually. The program continues to evolve with new payment models, telehealth expansions, and ongoing debates about long-term solvency.
Why history matters for your Medicare decisions: Medicare's structure — separate Parts A, B, C, and D — reflects decades of political compromise. Understanding why the program is designed the way it is helps explain why navigating it requires expertise. The gaps in Original Medicare that Medigap fills, the network restrictions in Medicare Advantage, and the complexity of Part D all have historical roots.
What Is Medicare?
Medicare is the federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services. It is funded primarily through payroll taxes (the Medicare tax), monthly premiums paid by beneficiaries, and general federal revenues.
Medicare is not a single program — it is a collection of related programs, each covering different types of healthcare services, each with its own rules, costs, and enrollment requirements.
Who Qualifies for Medicare?
Age 65 or Older
U.S. citizens or permanent residents who have lived in the U.S. for at least 5 consecutive years. Most qualify for premium-free Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters).
Under 65 with Disability
People who have received Social Security Disability Insurance (SSDI) for 24 months automatically become eligible for Medicare. The 24-month waiting period begins with the first month of SSDI entitlement.
End-Stage Renal Disease
People of any age with End-Stage Renal Disease (ESRD) — permanent kidney failure requiring dialysis or a kidney transplant — qualify for Medicare regardless of age or disability status.
ALS (Lou Gehrig's Disease)
People diagnosed with Amyotrophic Lateral Sclerosis (ALS) qualify for Medicare immediately upon receiving SSDI — the 24-month waiting period is waived for ALS patients.
Spouses & Dependents
You may qualify for premium-free Part A based on your spouse's work record if your spouse is 62 or older and has worked at least 40 quarters. Divorced spouses may also qualify based on an ex-spouse's record.
Government Employees
Federal, state, and local government employees who did not pay into Social Security may still qualify for Medicare if they paid the Medicare portion of FICA taxes. Rules vary by employer and hire date.
The Parts of Medicare — At a Glance
| Part | Name | What It Covers | Who Offers It | 2026 Premium |
|---|---|---|---|---|
| Part A | Hospital Insurance | Inpatient hospital, skilled nursing, hospice, some home health | Federal government (CMS) | $0 for most |
| Part B | Medical Insurance | Doctor visits, outpatient care, preventive services, durable medical equipment | Federal government (CMS) | $202.90/mo |
| Part C | Medicare Advantage | Everything Parts A & B cover, often plus dental/vision/hearing/drugs | Private insurers approved by CMS | $0–$100+/mo |
| Part D | Prescription Drugs | Prescription medications at pharmacies | Private insurers approved by CMS | $0–$100+/mo |
| Medigap | Supplement Insurance | Gaps in Original Medicare (deductibles, coinsurance) | Private insurers regulated by states | $70–$250+/mo |
How Medicare Is Funded
Payroll Taxes (FICA)
~36%Employees and employers each pay 1.45% of wages. Self-employed pay 2.9%. High earners (>$200K individual, >$250K joint) pay an additional 0.9% Medicare surtax.
General Federal Revenues
~43%The largest single source of Medicare funding. General tax revenues subsidize Part B and Part D, which are not fully funded by premiums or payroll taxes.
Beneficiary Premiums
~15%Monthly premiums paid by beneficiaries for Part B, Part D, and Medicare Advantage plans. Higher-income beneficiaries pay more through IRMAA surcharges.
Other Sources
~6%Includes interest on Medicare trust fund investments, state payments for dual-eligible beneficiaries, and drug manufacturer rebates under Part D.
Medicare Part A — Hospital Insurance
Medicare Part A is hospital insurance. It covers inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care. Most people receive Part A premium-free because they or their spouse paid Medicare taxes for at least 10 years (40 quarters) while working.
Inpatient Hospital Care
- Semi-private room and board
- General nursing care
- Drugs administered during stay
- Lab tests, X-rays, medical supplies
- Operating and recovery room
- Intensive care unit (ICU)
- Inpatient rehabilitation
- Mental health inpatient care
Your Cost
Days 1–60: $1,736 deductible (2026). Days 61–90: $433/day coinsurance. Days 91–150: $866/day (lifetime reserve days). After 150 days: you pay all costs.
Skilled Nursing Facility (SNF)
- Semi-private room
- Skilled nursing care
- Physical, occupational, speech therapy
- Medical social services
- Medications
- Medical supplies and equipment
- Dietary counseling
- Ambulance transportation (when needed)
Your Cost
Days 1–20: $0 (after qualifying hospital stay of 3+ days). Days 21–100: $216.50/day coinsurance (2026). After day 100: you pay all costs.
Home Health Care
- Part-time skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology
- Medical social services
- Part-time home health aide services
- Durable medical equipment (80%)
- Medical supplies
Your Cost
$0 for home health services. 20% coinsurance for durable medical equipment. Must be homebound and need skilled care ordered by a doctor.
Hospice Care
- Doctor and nursing services
- Medical equipment and supplies
- Prescription drugs for comfort
- Aide and homemaker services
- Physical, occupational, speech therapy
- Social work services
- Dietary counseling
- Grief and loss counseling
Your Cost
$0 for hospice care. Small copay for outpatient drugs ($5 max) and inpatient respite care (5% of Medicare-approved amount). Must be certified terminally ill (6-month prognosis).
