This is one of the first questions people ask when they become eligible for Medicare — and it is a genuinely good question, because the answer is more specific than most people expect.
Medicare is not a single, all-encompassing health insurance program. It is a collection of separate parts, each covering different types of care, and each with its own rules, costs, and enrollment window. Understanding what each part covers — and equally important, what it does not — is the foundation of every smart Medicare decision.
This guide is written for Cape Coral residents and others in Lee County who are new to Medicare, or who have been on Medicare for a while but have never fully understood the details. Think of it as a classroom explanation, not a sales pitch. My name is Brian Barrett. I spent 25 years as a teacher and school principal before becoming a licensed Medicare insurance advisor in Cape Coral, and I still approach Medicare the same way I approached every lesson: with patience, clarity, and respect for your time.
Let us go through it piece by piece.
Medicare Comes in Four Parts — Here Is What Each One Covers
Understanding Medicare starts with knowing that the program is divided into four parts, each with a specific role.
Medicare Part A, Part B, Part C, and Part D are not optional add-ons — they are the structure of the program itself. Here is what each one covers.
Medicare Part A — Hospital Insurance
Part A covers care that requires an overnight stay or facility-based treatment. This includes:
- Inpatient hospital care — rooms, meals, nursing care, and drugs administered during a hospital stay
- Skilled nursing facility care — short-term rehab or skilled nursing after a qualifying hospital stay of at least three days
- Hospice care — end-of-life care for individuals with a terminal diagnosis, including pain management, counseling, and support services
- Some home health care — intermittent skilled nursing care, physical therapy, or speech therapy provided at home under a doctor’s order
Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working. You will still pay deductibles and coinsurance for hospital and skilled nursing stays.
Medicare Part B — Medical Insurance
Part B covers the healthcare services you receive as an outpatient — in other words, care that does not require an overnight hospital stay. This includes:
- Doctor visits — primary care and specialist appointments
- Preventive services — annual wellness visits, certain screenings (cancer, cardiovascular, diabetes), flu shots, and other preventive care at no cost to you in most cases
- Outpatient procedures — surgeries and treatments performed in a clinic or doctor’s office without an overnight stay
- Durable medical equipment — wheelchairs, walkers, oxygen equipment, and other devices prescribed by your doctor for home use
- Mental health services — outpatient counseling and therapy
- Ambulance services — when medically necessary
- Some chemotherapy and immunotherapy — drugs administered in a clinical setting
Part B requires a monthly standard premium — $185.00/month for most beneficiaries in 2026 — plus an annual deductible and coinsurance for most services after the deductible is met.
Medicare Part C — Medicare Advantage
Medicare Advantage plans are an alternative way to receive your Medicare benefits. They are offered by private insurance companies that contract with Medicare, and they are required to cover everything Original Medicare covers — at minimum.
The key distinction is that Medicare Advantage plans bundle Part A and Part B together, and most also include Part D prescription drug coverage in a single plan. Many Medicare Advantage plans in Florida also offer additional benefits that Original Medicare does not cover, such as dental cleanings, vision exams, hearing aids, and gym memberships.
The trade-off is that Medicare Advantage plans operate with provider networks, prior authorization requirements for some services, and yearly limits on out-of-pocket spending. Whether a Medicare Advantage plan makes sense depends entirely on your doctors, your medications, and how you use healthcare.
Medicare Part D — Prescription Drug Coverage
Part D covers outpatient prescription medications. It is offered through private insurance companies as a standalone plan (if you have Original Medicare) or as part of a Medicare Advantage plan that includes drug coverage.
Each Part D plan has its own formulary — a list of covered drugs organized by tier — and its own pharmacy network. Formularies and pharmacy networks change annually, which is one reason why reviewing your Part D coverage during the Medicare Annual Enrollment Period matters.
What Original Medicare Does NOT Cover
This is where many new Medicare beneficiaries get a surprise. Despite comprehensive hospital and medical coverage, Original Medicare leaves some significant gaps.
Long-term care (custodial care): Medicare does not pay for long-term nursing home care or assisted living — the kind of care people need when they can no longer perform daily activities like bathing, dressing, or eating on their own. This is one of the most common and costly misunderstandings about Medicare coverage.
