Medicare

What it means

Medicare has four parts. Part A covers hospital stays and limited skilled nursing after one. Part B covers doctors, outpatient care and equipment. Part C is Medicare Advantage — the same benefits delivered by a private plan. Part D is prescription drugs.

Enrollment is tied to dates rather than to need. Missing an enrollment window can mean a permanently higher premium, and the windows are not the same for each part.

It is not Medicaid. Medicare is an entitlement based on age or disability and is not means-tested; Medicaid is means-tested and is the program that pays for most long-term care in the United States.

Why it matters

Almost every family assumes Medicare will pay for a nursing home. It pays for a limited period of skilled care after a qualifying hospital stay, and for nothing that is only help with daily living — which is what most long-term care is.

It also has to be told about a death, and it is a separate notification from Social Security's.

When you are likely to meet it

• When a parent turns sixty-five, or stops working.
• When a hospital discharge planner talks about coverage running out.
• When somebody dies and their coverage has to be ended.

The four parts, and what each is for

The parts are constantly confused, and which ones somebody has decides who to ring and what is covered.

Original Medicare means Parts A and B, usually with a separate Part D plan and often a Medigap policy. Medicare Advantage replaces that arrangement.

Related terms

• Benefit periodThe unit Medicare counts hospital and rehabilitation days in — and it is not a calendar year.
• COBRA continuation coverageThe right to keep an employer's health insurance for a period after the event that would otherwise end it — including the death of the employee.
• Creditable coverageDrug coverage at least as good as Medicare's — losing it involuntarily opens a window to enroll.
• Custodial careHelp with everyday living rather than medical treatment — bathing, dressing, eating, moving about. It is what most long-term care actually is.
• Extra HelpA federal subsidy that pays most of the cost of Medicare prescription drug coverage.
• Home healthSkilled clinical care delivered at home, ordered by a doctor. Medicare may pay for it while the clinical need lasts.
• Lifetime reserve daysSixty extra hospital days a person may draw on once in their life, and never get back.
• MedicaidA joint federal and state program that pays for health care, including long-term care, for people with limited income and assets.
• Medical expense deductionWhat you paid for a parent's care may be deductible even if their income is too high to claim them.
• Medicare AdvantageMedicare delivered by a private insurance plan instead of directly by the government. It is also called Part C.
• Medicare Part DMedicare's prescription drug coverage, bought as a separate plan from a private insurer.
• Medicare Savings ProgramA state-run program that pays Medicare premiums, and sometimes the deductibles too.
• Medication therapy managementA Part D service that reviews everything a person takes at once, with a written summary — and enrols people automatically.
• MedigapA private policy that pays some of what Original Medicare leaves the patient to pay. It cannot be combined with a Medicare Advantage plan.
• Observation statusBeing in a hospital bed as an outpatient, which changes what Medicare pays for afterwards.
• Skilled nursing facilityA facility providing nursing and rehabilitation care that has to be delivered by licensed clinical staff — not the same thing as a nursing home in the everyday sense.
• Survivor benefitA continuing payment to a spouse, child or other dependant after somebody dies — from Social Security, a pension, or an annuity.

Official sources

The authority this page describes, at the agency that publishes it. Sahvelo does not restate a rule from a secondary source.

• Medicare — the parts of Medicare (opens in a new tab)

Sahvelo guidance that uses this

• Medicare
• Health insurance after a death