What Medicare Part A Does NOT Cover
Part A Premium — 2026
40+ quarters worked
$0/month
Most beneficiaries qualify for premium-free Part A
30–39 quarters worked
$285/month
Reduced premium for those with 30–39 quarters
Fewer than 30 quarters
$518/month
Full premium for those with minimal work history
Medicare Part B — Medical Insurance
Medicare Part B is medical insurance. It covers medically necessary services and preventive services — doctor visits, outpatient care, lab tests, durable medical equipment, and much more. Unlike Part A, Part B always has a monthly premium. The standard premium in 2026 is $202.90/month.
Part B is the most important part of Medicare for most beneficiaries. It covers the vast majority of your day-to-day healthcare — every doctor visit, every outpatient procedure, every lab test. Without Part B, you would pay 100% of these costs out of pocket.
Part B Costs — 2026
Monthly Premium
$202.90
Standard premium. Higher-income beneficiaries pay more (IRMAA).
Annual Deductible
$283
You pay the first $283 of Part B-covered services each year.
Coinsurance
20%
After the deductible, you pay 20% of the Medicare-approved amount for most services.
The 20% problem: There is no out-of-pocket maximum for Original Medicare Part B. If you have a $100,000 surgery, you owe $20,000 (20% coinsurance). This is why Medigap Plan G — which covers that 20% — is so valuable for beneficiaries with significant health needs.
Medicare Part C — Medicare Advantage
Medicare Advantage (Part C) is an alternative way to receive your Medicare benefits through a private insurance company approved by Medicare. Instead of getting Parts A and B directly from the federal government, you get all your coverage through a private plan — which must cover everything Original Medicare covers, and often includes additional benefits.
As of 2026, more than 33 million Medicare beneficiaries — nearly half of all Medicare enrollees — are in Medicare Advantage plans. The program has grown dramatically since its creation as Medicare+Choice in 1997 and has become the dominant form of Medicare coverage in many markets.
Pros
Cons
Pros
Cons
Pros
Cons
Pros
Cons
Pros
Cons
Pros
Cons
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Provider choice | Any Medicare-accepting provider nationwide | In-network only (HMO) or higher cost out-of-network (PPO) |
| Referrals required | No | Yes (HMO) / No (PPO) |
| Prior authorization | Rarely | Frequently required |
| Out-of-pocket maximum | None (unlimited exposure) | Yes — $3,000–$8,850/year (2026) |
| Prescription drugs | Not included (need Part D) | Usually included |
| Dental/vision/hearing | Not included | Often included |
| Monthly premium | $202.90 (Part B only) | $0–$100+ (plus Part B) |
| Travel coverage | Nationwide | Service area only (except emergencies) |
| Medigap eligible | Yes | No |
| Prior auth for hospital | No | Yes — often required |
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Medicare Part D — Prescription Drug Coverage
Medicare Part D provides prescription drug coverage. It was created by the Medicare Modernization Act of 2003 and launched January 1, 2006. Part D is offered by private insurance companies approved by Medicare. You can get Part D as a standalone Prescription Drug Plan (PDP) alongside Original Medicare, or as part of a Medicare Advantage plan that includes drug coverage (MAPD).
How Part D Works in 2026 — The New Structure
The Inflation Reduction Act of 2022 fundamentally restructured Part D starting in 2025. The old "donut hole" coverage gap is gone. The new structure is simpler and more protective for beneficiaries with high drug costs.
You pay 100% of drug costs until you meet your plan's deductible (maximum $590 in 2026). Not all plans have a deductible — some plans have $0 deductibles for certain drug tiers.
You pay your plan's copays or coinsurance for covered drugs. The amount varies by drug tier (generic, preferred brand, non-preferred brand, specialty). You continue paying until your out-of-pocket costs reach $2,000.
NEW in 2025: Once your out-of-pocket costs reach $2,000, you pay $0 for covered drugs for the rest of the year. This is the most significant Part D improvement since the program launched in 2006.
| Tier | Drug Type | Typical Cost-Sharing | Examples |
|---|---|---|---|
| Tier 1 | Preferred Generic | $0–$5 copay | Metformin, lisinopril, atorvastatin |
| Tier 2 | Generic | $5–$15 copay | Most common generics |
| Tier 3 | Preferred Brand | $30–$50 copay | Common brand-name drugs with generics available |
| Tier 4 | Non-Preferred Brand | $60–$100+ copay | Brand-name drugs without preferred status |
| Tier 5 | Specialty | 25–33% coinsurance | Biologics, cancer drugs, specialty medications |
Part D Late Enrollment Penalty
If you don't enroll in Part D when you're first eligible and you go 63 or more consecutive days without creditable drug coverage, you'll owe a late enrollment penalty. The penalty is 1% of the national base beneficiary premium ($36.78 in 2026) for every month you went without coverage — and it's permanent.
Example:
If you went 24 months without creditable drug coverage, your penalty would be 24% × $36.78 = approximately $8.83/month added to your Part D premium — every month, for life.
Creditable coverage means drug coverage at least as good as Medicare Part D — typically employer coverage, VA benefits, or TRICARE. Always get written confirmation that your coverage is creditable.
Medigap — Medicare Supplement Insurance
Medigap (Medicare Supplement Insurance) is private insurance that fills the "gaps" in Original Medicare — primarily the 20% Part B coinsurance and the Part A deductible. With the right Medigap plan, your out-of-pocket costs for Medicare-covered services can be near zero.
