Medicare basics: what families should know
Medicare is the federal health insurance program for people 65 and older and some younger people with disabilities. This page explains the pieces in plain English, the deadlines that cause lifelong penalties, and where to get free, unbiased help.
The parts of Medicare
These descriptions come from Medicare.gov:
- Part A (Hospital Insurance): helps cover inpatient hospital care, skilled nursing facility care, hospice care, and home health care.
- Part B (Medical Insurance): helps cover doctors and other providers, outpatient care, home health care, medical equipment like walkers and wheelchairs, and many preventive services like screenings and shots.
- Part D (drug coverage): helps pay for prescription drugs. It’s offered by private insurance companies that follow Medicare’s rules, either as a separate drug plan added to Original Medicare or as part of a Medicare Advantage Plan.
- Part C (Medicare Advantage): an alternative to Original Medicare, offered by private plans that Medicare approves. These plans bundle Part A, Part B, and usually Part D. You may need to use the plan’s network and get approval before some care. They have a yearly limit on out-of-pocket costs, and most offer extra benefits.
- Medigap (Medicare Supplement Insurance): extra insurance you can buy from a private company to help pay your share of costs in Original Medicare. Policies are standardized and, in most states, named by letters. Medicare.gov says the benefits in each lettered plan are the same no matter which company sells it. You generally need Parts A and B to buy one.
Two main ways to get Medicare: Original Medicare (Parts A and B, with any doctor or hospital that takes Medicare, plus an optional drug plan and optional Medigap), or a Medicare Advantage Plan. Which is better depends on the person. A free SHIP counselor can go over your parent’s situation.
When to sign up or make changes
Missing a window can mean waiting months and paying a penalty for life. Medicare.gov lists these periods:
| Period | When | What you can do |
|---|---|---|
| Initial Enrollment Period | Generally 7 months: starts 3 months before the month you turn 65 and ends 3 months after it. | Sign up for Part A and Part B. You can also join a Medicare Advantage Plan or a drug plan. |
| General Enrollment Period | January 1 to March 31 each year. | Sign up for Part B (and premium Part A) if you missed your first chance. Coverage starts the month after you sign up. A late penalty may apply. |
| Special Enrollment Period (job coverage) | Up to 8 months after the job or the job-based coverage ends, whichever happens first. | Sign up for Part B without a penalty if you (or your spouse) had health coverage from current work. COBRA and retiree coverage don’t count. |
| Open Enrollment Period | October 15 to December 7 each year. | Join, switch, or drop a Medicare Advantage Plan or drug plan, or switch between Original Medicare and Medicare Advantage. Changes start January 1. |
| Medicare Advantage Open Enrollment Period | January 1 to March 31 (only if you’re already in a Medicare Advantage Plan), and within the first 3 months you have Medicare. | Switch to another Medicare Advantage Plan, or go back to Original Medicare and join a separate drug plan. |
| Medigap Open Enrollment Period | 6 months, one time only, starting the first month you have Part B and are 65 or older. | Buy any Medigap policy sold in your state. Companies can’t refuse you or charge more because of health problems. After it ends, you may be turned down or pay more. |
There are other Special Enrollment Periods, for example after a move, after losing Medicaid, or when you get Extra Help. Use Medicare.gov’s pages on when coverage starts and joining a plan, or ask a SHIP counselor.
Late enrollment penalties
Medicare.gov says late penalties are added to the monthly premium, aren’t a one-time fee, and for most people last as long as they have that coverage.
- Part B: an extra 10% for each full 12-month period your parent could have had Part B but didn’t, usually for as long as they have Part B. Generally no penalty if they qualified for a Special Enrollment Period or enrolled in a Medicare Savings Program.
- Part D: an extra 1% for each month (12% a year) without Part D or other creditable drug coverage, if they go 63 days or more without it after first getting Medicare. It’s added for as long as they have Medicare drug coverage. No penalty while getting Extra Help.
- Part A (only for people who have to buy Part A): the premium may go up 10%, for twice the number of years they could have had Part A but didn’t sign up.
Still working, or covered by a spouse’s job? Talk to the employer’s benefits office and a SHIP counselor before you delay Part B. Medicare.gov says COBRA and retiree coverage don’t give you a Special Enrollment Period.
