Health & Benefits

Generally, people 65 and over are eligible for premium-free Medicare Part A, if they are eligible for or receiving social security retirement or survivor benefits. This usually requires 40 plus quarters of employment, where someone paid Medicare taxes.

People under age 65 are eligible for premium-free Medicare if:

• They are entitled to receive Social Security Disability A federal program that gives money to people who cannot work because of a disability Insurance (SSDI) benefits or railroad retirement board disability A substantial impairment that functionally limits a person in carrying out major life activities, such as walking, lifting, seeing, or learning. benefits for at least 24 months,
• They have Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s disease), or
• They have End-stage Renal Disease (ESRD).

A person can also qualify for premium-free Medicare if they are the spouse or child of a qualified worker. Surviving spouses and children of deceased qualified workers may also be eligible.

They can enroll in Medicare Part A, and pay a monthly premium. A person can enroll with a monthly premium if:

• They are over 65 and either a US citizen or a lawful permanent resident (LPR or green card holder) who has been present in the US for at least five years, or
• They are a person with disabilities who stopped receiving SSDI because of their employment income.

For 2026, the premium cost is $565 per month for people who have less than 30 quarters of Medicare-covered employment. The price is $311 per month for people having 30-39 quarters of Medicare-covered employment. A quarter is three months in a year.

Services covered include:

• Inpatient hospital care, including psychiatric care,
• Skilled nursing facility care,
• Hospice care, and
• Some home health care, such as physical therapy, occupational therapy, and medical social service.

Learn more about covered home health services on the Medicare website.  Some home health care is also covered under Part B.

Centers for Medicare and Medicaid Services (CMS) issues Medicare & You. It has a thorough summary of covered services.

Medicaid recipients do not need to file a claim for coverage of a Part A covered service. The hospital, nursing home, or other provider submits the claim.

After the claim is filed, the patient will then receive a Benefits Notice explaining how much was paid. It will tell them the amount they are responsible for paying, if any.

A benefit period is the time someone spends in an inpatient hospital, or skilled nursing facility (SNF). A benefit period begins the day someone enters the hospital as an inpatient or an SNF. It ends when they have been out of the hospital or SNF for 60 straight days. A new benefits period begins after the last one ends and they are newly admitted to a hospital.

There is no limit to the number of benefit periods someone can have. Part A will only pay for up to 90 days of inpatient hospital care during a single benefit period. Medicare Part A recipients have 60 lifetime reserve days that can be used to cover days beyond the 90th day.

If treatment of an illness or injury is medically required, Medicare covers the hospital costs. But, the hospital stay must be medically necessary.

During the first 60 days of a hospital stay, Medicare pays the entire costs. In 2026, the Part A recipient must pay a $1,736 deductible in 2026 and no coinsurance for days 1 - 60 of each benefit period.

During the 61st to the 90th days, they must pay a coinsurance amount. As of 2026, this amount is $434 per day. For any lifetime reserve days used beyond the 90th day, the coinsurance amount is higher. As of 2026, that amount is $868 per day. Unless someone has supplemental insurance, they are responsible for all costs beyond their lifetime reserve days.

Part A pays for the following things:

• A semi-private room,
• Meals,
• Regular nursing and rehab services,
• Drugs and medical supplies administered during the hospital stay,
• Lab tests,
• X-rays,
• Operating and recovering rooms,
• Intensive care, and
• Other medically necessary services provided while in hospital.

Medicare does not cover:

• Personal convenience items,
• Telephone use or private duty A legal obligation to do something nursing, or
• Extra charges for a private room (unless medically necessary).

Medicare helps pay for inpatient mental health services in a hospital. This care can be in a general hospital or in a psychiatric hospital.

There’s no limit to the number of benefit periods when receiving care in a general hospital. A person can have multiple benefit periods when you get care in a psychiatric hospital. There is a lifetime limit of 190 days.

As of 2026, Part A recipients pay:

• $1,736 for each benefit period,
• $0 deductible for days 1-60 of each benefit period, and
• $434 per day coinsurance payment for days 61-90 of each benefit period.

Medicare covers medically necessary care in a skilled nursing facility (SNF) if:

• A person was hospitalized for at least three consecutive days before entering the nursing facility. This does not include the day of discharge,
• They were admitted to the facility shortly after leaving the hospital (usually within 30 days), and
• The condition for which they are in the nursing facility was treated or arose while they were hospitalized.

Part A pays for the full cost of the first 20 days in an SNF. During the 21st to the 100th day, the Part A recipient must pay coinsurance. As of 2026, the amount is $217 per day. Medicare does not cover any days beyond the 100th day.

If someone leaves an SNF and are re-admitted within 30 days for the same condition, Medicare will resume coverage up to the 100th day.

Medicare covers hospice care if someone is terminally ill. This means a doctor confirms that the patient's life expectancy is six months or less. Hospice care is usually provided in a person’s home. But, inpatient respite care is covered, too. Different parts of Medicare can also cover:

• Homemaker services,
• Counseling, and
• Some prescription medications.

The patient may pay:

• A copayment of up to $5 for each prescription drug and other similar products for pain relief and symptom control while you are at home, and
• Up to 5% of the Medicare-approved amount for inpatient respite care.

Medicare covers the following home health care items:

• Part-time or intermittent skilled nursing services,
• Home health aide service,
• Physical, speech-language, and occupational therapy, and
• Medical supplies provided by the home health agency.

To be eligible for home health care services, a person must be confined to their home. Their doctor must establish a care plan. 

Medicare covers 80% of the Medicare approved amount of durable medical equipment needed to help someone stay in their home. It also covers all the costs for home health care services. The rate at which home health care agencies are reimbursed has been greatly reduced. As a result, it may be difficult to locate a provider for home health care services.

Home health services will be covered for as long as part-time or intermittent skilled services are needed because someone is “homebound.” A person is homebound if:

• They have trouble leaving their home without help because of an illness or injury,
• Leaving their home is not recommended because of their condition, or
• They are normally unable to leave their home because it is a major effort.

A person may qualify for a personal attendant or other home services. State programs offering these services include:

• Illinois Department on Aging’s Community Care Program
• Illinois Department of Human Services’ Home Services Program