Medigap plans are standardized by the federal government — Plan G from Company A covers exactly the same benefits as Plan G from Company B. The only difference is the premium. This makes Medigap one of the most straightforward insurance products to compare.
| Benefit | A | B | C* | D | F* | G | K | L | M | N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A coinsurance & hospital costs (up to 365 days after Medicare benefits used) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
| Part B coinsurance or copayment | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓† |
| Blood (first 3 pints) | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A hospice care coinsurance | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Skilled nursing facility coinsurance | — | — | ✓ | ✓ | ✓ | ✓ | 50% | 75% | ✓ | ✓ |
| Part A deductible | — | ✓ | ✓ | ✓ | ✓ | ✓ | 50% | 75% | 50% | ✓ |
| Part B deductible | — | — | ✓ | — | ✓ | — | — | — | — | — |
| Part B excess charges | — | — | — | — | ✓ | ✓ | — | — | — | — |
| Foreign travel emergency (80%) | — | — | ✓ | ✓ | ✓ | ✓ | — | — | ✓ | ✓ |
* Plans C and F are not available to people who became eligible for Medicare on or after January 1, 2020. † Plan N pays 100% of Part B coinsurance except for copays up to $20 for office visits and up to $50 for ER visits.
Plan G
Premium: $100–$200/mo
You pay: Part B deductible only ($283)
Best for: Most new enrollees who want comprehensive coverage and access to any Medicare provider nationwide.
Plan N
Premium: $70–$140/mo
You pay: Part B deductible + copays ($20 office, $50 ER)
Best for: Healthy beneficiaries who want lower premiums and are comfortable with modest copays.
HD Plan G
Premium: $30–$60/mo
You pay: $2,870 deductible (2026) before benefits begin
Best for: Healthy beneficiaries who want catastrophic protection at minimal monthly cost.
The Most Important Medigap Rule: Medical Underwriting
When you first enroll in Medicare Part B, you have a 6-month Medigap Open Enrollment Period during which you have guaranteed-issue rights — no health questions, no underwriting, no denials. After that window closes, most states allow carriers to use medical underwriting, meaning they can charge higher premiums or deny coverage based on your health history.
The implication: If you start with Medicare Advantage and later want to switch to Medigap, you may face underwriting. A serious diagnosis can make you uninsurable for Medigap. This is why many beneficiaries choose Medigap from the start — even if the premium seems high at 65.
Medicare Enrollment Rules and Periods
Medicare enrollment has strict rules and deadlines. Missing the right window can result in permanent premium penalties, coverage gaps, or loss of guaranteed-issue rights. Here is every enrollment period you need to know.
Initial Enrollment Period (IEP)
When
7-month window: 3 months before your 65th birthday month, your birthday month, and 3 months after
What You Can Do
Enroll in Parts A, B, and D for the first time. Also your Medigap Open Enrollment Period (6 months from Part B effective date).
If You Miss It
Enrolling in months 5–7 of your IEP delays your coverage start date. Enrolling after your IEP without qualifying coverage triggers permanent late enrollment penalties.
Pro Tip
Enroll in the first 3 months of your IEP (before your birthday month) to ensure coverage starts on the 1st of your birthday month.
Special Enrollment Period (SEP)
When
Triggered by qualifying life events — most commonly losing employer coverage, moving, or gaining/losing Medicaid
What You Can Do
Enroll in or change Medicare coverage outside of standard enrollment periods. The most important SEP is the 8-month window after losing employer coverage.
If You Miss It
SEPs have strict deadlines. Missing your SEP window means waiting for the next available enrollment period and potentially owing late penalties.
Pro Tip
The employer coverage SEP gives you 8 months from when employer coverage ends to enroll in Part B without penalty. Do NOT wait until COBRA ends — COBRA is not employer coverage for SEP purposes.
General Enrollment Period (GEP)
When
January 1 – March 31 each year. Coverage begins July 1.
What You Can Do
Enroll in Part B if you missed your IEP and don't qualify for an SEP. Also available for Part A if you're not eligible for premium-free Part A.
If You Miss It
Enrolling during GEP instead of IEP means you'll owe the permanent Part B late enrollment penalty (10% per year of delay) and your coverage won't start until July 1.
Pro Tip
Avoid the GEP if at all possible. The 3-month coverage gap (April–June) and permanent premium penalty make it a costly option.
Annual Enrollment Period (AEP)
When
October 15 – December 7 each year. Changes take effect January 1.
What You Can Do
Switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, join or change Part D plans. Available to all Medicare beneficiaries.
If You Miss It
No penalty for making changes during AEP. However, switching from Medicare Advantage to Original Medicare may require Medigap underwriting.
Pro Tip
Review your coverage every AEP. Plans change premiums, formularies, and provider networks annually. Your perfect plan from last year may not be the best option this year.
Medicare Advantage Open Enrollment Period (MA OEP)
When
January 1 – March 31 each year. Changes take effect the first of the following month.
What You Can Do
If you're enrolled in a Medicare Advantage plan, you can switch to a different MA plan or return to Original Medicare (and enroll in a standalone Part D plan). One change allowed.
If You Miss It
No penalty for making changes. However, returning to Original Medicare during MA OEP does not give you guaranteed-issue Medigap rights in most states.
Pro Tip
If you enrolled in MA during AEP and realize it's not right for you, use the MA OEP to switch back to Original Medicare. Act quickly — you have until March 31.
Medigap Open Enrollment Period
When
6 months starting the month you turn 65 AND are enrolled in Part B
What You Can Do
Buy any Medigap plan from any carrier without medical underwriting — no health questions, no denials, no higher premiums based on health. This is your most valuable Medicare enrollment right.
If You Miss It
After this window closes, most states allow medical underwriting. A serious health condition can make you uninsurable for Medigap or result in much higher premiums.
Pro Tip
This is the most important enrollment window in Medicare. Do not let it pass without carefully considering whether Medigap is right for you.
