Everything you need to know about Medicare Parts A, B, C, and D, eligibility, costs, and coverage for senior care services including skilled nursing and home health care.
Medicare is the federal health insurance program for people age 65 and older, as well as certain younger individuals with disabilities or end-stage renal disease. Established in 1965, Medicare provides health coverage to over 65 million Americans.
Medicare is divided into four parts—A, B, C, and D—each covering different healthcare services. Understanding how these parts work together helps you maximize your coverage and minimize out-of-pocket costs.
Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. Most people don't pay a monthly premium for Part A because they paid Medicare taxes while working.
| Service | What You Pay |
|---|---|
| Part A Monthly Premium | $0 for most people (if worked 40+ quarters) |
| Premium (30-39 quarters worked) | $311/month |
| Premium (fewer than 30 quarters) | $565/month |
| Hospital Deductible | $1,736 per benefit period |
| Hospital Days 1-60 | $0 coinsurance per day |
| Hospital Days 61-90 | $434 coinsurance per day |
| Hospital Days 91+ (lifetime reserve) | $868 coinsurance per day |
| Skilled Nursing Days 1-20 | $0 per day |
| Skilled Nursing Days 21-100 | $217 coinsurance per day |
| Skilled Nursing Days 101+ | All costs (no Medicare coverage) |
Benefit Period: A benefit period begins when you're admitted to a hospital or skilled nursing facility and ends when you haven't received inpatient care for 60 consecutive days. You can have multiple benefit periods per year, and you pay the deductible for each one.
Part B covers medically necessary services like doctors' visits, outpatient care, preventive services, and durable medical equipment. Unlike Part A, most people pay a monthly premium for Part B.
If your modified adjusted gross income (MAGI) exceeds certain thresholds, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) in addition to the standard Part B premium.
| 2024 Income (Single) | 2024 Income (Married Filing Jointly) | 2026 Part B Premium |
|---|---|---|
| $106,000 or less | $212,000 or less | $202.90 |
| $106,001 - $133,000 | $212,001 - $266,000 | $284.10 |
| $133,001 - $167,000 | $266,001 - $334,000 | $405.60 |
| $167,001 - $200,000 | $334,001 - $400,000 | $527.10 |
| $200,001 - $500,000 | $400,001 - $750,000 | $648.60 |
| Above $500,000 | Above $750,000 | $689.90 |
Note: IRMAA is based on income from two years prior. Your 2026 premium is based on your 2024 tax return.
Medicare Advantage plans, also called Part C, are private insurance plans approved by Medicare that provide all Part A and Part B coverage. Most plans also include Part D prescription drug coverage and additional benefits not offered by Original Medicare.
Medicare Advantage plans must now match or improve upon Original Medicare cost-sharing for behavioral health services. This means you won't pay more for mental health or substance use disorder services than you would under Original Medicare.
| Feature | Original Medicare (A + B) | Medicare Advantage (Part C) |
|---|---|---|
| Provider Network | Any provider accepting Medicare | Usually network restrictions (HMO/PPO) |
| Prescription Coverage | Must add Part D separately | Usually included |
| Additional Benefits | None (dental, vision separate) | Often includes dental, vision, hearing, fitness |
| Out-of-Pocket Maximum | No limit (consider Medigap) | $9,250 maximum in 2026 |
| Monthly Costs | Part B premium ($202.90) + Part D | Part B premium + plan premium (often $0) |
| Travel Coverage | Coverage nationwide | May be limited to service area |
Note: You must continue paying your Part B premium ($202.90 in 2026) even if you enroll in a Medicare Advantage plan. The Advantage plan premium is in addition to Part B.
You must have both Part A and Part B to enroll in Medicare Advantage, and you cannot have a Medigap policy while enrolled in Medicare Advantage.
Medicare Part D provides prescription drug coverage through private insurance plans approved by Medicare. You can add Part D coverage to Original Medicare or get it as part of most Medicare Advantage plans.
You pay the first $615 of drug costs in 2026 (unless your plan has a lower or no deductible).
After meeting the deductible, you typically pay a copayment or coinsurance (usually 25% for generic drugs, more for brand-name drugs) until you reach $5,030 in total drug costs.
After you reach $2,100 in out-of-pocket costs in 2026, you pay nothing for covered drugs for the rest of the year.
Starting in 2026, your annual out-of-pocket costs for prescription drugs are capped at $2,100, up from $2,000 in 2025. After you spend $2,100, you pay $0 for all covered medications for the rest of the year. This cap provides significant protection against high drug costs.
If your income exceeds certain thresholds, you'll pay an additional monthly amount in addition to your plan premium.
| 2024 Income (Single) | 2024 Income (Married Filing Jointly) | Monthly IRMAA Amount |
|---|---|---|
| $106,000 or less | $212,000 or less | $0 |
| $106,001 - $133,000 | $212,001 - $266,000 | $14.50 |
| $133,001 - $167,000 | $266,001 - $334,000 | $37.60 |
| $167,001 - $200,000 | $334,001 - $400,000 | $60.60 |
| $200,001 - $500,000 | $400,001 - $750,000 | $83.70 |
| Above $500,000 | Above $750,000 | $91.00 |
Your Initial Enrollment Period (IEP) lasts for 7 months:
Sign up during the 3 months before your birthday for coverage to start on your birthday. Signing up during or after your birthday month may delay coverage.
You're automatically enrolled in Medicare Parts A and B if you:
If not automatically enrolled, you can sign up:
You may qualify for a Special Enrollment Period (SEP) if you:
If you don't enroll when first eligible and don't have creditable coverage, you may face:
These penalties typically last for as long as you have Medicare coverage.
