Navigating Medicare, Medicaid, and Health Insurance for an Aging Parent Cheat Sheet

Updated 2026-07-31

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Once a parent turns 65, health insurance stops being one decision and becomes an annual, multi-payer puzzle: Original Medicare, Medicare Advantage, Medigap, Part D, and sometimes Medicaid all interact, and a wrong choice made at 65 can lock in higher costs for years. This sheet is written for the adult child or caregiver who needs to understand how the pieces fit together well enough to sit beside a parent during enrollment season, read a denial letter, or pick a drug plan without guessing. The single biggest mental model to hold onto: Original Medicare and Medicare Advantage are two different systems for delivering the same government benefit, one pays doctors directly with a government fee schedule and no network, the other hands your parent's Medicare dollars to a private insurer that runs its own network and rules, and almost every other decision here, Medigap, drug coverage, dual eligibility, flows from which of those two paths a parent is on.

What This Cheat Sheet Covers

This topic spans 14 focused tables and 110 indexed concepts. Below is a complete table-by-table outline of this topic, spanning foundational concepts through advanced details.

Table 1: Medicare Basics — The Four Parts and Who QualifiesTable 2: Enrollment Periods — When to Sign UpTable 3: Special Enrollment Period (SEP) TriggersTable 4: Late Enrollment PenaltiesTable 5: 2026 Original Medicare Costs (Parts A, B, D)Table 6: Medicare Advantage (Part C) — Plan TypesTable 7: Original Medicare vs. Medicare Advantage — Key TradeoffsTable 8: Medigap (Medicare Supplement Insurance)Table 9: Part D Prescription Drug CoverageTable 10: What Medicare Covers (and Doesn't) for Long-Term CareTable 11: Medicare + Medicaid Dual Eligibility and Savings ProgramsTable 12: Appealing a Denied ClaimTable 13: Coordinating Benefits Across Multiple PayersTable 14: Caregiver Toolkit — Access, Fraud Protection, and Help

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Table 1: Medicare Basics — The Four Parts and Who Qualifies

Medicare is a federal health insurance program built from four lettered parts that each cover a different slice of care; understanding what each letter actually buys is the foundation for every other decision on this sheet.

Part	Example	Description
Part A (Hospital Insurance)	`Inpatient hospital, skilled nursing facility (limited), hospice, some home health`	• Covers inpatient hospital stays, hospice, and short skilled-nursing stays • Free for most people who worked 40+ quarters (10 years)
Part B (Medical Insurance)	`Doctor visits, outpatient care, preventive screenings, durable medical equipment`	Covers outpatient medically necessary and preventive services; carries a monthly premium for nearly everyone.
Original Medicare	`Part A + Part B, billed by the federal government`	The traditional fee-for-service program run directly by the government, no provider network.
Medicare Advantage (Part C)	`HMO, PPO, PFFS, or SNP plan sold by a private insurer`	A private-insurer alternative to Original Medicare that must cover everything Part A/B covers, usually bundles Part D and extras.

Table 1: Medicare Basics — The Four Parts and Who Qualifies

Part	Example	Description
Part A (Hospital Insurance)	`Inpatient hospital, skilled nursing facility (limited), hospice, some home health`	• Covers inpatient hospital stays, hospice, and short skilled-nursing stays • Free for most people who worked 40+ quarters (10 years)
Part B (Medical Insurance)	`Doctor visits, outpatient care, preventive screenings, durable medical equipment`	Covers outpatient medically necessary and preventive services; carries a monthly premium for nearly everyone.
Original Medicare	`Part A + Part B, billed by the federal government`	The traditional fee-for-service program run directly by the government, no provider network.
Medicare Advantage (Part C)	`HMO, PPO, PFFS, or SNP plan sold by a private insurer`	A private-insurer alternative to Original Medicare that must cover everything Part A/B covers, usually bundles Part D and extras.