How to Enroll in Medicare
Online
- Visit ssa.gov/medicare
- Create or log in to my Social Security account
- Complete the online application
- Takes about 10 minutes
- Confirmation sent by mail
Fastest method. Available 24/7.
By Phone
- Call Social Security: 1-800-772-1213
- TTY: 1-800-325-0778
- Available Mon–Fri 8am–7pm
- Have your Social Security number ready
- Request a confirmation number
Good if you have questions during enrollment.
In Person
- Visit your local Social Security office
- Find your office at ssa.gov/locator
- Bring your Social Security card
- Bring proof of age (birth certificate)
- Bring proof of citizenship or legal residency
Best for complex situations or if you need help.
Medicare Costs — Complete 2026 Reference
Medicare costs include premiums, deductibles, coinsurance, and copays. Here is every cost figure you need for 2026, including IRMAA surcharges for higher-income beneficiaries.
| Cost Item | 2026 Amount | Notes |
|---|---|---|
| PART A | ||
| Part A Premium (40+ quarters) | $0/month | Premium-free for most beneficiaries |
| Part A Premium (30–39 quarters) | $285/month | Reduced premium |
| Part A Premium (<30 quarters) | $518/month | Full premium |
| Part A Inpatient Deductible | $1,736 per benefit period | Per hospitalization, not per year |
| Part A Days 61–90 Coinsurance | $433/day | Per benefit period |
| Part A Days 91–150 (Lifetime Reserve) | $866/day | 60 lifetime reserve days total |
| Skilled Nursing Days 21–100 | $216.50/day | Days 1–20 are $0 after qualifying stay |
| PART B | ||
| Part B Standard Premium | $202.90/month | Deducted from Social Security if receiving benefits |
| Part B Annual Deductible | $283/year | Applies once per calendar year |
| Part B Coinsurance | 20% | Of Medicare-approved amount, after deductible |
| Part B Excess Charges | Up to 15% | If provider doesn't accept Medicare assignment |
| PART D | ||
| Part D Maximum Deductible | $590/year | Not all plans charge the maximum |
| Part D Out-of-Pocket Cap | $2,000/year | New in 2025 — after this, you pay $0 |
| Part D National Base Premium | $36.78/month | Used to calculate late enrollment penalty |
| Part D Late Penalty | 1% per month without coverage | Permanent — added to premium for life |
| MEDIGAP | ||
| Medigap Plan G Premium | $100–$200/month | Varies by age, carrier, tobacco use, state |
| Medigap Plan N Premium | $70–$140/month | Varies by age, carrier |
| HD Plan G Premium | $30–$60/month | Varies by age, carrier |
| HD Plan G Deductible | $2,870/year | Before HD Plan G benefits begin |
IRMAA — Income-Related Monthly Adjustment Amount (2026)
Higher-income Medicare beneficiaries pay more for Part B and Part D through IRMAA surcharges. IRMAA is based on your income from 2 years ago (2024 income determines 2026 IRMAA). If your income dropped significantly due to retirement, divorce, or death of spouse, you can appeal using SSA Form SSA-44.
| 2024 Income (Individual) | 2024 Income (Joint) | 2026 Part B Premium | Part D IRMAA Add-On |
|---|---|---|---|
| ≤$106,000 | ≤$212,000 | $202.90/month | $0 |
| $106,001–$133,000 | $212,001–$266,000 | $285.00/month | $13.70 |
| $133,001–$167,000 | $266,001–$334,000 | $367.00/month | $35.30 |
| $167,001–$200,000 | $334,001–$400,000 | $449.10/month | $57.00 |
| $200,001–$500,000 | $400,001–$750,000 | $530.90/month | $78.60 |
| Above $500,000 | Above $750,000 | $594.00/month | $85.80 |
Help Paying Medicare Costs — Low-Income Programs
Extra Help (Low Income Subsidy)
Who qualifies: Limited income and resources
Reduces Part D premiums, deductibles, and copays. Full Extra Help eliminates the Part D premium for benchmark plans.
Medicare Savings Programs (MSPs)
Who qualifies: Limited income and resources
State programs that pay Part B premiums (QMB, SLMB, QI) and sometimes Part A premiums and cost-sharing. Apply through your state Medicaid office.
Qualified Medicare Beneficiary (QMB)
Who qualifies: Income ≤100% FPL
Pays Part A and B premiums, deductibles, and coinsurance. Providers cannot bill QMB beneficiaries for Medicare cost-sharing.
Specified Low-Income Medicare Beneficiary (SLMB)
Who qualifies: Income 100–120% FPL
Pays Part B premium only. Apply through your state Medicaid office.
Want to Know Your Exact Medicare Costs?
William calculates your real annual costs across every plan option — free, no obligation.
Medicare Forms — Complete Reference
Medicare involves dozens of official forms for enrollment, appeals, billing disputes, and coverage changes. Here are the most important forms every Medicare beneficiary should know, with links to official sources.
Application for Enrollment in Medicare — Part B
Apply for Medicare Part B if you missed your Initial Enrollment Period or are applying during a Special Enrollment Period.
Where to get it: ssa.gov or your local Social Security office
Request for Employment Information
Verify that you had employer-sponsored health coverage when applying for Part B under the employer coverage Special Enrollment Period. Your employer must complete this form.
Where to get it: cms.gov — submit with CMS-40B
Request for Medicare Part A (Hospital Insurance)
Apply for Medicare Part A if you are not automatically enrolled and are not yet receiving Social Security benefits.
