Medicare
Understand Medicare vs. Medicaid, enrollment, and how to check eligibility for your family.
Overview
Medicare is the federal health insurance most people qualify for at 65, but its structure trips up nearly every family. It comes in parts: Part A (hospital), Part B (doctors and outpatient care), Part C (Medicare Advantage, which bundles coverage through private plans), and Part D (prescriptions). The single most important thing for caregivers to understand is what Medicare does not cover: long-term custodial care, the ongoing help with bathing, dressing, and supervision that most aging parents eventually need. Medicare covers short-term, skilled care after qualifying events, not indefinite personal care. Enrollment timing also matters; missing your Part B enrollment window can result in a late-enrollment penalty that lasts as long as you have Part B coverage. Every year, the Medicare Annual Open Enrollment Period (October 15–December 7) is the one window when your parent can change Medicare Advantage or Part D coverage in any direction, and it's worth a look even for a plan that's worked fine for years, since premiums, drug coverage, and provider networks can all change on January 1.
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Frequently Asked Questions
What is the difference between Medicare and Medicaid?
Medicare is federal health insurance based mostly on age or disability and it is not means-tested. Medicaid is a joint federal and state program for people with limited income and assets, and in Illinois it is the primary payer for long-term nursing home care. Some people qualify for both, which is usually described as being dual eligible.
Does Medicare pay for a nursing home?
Only in narrow circumstances. Medicare can cover a limited stretch in a skilled nursing facility following a qualifying inpatient hospital stay, and it is designed for rehabilitation rather than permanent residence. Once a person needs ongoing custodial care, families are generally looking at private pay, long-term care insurance, veterans benefits, or Medicaid.
Original Medicare or Medicare Advantage?
There is no universally correct answer. It depends on which doctors and hospitals your parent uses, their prescriptions, how much they travel, and their tolerance for prior authorization. Networks and rules also change every year. This is exactly the kind of decision an Illinois SHIP counselor can walk through without earning a commission on the outcome.
Where can we get free, unbiased help?
The Illinois Senior Health Insurance Program, known as SHIP, offers free counseling from trained volunteers who do not sell insurance. Medicare.gov also has a plan comparison tool. Both are better first stops than a broker, since brokers are generally paid by the plans they are able to sell you.
When can my parent actually change their Medicare coverage?
The main window is October 15 through December 7 every year, with changes taking effect January 1. A separate, more limited window (January 1–March 31) exists only for people already on Medicare Advantage. See our Medicare Open Enrollment guide for exactly what each window allows.
Does it matter which Medicare plan my parent had last year?
It matters enough to check every fall, not just when something changes. Even a plan that worked well last year can raise premiums, change which pharmacies or doctors are in-network, or move a medication to a more expensive tier for the new year, and none of those changes require your parent to do anything for them to take effect.