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Medicare & Insurance Navigator

Understanding your parent's health coverage, Parts A, B, C, D, Medigap, and more

Parent Care Guide © 2026

Medicare at a Glance

The four parts and what each covers

Medicare is the federal health insurance program for people 65+ (and some younger people with disabilities). It's divided into four parts, each covering different services.

A

Hospital Insurance

Inpatient care when you're admitted

Premium: Usually $0 if you or spouse paid Medicare taxes for 10+ years

✓ Hospital stays (inpatient)
✓ Skilled nursing facility (limited)
✓ Hospice care
✓ Home health care (limited)
✗ Long-term care / Custodial care
✗ Private room (unless medically needed)
B

Medical Insurance

Doctor visits and outpatient care

Premium: ~$185/month (2026, income-based)

✓ Doctor visits
✓ Outpatient procedures
✓ Preventive care (screenings, vaccines)
✓ Durable medical equipment
✗ Prescription drugs (that's Part D)
✗ Routine dental, vision, hearing
C

Medicare Advantage

All-in-one alternative to Original Medicare

Premium: Varies by plan ($0 to $200+/month, plus Part B premium)

✓ Everything in Parts A & B
✓ Usually includes Part D (drugs)
✓ Often includes dental, vision, hearing
✓ May include gym, transportation
✗ Limited to network doctors
✗ May need referrals for specialists
D

Prescription Drug Coverage

Medications from a pharmacy

Premium: ~$35–$100/month depending on plan

✓ Prescription medications
✓ Some vaccines
✗ Over-the-counter drugs
✗ Drugs not on plan's formulary

Original Medicare vs. Medicare Advantage

Understanding the two paths

Feature Original Medicare (A+B) Medicare Advantage (C)
Doctor Choice Any doctor who accepts Medicare (most do) Must use network doctors (HMO) or pay more (PPO)
Referrals No referrals needed for specialists Often need referral from primary care
Drug Coverage Must add separate Part D plan Usually included
Extra Benefits No dental, vision, hearing Often includes extras
Out-of-Pocket Max No limit (unless you add Medigap) Has yearly maximum
Best For Those who travel, want doctor flexibility, or can afford Medigap Those who want lower premiums and don't mind networks

What is Medigap (Medicare Supplement)?

Medigap policies are sold by private insurers to fill the "gaps" in Original Medicare, covering deductibles, copays, and coinsurance. If your parent has Original Medicare plus Medigap, their out-of-pocket costs become predictable and often low.

Important: You cannot have Medigap if you have Medicare Advantage.

The Medigap Enrollment Window

The best time to buy Medigap is during the 6-month period starting when you turn 65 AND are enrolled in Part B. During this window, insurance companies must accept you regardless of health conditions. After that, they can deny coverage or charge more based on health.

Common Coverage Gaps (What Medicare Doesn't Cover)

Long-Term Care

Nursing home stays beyond 100 days, assisted living, custodial care

Dental

Routine cleanings, fillings, dentures, extractions

Vision

Eye exams for glasses, eyeglasses, contacts

Hearing

Hearing aids, routine hearing exams, fittings

Critical Enrollment Periods

Miss these and face penalties or coverage gaps

Medicare Enrollment Windows

3 months before 65th birthday
Initial Enrollment Period (IEP) begins: 7-month window to sign up for Medicare (3 months before, birthday month, 3 months after)
Jan 1 – Mar 31
Medicare Advantage Open Enrollment: Can switch from one MA plan to another, or drop MA and return to Original Medicare
Oct 15 – Dec 7
Annual Enrollment Period (AEP): Can switch between Original Medicare and MA, change Part D plans, or add/drop coverage
Anytime (if eligible)
Special Enrollment Period (SEP): Triggered by life events like moving, losing employer coverage, or qualifying for Medicaid

Late Enrollment Penalties

These penalties apply FOR LIFE. Enroll on time!

Still Working at 65?

If your parent (or their spouse) is still working and has employer health coverage, they may be able to delay Medicare without penalty. They'll qualify for a Special Enrollment Period when the employment or coverage ends. Talk to their employer's HR department AND Medicare to understand the rules.

Your Parent's Coverage

Document their current insurance situation

Medicare Information

Medicare Advantage Plan (if applicable)

Part D Drug Plan (if separate from MA)

Medigap / Supplemental Insurance (if applicable)

Annual Review Checklist

Review coverage every year during Open Enrollment (Oct 15–Dec 7)

Find Your State's SHIP Program

SHIP counselors are trained volunteers who provide free, unbiased Medicare advice. They can review your parent's coverage and help find the best plan. Find yours at shiphelp.org or call 1-800-MEDICARE.

Key Phone Numbers