Where to get it: ssa.gov
Medicare Advantage Enrollment Request
Enroll in a Medicare Advantage plan. Most plans now accept enrollment online or by phone, but this paper form is the official CMS form.
Where to get it: Your Medicare Advantage plan or medicare.gov
Medicare Redetermination Request
Appeal a Medicare coverage or payment decision. This is the first level of the Medicare appeals process. Must be filed within 120 days of receiving the initial determination.
Where to get it: medicare.gov or your Medicare contractor
Medicare Summary Notice (MSN) Dispute
Dispute a charge on your Medicare Summary Notice. Use this form to report billing errors or services you didn't receive.
Where to get it: medicare.gov
Appointment of Representative
Authorize someone (family member, attorney, advocate) to act on your behalf in Medicare matters, including appeals.
Where to get it: cms.gov
Request for ALJ Hearing
Request a hearing before an Administrative Law Judge — the third level of the Medicare appeals process. Used when you disagree with a Qualified Independent Contractor (QIC) decision.
Where to get it: hhs.gov/dab
Medicare Income-Related Monthly Adjustment Amount — Life-Changing Event
Appeal your IRMAA surcharge if your income dropped significantly due to retirement, divorce, death of spouse, loss of income-producing property, or other qualifying life-changing events.
Where to get it: ssa.gov or your local Social Security office
Social Security Benefit Statement
Shows your total Social Security benefits and Medicare premiums deducted. Used for tax purposes and to verify your Medicare premium amounts.
Where to get it: Mailed annually; available at ssa.gov/myaccount
Request for Termination of Premium Hospital and/or Supplementary Medical Insurance
Voluntarily disenroll from Medicare Part B. This is a serious decision — you will owe a permanent late enrollment penalty if you re-enroll later. Requires an in-person interview with Social Security.
Where to get it: Your local Social Security office (in-person required)
Medicare Advantage Disenrollment Request
Disenroll from a Medicare Advantage plan and return to Original Medicare. Can also be done by calling 1-800-MEDICARE or online at medicare.gov.
Where to get it: Your Medicare Advantage plan or medicare.gov
Application for Extra Help with Medicare Prescription Drug Plan Costs
Apply for Extra Help (Low Income Subsidy) to reduce Part D premiums, deductibles, and copays. Can save $5,000+ per year for qualifying beneficiaries.
Where to get it: ssa.gov or your local Social Security office
Medicare Savings Program Application
Apply for a Medicare Savings Program (QMB, SLMB, QI) to get help paying Part B premiums and sometimes cost-sharing. Application varies by state — in Florida, apply through the Department of Children and Families.
Where to get it: Your state Medicaid office (Florida: myflorida.com/accessflorida)
Health Insurance Claim Form
The standard claim form used by physicians and other healthcare providers to bill Medicare for services. You may receive a copy if you request an itemized bill.
Where to get it: Completed by your provider — not a patient form
Uniform Billing Form
The standard claim form used by hospitals and facilities to bill Medicare. Used for inpatient and outpatient hospital services.
Where to get it: Completed by your hospital — not a patient form
Advance Beneficiary Notice of Noncoverage
A notice your provider must give you before providing a service that Medicare may not cover, so you can decide whether to receive the service and accept financial responsibility.
Where to get it: Your provider gives you this form before the service
Official sources: All Medicare forms are available at cms.gov/medicare/cms-forms and ssa.gov/forms. Always use the most current version — form numbers and instructions change periodically.
Key Medicare Rules, Laws, and Regulations
Medicare is governed by a complex web of federal laws, regulations, and CMS rules. Here are the most important rules every beneficiary and their family should understand.
The 2-Midnight Rule
CMS Regulation (42 CFR § 412.3)
Medicare pays for inpatient hospital care under Part A only when a physician expects a patient to require hospital care spanning at least 2 midnights. Stays shorter than 2 midnights are typically billed as outpatient observation stays — which are covered under Part B, not Part A, and can result in significantly higher cost-sharing for the patient.
Why It Matters to You
If you're in the hospital for less than 2 midnights, you may be classified as "observation status" rather than inpatient. This affects your cost-sharing and your eligibility for Medicare-covered skilled nursing facility care (which requires a 3-day inpatient hospital stay).
Medicare Assignment
Social Security Act § 1842(b)
A provider who "accepts assignment" agrees to accept the Medicare-approved amount as full payment for covered services. They can only charge you the deductible and 20% coinsurance — they cannot bill you more. Providers who don't accept assignment can charge up to 15% above the Medicare-approved amount (Part B excess charges).
Why It Matters to You
Always ask if your provider accepts Medicare assignment. Medigap Plan G and Plan F cover Part B excess charges — Plan N does not. Participating providers (who always accept assignment) are listed at medicare.gov/care-compare.
Coordination of Benefits (COB)
CMS Medicare Secondary Payer (MSP) Rules
When you have Medicare and another form of insurance, coordination of benefits rules determine which insurance pays first (primary) and which pays second (secondary). Medicare is generally primary for people 65+ who are not covered by employer insurance. Medicare is secondary when you have active employer coverage through a large employer (20+ employees).
Why It Matters to You
If you're still working at 65 and have employer coverage through a large employer, your employer plan pays first and Medicare pays second. You may be able to delay Part B enrollment without penalty. Rules are complex — verify with your employer's benefits department.
Medicare Secondary Payer (MSP)
Social Security Act § 1862(b)
Medicare Secondary Payer rules require Medicare to pay second (after other insurance) in certain situations: active employer coverage, workers' compensation, liability insurance, no-fault insurance, and Veterans Administration benefits. Providers and insurers are required to report MSP situations to CMS.