Help paying Medicare costs
- Medicare Savings Programs are run by states. Medicare.gov says they help pay Part A and Part B premiums and, for some people, deductibles, coinsurance, and copays. Medicare.gov says to apply through your state even if you don’t think you qualify, because some states don’t count certain types or amounts of income or resources. Find your parent’s state Medicaid agency on our state list.
- Qualified Medicare Beneficiary (QMB) program: one of these programs. If your parent is in it, Medicare.gov says Medicare providers aren’t allowed to bill them for Medicare-covered services, including deductibles, coinsurance, and copays. Getting billed anyway? See our medical bills guide.
- Extra Help is a Medicare program that helps people with limited income and resources pay Part D premiums, deductibles, and other drug costs. Medicare.gov says people who get full Medicaid, a Medicare Savings Program, or SSI get it automatically. Others can apply with Social Security or get free help applying from a SHIP.
What Medicare doesn’t cover
Medicare.gov says Medicare doesn’t pay for long-term care, meaning help with everyday tasks like bathing and dressing, at home, in assisted living, or in a nursing home. It covers only short-term skilled nursing facility care and part-time home health care when certain conditions are met. See paying for long-term care.
Scams: protect the Medicare number
Medicare.gov’s tips to prevent fraud and medical identity theft:
- Don’t give out the Medicare card or number, or a Social Security number, except to doctors or others you know should have it, like your insurer or your SHIP counselor.
- Don’t join a health or drug plan over the phone unless you called and asked for help.
- Don’t accept money or gifts in exchange for free medical care.
- Don’t let anyone except your doctors or other Medicare providers review your medical records or recommend services.
- Check statements and receipts against your calendar. A secure Medicare.gov account lets you see Original Medicare claims as soon as they’re processed.
Report suspected fraud to 1-800-MEDICARE (1-800-633-4227) or online at Medicare.gov. For a Medicare Advantage or drug plan, Medicare.gov also lists the I-MEDIC at 1-877-772-3379. Your state’s Senior Medicare Patrol, funded by ACL, can help you spot and report fraud: smpresource.org or 1-877-808-2468. Already gave out a number? See identity theft and scam calls.
Free, unbiased help
- SHIP (State Health Insurance Assistance Program): free, local, one-on-one Medicare counseling. Medicare.gov says SHIPs aren’t connected to any insurance company or health plan. Find your parent’s SHIP at shiphelp.org.
- 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, and Medicare.gov. Medicare’s own plan finder shows the plans available in your area.
- Social Security handles signing up for Part A and Part B for most people, and Extra Help applications.
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Sources
Last checked Oct 18, 2026.
- Medicare.gov: Parts of Medicare: https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/parts-of-medicare
- Medicare.gov: What's Medicare Supplement Insurance (Medigap)?: https://www.medicare.gov/health-drug-plans/medigap
- Medicare.gov: Medigap, get ready to buy (Medigap Open Enrollment Period): https://www.medicare.gov/health-drug-plans/medigap/ready-to-buy
- Medicare.gov: When does Medicare coverage start? (enrollment periods): https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start
- Medicare.gov: Joining a plan (Open Enrollment, Medicare Advantage Open Enrollment, SHIP): https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
- Medicare.gov: Avoid late enrollment penalties: https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties
- Medicare.gov: Medicare Savings Programs: https://www.medicare.gov/basics/costs/help/medicare-savings-programs
- Medicare.gov: Help with drug costs (Extra Help): https://www.medicare.gov/basics/costs/help/drug-costs
- Social Security: Apply for Part D Extra Help: https://www.ssa.gov/medicare/part-d-extra-help
- Medicare.gov: Long-term care coverage: https://www.medicare.gov/coverage/long-term-care
- Medicare.gov: Reporting Medicare fraud & abuse: https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse
- Senior Medicare Patrol National Resource Center (supported by ACL): https://smpresource.org/
- SHIP National Technical Assistance Center: find your local SHIP: https://www.shiphelp.org/
- ACL: State Health Insurance Assistance Program (SHIP): https://acl.gov/programs/connecting-people-services/state-health-insurance-assistance-program-ship
- Medicare.gov: Plan Finder: https://www.medicare.gov/plan-compare/
Rules and numbers change. If something here does not match what an agency tells you, trust the agency, and please let us know.