Benefit Basics to Help Someone Understand Medicare Health Insurance
Learn the Medicare fundamentals before helping someone enroll in a Medicare plan
Reviewed by: Ed McClane, Licensed Insurance Agent. Written by: Aaron Garcia.
Medicare is health insurance for Americans age 65 and older. Individuals living with specific disabilities may be eligible before 65.
Medicare AdvantageMedicare Advantage is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans are a private insurance that combine both Medicare Parts A and B (Original Medicare). Most Medicare Advantage plans also include Part D (prescription coverage) and may have additional benefits like dental, vision and hearing coverage.
Homebound enrollees may be eligible to receive in-home care.
Serving as a caregiver is a life-changing responsibility. You can expect a learning curve for care and services available to the person in your care. This overview can help shorten the curve and get you up to speed on the basics.
Medicare Parts A and B serve as the foundation for coverage, known as Original Medicare.
- Medicare Part A: Covers hospital services.
- Medicare Part B: Covers medical services.
Original Medicare does not cover all costs, so beneficiaries have the option to add coverage to fill gaps. These options include:
- Medicare Prescription Drug Plan (Part D): Part D is prescription drug coverage from private insurance companies. Part D costs vary from one carrier to another and are subject to late enrollment penalties.
- Medicare Supplement Insurance (Medigap): These plans are offered by private insurance companies. They exist to help beneficiaries cover coinsurance and deductibles, not covered by Original Medicare. Medigap plans have monthly premiums, and plan availability varies by state.
Medicare Advantage (also known as Part C) plans are private insurance plans that combine Medicare Parts A and B. Most Medicare Advantage plans include Part D and may include dental, vision, and hearing coverage.
Medically necessary services include:
- Doctor visits
- Physical therapy
- Mental health
- Durable medical equipment 
Preventive services are usually covered at no cost and include:
- Wellness visits
- Women’s services
Inpatient stays require an overnight stay and typically occur in three locations:
- Rehabilitation facilities
- Skilled nursing facilities
Skilled nursing facilities and nursing homes may be covered by Medicare following surgery or an injury to the person in your care. Medicare usually covers the first 20 days.
Home healthcare must be part of a doctor’s plan of care to be eligible.
If your loved one is homebound and needs therapy (speech, occupational or physical) or skilled nursing care, they may qualify. 
Hospice prepares a patient for the end of their life rather than treating a terminal illness. Hospice is holistic care, including but not limited to symptom management, social services, and home service. Hospice requires a life expectancy of six months or shorter, unless there are exceptional circumstances. 
Palliative care is the treatment to manage daily life with a severe illness. The care is for physical, mental and emotional pain after a heartbreaking diagnosis. Treatment must be in relief of a terminal illness to be covered by Medicare.
When my loved one turns 65, will they be enrolled automatically?
Most people are automatically enrolled into Medicare when they turn 65. There are some exceptions to this rule. If you’re unsure, visit our page on Medicare enrollment.
Can you be on Medicare if you never worked full time?
Yes, but you may pay more. If you worked fewer than 10 years, you may have to pay a Medicare Part A premium. Medicare Part B and D are not affected by your work history.
If your spouse worked for more than 10 years, you might not have to pay a Part A premium, even if you never worked.
When do I enroll my loved one?
Caregivers should be familiar with Medicare enrollment periods.
- If your loved one is under 65: Everyone has an Initial Enrollment Period the year they turn 65. It’s a seven-month window that includes the three months before and after their birth month.
- If you care for someone over 65 who is not enrolled: You should enroll them in Medicare as soon as possible to limit late penalties. Different enrollment periods provide specific enrollment options. Also, Special Enrollment Periods (SEP) are unique periods triggered by certain circumstances. An available SEP might allow them to enroll without penalty.
What does Medicare cost?
Medicare Part A is usually free, but individuals who do not automatically qualify for Medicare Part A may have a monthly premium. Medicare Part B is $148.50 per month for the 2021 plan year. Stand alone Part D plans also have premiums. However, individuals with Medicaid and/or a Low Income Subsidy (LIS), may not have to pay a Part B or Part D premium. Other Medicare costs include deductibles, copayment and coinsurance.