Why It Matters to You
If you receive a settlement from a liability claim or workers' compensation, Medicare may have a right to be reimbursed for any Medicare payments related to the injury. This is called a Medicare lien. Failure to address Medicare's interest can result in Medicare refusing to pay future claims related to the injury.
Guaranteed Issue Rights
Social Security Act § 1882(s)
Federal law guarantees your right to buy certain Medigap plans without medical underwriting in specific situations: your Medigap Open Enrollment Period (6 months from Part B effective date), when your Medicare Advantage plan leaves your area or loses Medicare certification, when you move out of your plan's service area, and certain other qualifying events.
Why It Matters to You
Outside of guaranteed issue situations, most states allow Medigap carriers to use medical underwriting. A serious health condition can result in denial or higher premiums. Know your guaranteed issue rights and use them — they are your most valuable Medicare protection.
Medicare Appeals Process
Social Security Act § 1869; 42 CFR Part 405
You have the right to appeal any Medicare coverage or payment decision. The Medicare appeals process has 5 levels: (1) Redetermination by the Medicare contractor, (2) Reconsideration by a Qualified Independent Contractor (QIC), (3) Hearing before an Administrative Law Judge (ALJ), (4) Review by the Medicare Appeals Council, (5) Federal district court review.
Why It Matters to You
Medicare denials are frequently overturned on appeal. If Medicare denies coverage for a service your doctor ordered, appeal immediately. You have 120 days from the initial determination to file a redetermination request. For expedited appeals (when your health is at risk), you have 60 days.
Anti-Kickback Statute & Stark Law
42 U.S.C. § 1320a-7b(b); 42 U.S.C. § 1395nn
The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals of Medicare business. The Stark Law prohibits physicians from referring patients to entities with which they have a financial relationship, unless an exception applies. These laws protect Medicare beneficiaries from conflicts of interest in their care.
Why It Matters to You
These laws affect how Medicare plans can market to beneficiaries. Medicare Advantage plans cannot offer gifts worth more than $15 to prospective enrollees. Agents cannot accept payments from plans for enrolling beneficiaries in specific plans. These protections exist to ensure your Medicare agent is working for you, not the insurance company.
HIPAA & Medicare Privacy Rights
Health Insurance Portability and Accountability Act of 1996
HIPAA gives Medicare beneficiaries the right to access their health information, request corrections, know how their information is used, and file complaints about privacy violations. Medicare plans and providers must comply with HIPAA privacy and security rules.
Why It Matters to You
You have the right to request a copy of your Medicare records, including your Medicare Summary Notices, claims history, and coverage decisions. You can access your Medicare information at mymedicare.gov.
Medicare vs. Medicaid — Key Differences
Medicare and Medicaid are often confused — they were created by the same law (Social Security Amendments of 1965) and are both administered by CMS, but they are fundamentally different programs serving different populations with different funding structures.
| Feature | Medicare | Medicaid |
|---|---|---|
| Who it's for | People 65+, disabled, ESRD/ALS | Low-income individuals of any age |
| Eligibility basis | Age, disability, or specific condition | Income and assets (means-tested) |
| Federal vs. state | Federal program, uniform nationwide | Joint federal-state; varies by state |
| Funding | Payroll taxes, premiums, general revenues | Federal and state general revenues |
| Premiums | Yes (Part B, D, and some Part A) | Generally none or minimal |
| Deductibles | Yes (Part A and B) | Generally none |
| Long-term care | Limited (up to 100 days SNF) | Yes — covers nursing home care |
| Dental coverage | Not covered (some MA plans) | Covered in most states |
| Vision coverage | Not covered (some MA plans) | Covered in most states |
| Prescription drugs | Part D (separate enrollment) | Covered in most states |
| Income limits | None | Yes — varies by state and program |
| Asset limits | None | Yes — varies by state and program |
| Can you have both? | Yes — called "dual eligible" | Yes — called "dual eligible" |
Dual Eligible — Having Both Medicare and Medicaid
About 12 million Americans qualify for both Medicare and Medicaid — they are called "dual eligible" beneficiaries. Dual eligibles are among the most vulnerable Medicare beneficiaries, often with complex health needs and limited incomes. They have access to special coordination programs designed to improve their care.
Full Dual Eligible
Qualify for full Medicaid benefits. Medicaid pays Medicare premiums, deductibles, and coinsurance. May qualify for a Dual Eligible Special Needs Plan (D-SNP).
Partial Dual Eligible
Qualify for a Medicare Savings Program (QMB, SLMB, or QI) that pays some or all Medicare premiums. May not qualify for full Medicaid benefits.
D-SNP Plans
Dual Eligible Special Needs Plans are Medicare Advantage plans specifically designed for dual eligibles. They coordinate Medicare and Medicaid benefits and often include enhanced care management.
PACE Programs
Programs of All-inclusive Care for the Elderly (PACE) provide comprehensive medical and social services to dual eligibles who need nursing home-level care but want to remain in the community.
Top 30 Medicare Questions — Answered
These are the questions Americans ask most about Medicare — answered clearly and completely.
1What is Medicare?
Medicare is the federal health insurance program for people age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease. It was signed into law on July 30, 1965, and now covers more than 67 million Americans.
2What are the parts of Medicare?
Medicare has four main parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage — private plans that combine A and B), and Part D (prescription drug coverage). Medigap (Medicare Supplement Insurance) is private insurance that covers gaps in Original Medicare.
3When am I eligible for Medicare?
