Medicare has a reputation for being confusing, but the basics fit on a single page. Here's a plain-English overview to help your family make sense of it — and to know where to get free, unbiased help.
This is general education, not personalized advice. For decisions about specific plans, a free SHIP counselor is your best friend.
The four parts, simply
- Part A — hospital insurance: inpatient stays, short-term skilled nursing after a hospital stay, hospice, some home health
- Part B — medical insurance: doctor visits, outpatient care, preventive services, and durable medical equipment
- Part C — Medicare Advantage: an all-in-one private plan alternative that bundles A and B (usually plus drug coverage)
- Part D — prescription drug coverage through private plans
Original Medicare vs. Medicare Advantage
With Original Medicare (A and B), your loved one can use any provider that accepts Medicare, with no networks, and can add a separate Part D drug plan and a Medigap supplement to help with out-of-pocket costs. Medicare Advantage plans usually use networks and may require referrals, but often bundle drug coverage and extras like dental or vision and include a yearly out-of-pocket cap. You can't have both a Medicare Advantage plan and a Medigap policy.
Medicare generally does NOT pay for long-term custodial care — the ongoing help with bathing, dressing, and eating that many older adults eventually need. It covers only short-term skilled nursing (up to 100 days) after a qualifying hospital stay. Long-term care is usually paid out of pocket, through long-term-care insurance, or through Medicaid for those who qualify. Planning for this early matters.
2026 costs and key deadlines
For 2026, the standard Part B premium is $202.90/month (up from $185.00 in 2025) with a $283 annual deductible, and the Part A hospital deductible is $1,736 per benefit period. A recent, welcome change caps what enrollees pay out of pocket for covered Part D drugs — $2,100 in 2026. Watch the deadlines: the 7-month window around the 65th birthday to first enroll, and Fall Open Enrollment (Oct 15 - Dec 7) to review and switch plans each year.
- Mark the enrollment windows on a calendar (around 65, and Oct 15-Dec 7 each fall).
- Contact a free SHIP counselor before making plan decisions (1-877-839-2675).
- Use the official Plan Finder at Medicare.gov with actual medications and pharmacies.
- Plan separately and early for long-term care — Medicare won't cover it.
- Compare Original Medicare + Medigap vs. Medicare Advantage during your enrollment window.
Keep the Medicare card, plan ID cards, and any Medigap or Part D policy numbers together, plus a calendar of enrollment deadlines, a current medication list, and your SHIP counselor's contact info.
Frequently asked questions
What are the four parts of Medicare?
Part A is hospital and inpatient care, Part B is doctor and outpatient care, Part C is Medicare Advantage (a private all-in-one alternative), and Part D is prescription drug coverage.
Does Medicare cover long-term care or nursing homes?
No — Medicare doesn't pay for long-term custodial care. It covers only short-term skilled nursing (up to 100 days per benefit period) after a qualifying hospital stay. Long-term care is usually paid privately or through Medicaid.
How much does Medicare cost in 2026?
In 2026 the standard Part B premium is $202.90/month with a $283 deductible, and the Part A hospital deductible is $1,736 per benefit period. Higher earners pay more for Part B. (2025 figures were $185.00 and $257.)
What's the difference between Medicare and Medicaid?
Medicare is a federal program based on age (65+) or disability, regardless of income, and generally doesn't cover long-term care. Medicaid is a joint federal-state program based on limited income and assets, and it does help cover long-term care.
Where can I get free help understanding Medicare?
Every state has a free State Health Insurance Assistance Program (SHIP) offering unbiased, one-on-one counseling with no ties to insurance companies. Call 1-877-839-2675 or visit shiphelp.org.