Understanding what Medicare does and doesn't cover for senior care is crucial for financial planning. Medicare provides limited coverage for certain skilled care services but does not cover long-term custodial care.
Medical care provided by licensed professionals (nurses, physical therapists) ordered by a doctor.
Non-medical assistance with activities of daily living that could be provided by someone without professional medical skills.
Medicare Part A covers up to 100 days of skilled nursing care per benefit period if you meet all requirements.
Effective January 1, 2026, patients receiving one of five specific surgical procedures (lower extremity joint replacement, surgical hip/femur fracture treatment, spinal fusion, coronary artery bypass graft, major bowel procedure) may receive skilled nursing facility care without the 3-day hospital stay requirement if their doctor participates in the TEAM (Transforming Episode Accountability Model) program.
Important: Time spent under observation or in the emergency room does NOT count toward the 3-day qualifying hospital stay, even if you're there overnight. You must be formally admitted as an inpatient, and the clock starts on your admission day.
Medicare makes an important distinction between home health care (skilled medical services) and home care (personal assistance). Only home health care is covered.
Skilled medical services provided at home by licensed professionals.
Long-term, non-medical personal assistance with daily activities.
Medicare does not pay for assisted living facilities, including:
While living in assisted living, Medicare continues to cover:
Memory care is a specialized form of assisted living for individuals with Alzheimer's disease, dementia, and other cognitive impairments. Since memory care provides custodial care and supervision, Medicare does not cover memory care facilities, room and board, or specialized dementia care services.
What Medicare does cover for people with dementia:
| Care Type | Medicare Coverage | Key Requirements | What You Pay (2026) |
|---|---|---|---|
| Skilled Nursing Facility | ✓ Yes (up to 100 days per benefit period) | 3-day hospital stay, need skilled care, doctor's order | $0 (days 1-20), $217/day (days 21-100) |
| Home Health Care | ✓ Yes (part-time skilled care) | Homebound, doctor's order, need skilled care | $0 for services, 20% for equipment |
| Assisted Living | ✗ No | N/A (custodial care) | All costs (avg. $5,900/month) |
| Memory Care | ✗ No | N/A (custodial care) | All costs (avg. $7,200/month) |
| Home Care (Personal Care) | ✗ No | N/A (custodial care) | All costs (avg. $30/hour) |
| Hospice Care | ✓ Yes (comprehensive) | Terminal illness (6 months or less prognosis) | $0 for most services, small copays |
| Nursing Home (Long-Term) | ✗ No | N/A (custodial care) | All costs (avg. $10,965/month) |
It depends on the size of your employer. If you work for an employer with fewer than 20 employees, you should enroll in Medicare at 65 because Medicare becomes your primary insurance. If your employer has 20 or more employees, you can delay Part B enrollment without penalty as long as you maintain employer coverage. However, you should still enroll in Part A at 65 since it's free for most people.
No. Medicare does not cover assisted living room and board or personal care services. However, if you live in assisted living and need skilled home health care (physical therapy, wound care, skilled nursing), Medicare may cover those specific medical services provided in your assisted living apartment. The facility charges for room, board, and personal care are not covered.
Medicare Advantage (Part C) replaces Original Medicare and is provided by private insurance companies. It includes all Part A and Part B coverage, usually Part D, and often additional benefits. Medigap (Medicare Supplement Insurance) works alongside Original Medicare to help pay your out-of-pocket costs like deductibles, coinsurance, and copayments. You cannot have both Medicare Advantage and Medigap—it's one or the other.
Medicare does not cover custodial home care (help with bathing, dressing, meal preparation, etc.) when that's the only type of care needed. Medicare only covers home health care when skilled medical services are required. If your parent needs skilled care (nursing, physical therapy), Medicare may cover part-time home health aide services in addition to the skilled care. For long-term personal care assistance, you'll need to explore Medicaid (if eligible), long-term care insurance, or private pay options.
Medicare covers up to 100 days per benefit period in a skilled nursing facility. Days 1-20 are fully covered. Days 21-100 require $217 per day coinsurance in 2026. After day 100, Medicare coverage ends, and you're responsible for all costs. To qualify, you must have a 3-day qualifying hospital stay, enter the SNF within 30 days, need daily skilled care, and be in a Medicare-certified facility.
Yes. Medicare Part B covers physical therapy at home if you're homebound, your doctor orders it, it's provided by a Medicare-certified home health agency, and it's medically necessary. You pay nothing for the therapy visits after meeting your Part B deductible ($283 in 2026). This coverage is unlimited as long as you continue to show improvement and meet the medical necessity requirement.
After 100 days, Medicare coverage ends for that benefit period. You would need to pay privately or apply for Medicaid if you meet eligibility requirements. Medicaid covers long-term nursing home care for individuals with limited income (under $2,982/month in most states) and assets (under $2,000). Alternatively, if you have long-term care insurance, it may cover extended stays. Some people qualify for a new Medicare benefit period if they go 60 consecutive days without inpatient care.
Medicare coverage can be complex. Explore our guides to learn about specific care options and how to pay for senior care services.
- 2026 Medicare Parts A & B Premiums and Deductibles | CMS
- What You'll Pay in Out-of-Pocket Medicare Costs in 2026 | NCOA
- Medicare Costs | Medicare.gov
- Get Started with Medicare | Medicare.gov
- Skilled Nursing Facility Care | Medicare.gov
- Home Health Services Coverage | Medicare.gov
- Medicare Eligibility: Age, Qualifications and Requirements | Humana
- Does Medicare Cover Home Health Care and Home Care? | A Place for Mom
- Does Medicare Pay for Assisted Living? | Humana
- Repeal the 3-Day Hospital Stay Requirement | Center for Medicare Advocacy