You're eligible at age 65 if you're a U.S. citizen or permanent resident who has lived in the U.S. for at least 5 consecutive years. You may also qualify under 65 if you've received Social Security Disability Insurance (SSDI) for 24 months, or if you have End-Stage Renal Disease or ALS.
4Is Medicare free?
Part A is free for most people (if you or your spouse worked and paid Medicare taxes for at least 10 years). Part B has a monthly premium ($202.90 in 2026). Part D and Medicare Advantage plans have their own premiums. There are also deductibles, coinsurance, and copays for most services.
5When should I sign up for Medicare?
Sign up during your Initial Enrollment Period — the 7-month window centered on your 65th birthday month. Enroll in the first 3 months (before your birthday month) to ensure coverage starts on the 1st of your birthday month. If you have employer coverage, you may be able to delay — but verify the rules first.
6What happens if I miss my Medicare enrollment deadline?
Missing your Part B enrollment deadline without qualifying employer coverage results in a permanent 10% per-year late enrollment penalty. Missing your Part D deadline results in a permanent 1%-per-month penalty. These penalties are added to your premium for life.
7What is the difference between Medicare and Medicare Advantage?
Original Medicare (Parts A and B) is the federal program with no network restrictions — you can see any Medicare-accepting provider nationwide. Medicare Advantage (Part C) is private insurance that replaces Original Medicare, typically with network restrictions, prior authorization requirements, and often extra benefits like dental and vision.
8What does Medicare not cover?
Original Medicare does not cover routine dental, vision, or hearing care; long-term custodial care (nursing home); most care outside the U.S.; cosmetic surgery; or prescription drugs (need Part D). Many Medicare Advantage plans add dental, vision, and hearing benefits.
9What is Medigap?
Medigap (Medicare Supplement Insurance) is private insurance that covers the gaps in Original Medicare — primarily the 20% Part B coinsurance and the Part A deductible. Plan G is the most comprehensive plan available to new enrollees. With Plan G, your only out-of-pocket cost for covered services is the $283 Part B deductible (2026).
10Can I have Medicare and employer insurance at the same time?
Yes. If you're still working and have employer coverage, you can have both. Which pays first depends on your employer's size: if your employer has 20+ employees, employer insurance pays first (primary) and Medicare pays second. If your employer has fewer than 20 employees, Medicare pays first.
11Does Medicare cover dental?
Original Medicare does not cover routine dental care — cleanings, fillings, extractions, dentures, or implants. Some Medicare Advantage plans include dental benefits. Standalone dental plans are also available. This is one of the most significant gaps in Medicare coverage.
12Does Medicare cover vision?
Original Medicare covers eye exams for medical conditions (glaucoma, diabetic retinopathy) but not routine eye exams or eyeglasses. Some Medicare Advantage plans include vision benefits. Standalone vision plans are also available.
13Does Medicare cover hearing aids?
Original Medicare does not cover hearing aids or routine hearing exams. Some Medicare Advantage plans include hearing benefits. The Inflation Reduction Act of 2022 did not add hearing coverage to Original Medicare, though this remains a legislative priority for many advocates.
14Does Medicare cover long-term care?
Medicare covers skilled nursing facility care for up to 100 days after a qualifying 3-day inpatient hospital stay — but only for skilled care (nursing, therapy), not custodial care (help with daily activities). Medicare does not cover long-term nursing home care. Medicaid covers long-term care for those who qualify financially.
15What is the Medicare donut hole?
The Medicare Part D "donut hole" was a coverage gap where beneficiaries paid higher drug costs after reaching an initial coverage limit. The Inflation Reduction Act of 2022 eliminated the donut hole starting in 2025. Now there is a $2,000 annual out-of-pocket cap — after which you pay $0 for covered drugs.
16What is IRMAA?
IRMAA (Income-Related Monthly Adjustment Amount) is a surcharge added to Part B and Part D premiums for higher-income beneficiaries. It's based on your income from 2 years ago. In 2026, individuals with income above $106,000 (couples above $212,000) pay more than the standard $202.90 Part B premium.
17Can I change my Medicare plan?
Yes. During the Annual Enrollment Period (October 15 – December 7), you can switch between Original Medicare and Medicare Advantage, change MA plans, or change Part D plans. During the Medicare Advantage Open Enrollment Period (January 1 – March 31), you can switch MA plans or return to Original Medicare.
18What is a Medicare Summary Notice?
A Medicare Summary Notice (MSN) is a statement Medicare sends every 3 months showing the services billed to Medicare on your behalf, what Medicare paid, and what you may owe. Review your MSN carefully for errors. You can also view your claims online at mymedicare.gov.
19What is Medicare Part B excess charges?
Part B excess charges occur when a provider doesn't accept Medicare assignment and charges more than the Medicare-approved amount — up to 15% more. Medigap Plan G and Plan F cover excess charges; Plan N does not. To avoid excess charges, use providers who accept Medicare assignment.
20What is a Medicare Advantage out-of-pocket maximum?
Medicare Advantage plans are required to have an annual out-of-pocket maximum — the most you'll pay in a year for covered in-network services. In 2026, the maximum allowed is $8,850 for in-network services. Once you reach this limit, the plan pays 100% of covered services for the rest of the year.
21What is creditable coverage?
Creditable coverage is health or drug coverage that is at least as good as Medicare. Having creditable coverage allows you to delay Medicare enrollment without penalty. Common examples: employer coverage from a large employer (20+ employees), VA benefits (for Part D), and TRICARE for active duty military.
22Can I appeal a Medicare denial?
Yes. You have the right to appeal any Medicare coverage or payment decision. The appeals process has 5 levels, starting with a redetermination request to your Medicare contractor. Medicare denials are frequently overturned on appeal — especially for inpatient hospital stays and skilled nursing facility care.
23What is the Medicare Welcome to Medicare visit?
The "Welcome to Medicare" preventive visit is a one-time benefit available within the first 12 months of your Part B enrollment. It includes a review of your medical history, preventive screenings, and a personalized prevention plan. It's covered at 100% — no copay or deductible.
24Does Medicare cover telehealth?
Yes. Medicare covers telehealth services including video visits with doctors, mental health services, and certain other services. Coverage expanded significantly during the COVID-19 pandemic. In 2026, many telehealth flexibilities have been made permanent, including coverage for mental health services via telehealth.
25What is Medicare Part B excess charges and how do I avoid them?
Part B excess charges are the additional amount (up to 15% above the Medicare-approved amount) that non-participating providers can charge. To avoid them: (1) use providers who accept Medicare assignment, (2) enroll in Medigap Plan G or Plan F which cover excess charges, or (3) check medicare.gov/care-compare before your appointment.
26What is the difference between Medicare Part A and Part B?
Part A is hospital insurance — it covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Part B is medical insurance — it covers doctor visits, outpatient care, preventive services, and durable medical equipment. Most people get both Part A and Part B together as "Original Medicare."
27How do I find a Medicare doctor?
Use the Medicare.gov Care Compare tool (medicare.gov/care-compare) to find doctors, hospitals, and other providers who accept Medicare. For Medicare Advantage, use your plan's provider directory — but always call the provider's office to verify current network participation, as directories are often outdated.
28What is Extra Help for Medicare Part D?
Extra Help (also called the Low Income Subsidy or LIS) is a federal program that helps people with limited income and resources pay for Part D premiums, deductibles, and copays. Full Extra Help can save $5,000+ per year. Apply through Social Security (ssa.gov) or your state Medicaid office.
29Can I have Medicare if I'm still working?
Yes. You can have Medicare while still working. If your employer has 20+ employees, your employer plan pays first and Medicare pays second. You may be able to delay Part B enrollment without penalty while you have qualifying employer coverage. Consult with a Medicare specialist before making this decision.
30What is the Medicare Annual Wellness Visit?
The Medicare Annual Wellness Visit is a free preventive benefit covered 100% by Part B — no copay, no deductible. It includes a health risk assessment, medication review, cognitive assessment, and personalized prevention plan. It's different from a regular physical exam — ask your doctor to schedule it specifically as the Annual Wellness Visit.
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Get Medicare Help — Official Resources & Local Experts
Medicare is complex. Here are the official resources you can trust — and how to get personalized help from a local Florida Medicare expert.
Medicare.gov
Official Medicare website. Compare plans, find providers, view your claims, and access official Medicare publications.
Visit1-800-MEDICARE
Official Medicare helpline. Available 24/7. TTY: 1-877-486-2048. Can answer questions about coverage, claims, and enrollment.
VisitMyMedicare.gov
Your personal Medicare account. View claims, check coverage, manage your Medicare card, and access your Medicare Summary Notices.
VisitSocial Security Administration
Enroll in Medicare Parts A and B. Apply for Extra Help. Appeal IRMAA surcharges. Find your local SSA office.
VisitFlorida SHINE Program
Serving Health Insurance Needs of Elders — free, unbiased Medicare counseling from trained volunteers. Florida's State Health Insurance Assistance Program (SHIP).
VisitCMS.gov
Centers for Medicare & Medicaid Services. Official regulations, forms, and policy guidance. For beneficiaries and professionals.
VisitMedicare Plan Finder
Compare Medicare Advantage and Part D plans available in your ZIP code. Enter your drugs to compare formularies and costs.
VisitMedicare Rights Center
National nonprofit providing free Medicare counseling and advocacy. Helpline: 800-333-4114. Excellent resource for complex Medicare situations.
VisitWork With a Local Florida Medicare Expert
William Gray is an independent Medicare insurance agent serving Northeast Florida — Jacksonville, Daytona Beach, St. Augustine, Deltona, and surrounding areas. He has been a licensed insurance agent since 1998 and has helped hundreds of Florida families navigate Medicare enrollment, plan selection, and annual reviews.
Florida License
#W690237
NPN
#1345734
Licensed Since
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Florida Medicare Resources
William Gray is a licensed independent insurance agent (Florida License #W690237, NPN #1345734). He is not connected with or endorsed by the federal Medicare program or any government agency. This guide is for informational purposes only and does not constitute legal, financial, or insurance advice. Medicare rules, costs, and plan availability change annually — always verify current information at medicare.gov or with a licensed Medicare specialist. Last updated June 2026.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-486-2048) to get information on all of your options.
Not affiliated with or endorsed by the U.S. government or the federal Medicare program. This is an advertisement for insurance. William Gray and affiliated licensed agents are independent insurance agents, not government employees or representatives. Medicare has neither reviewed nor endorsed this information.
Not all plans or types of coverage may be available in your area. Plan availability, benefits, and premiums vary by county and ZIP code. Enrollment in any plan depends on contract renewal. Benefits, premiums, and cost-sharing may change on January 1 of each year.
Independent Agent & Compensation Disclosure. William Gray is an independent licensed insurance agent (FL License #W690237) and is not employed by or exclusively affiliated with any single insurance company. William is compensated by insurance carriers when you enroll in a plan. This compensation does not affect the premium you pay — your premium is the same whether you enroll through a broker or directly with the carrier. Affiliated agents are independent contractors solely responsible for their own conduct and representations.