Routine dental care: Original Medicare does not cover cleanings, fillings, crowns, extractions, or dentures. Some Medicare Advantage plans offer dental benefits — but these vary widely, so check the specifics of any plan you are considering.
Routine vision care: Eye exams for glasses or contact lenses, glasses themselves, and contact lenses are not covered by Original Medicare. Medicare does cover cataract surgery and certain eye disease treatments, but routine vision care requires a separate plan or a Medicare Advantage plan that includes vision benefits.
Hearing aids and routine hearing exams: Original Medicare does not pay for hearing aids or the exams required to fit them. This is a significant gap for many seniors, given that hearing loss is one of the most common conditions among Americans over 65.
Care outside the United States: Original Medicare generally does not cover healthcare received outside the United States, except in very limited circumstances (certain emergency care in Canada or Mexico, for example, while traveling directly between Alaska and another state).
Medicare Supplement Plans: How They Work with Original Medicare
Medicare Supplement plans — also called Medigap — are designed specifically to fill the gaps that Original Medicare leaves behind. They are sold by private insurance companies and are designed to work alongside your Original Medicare coverage.
When you have a Medigap plan, Medicare pays its share of your covered healthcare costs first, and then your Supplement plan pays its share. This can significantly reduce or eliminate your out-of-pocket costs for hospital and medical services covered under Parts A and B.
Key facts about Medicare Supplement plans:
- You must have Original Medicare to buy a Medigap plan — you cannot have a Supplement plan and a Medicare Advantage plan at the same time
- Each Medigap plan is standardized by the federal government — Plan G in Florida covers the same benefits as Plan G in Ohio, though prices vary by insurance company
- Medical underwriting may apply if you enroll outside your Medigap Open Enrollment Period — this is why many people choose their Supplement plan when they first enroll in Medicare
- Medigap does not include prescription drug coverage — you will still need a separate Part D plan for medications
If you are approaching 65, understanding the difference between Medicare Advantage and Original Medicare plus a Supplement is one of the most important healthcare decisions you will make. Our guide on How Medicare Works in Florida covers this in more depth.
When to Enroll in Medicare
Most people become eligible for Medicare when they turn 65. Your Initial Enrollment Period is a seven-month window that begins three months before your 65th birthday month, includes your birthday month, and ends three months after your birthday month.
If you are turning 65 in Cape Coral, now is the time to understand your options — not after your enrollment window closes.
If you are already on Medicare and reviewing your coverage, the Annual Enrollment Period (October 15 – December 7) is your annual opportunity to make changes. Even if you are satisfied with your current plan, it is worth taking 30 minutes to review what has changed.
Frequently Asked Questions
Does Medicare cover everything?
No. Original Medicare covers a wide range of hospital and medical services, but it does not cover long-term care, routine dental care, routine vision care, hearing aids, or care received outside the United States. Medicare Advantage plans may cover some of these services, depending on the specific plan.
How do I get prescription drug coverage through Medicare?
You enroll in a Medicare Part D prescription drug plan during your Initial Enrollment Period, Annual Enrollment Period, or a Special Enrollment Period if you qualify. Part D plans are sold by private insurance companies and vary by formulary, pharmacy network, and monthly premium. Review your Part D coverage annually to confirm your medications are still covered at the lowest cost.
Does Medicare cover dental and vision?
Original Medicare does not cover routine dental or vision care. Some Medicare Advantage plans sold in Florida include dental and vision benefits — these vary by plan and carrier. If dental and vision coverage is important to you, compare Medicare Advantage plans in Lee County during your enrollment window.
Can I have both Medicare Supplement and Medicare Advantage?
No. By federal law, you cannot hold a Medicare Supplement plan and a Medicare Advantage plan at the same time. One strategy is to start with a Medicare Advantage plan when you first enroll (often with low or no monthly premium) and switch to Original Medicare plus a Supplement later if you want broader provider access — though medical underwriting may apply at that point.
When should I review my Medicare coverage?
At minimum, once during the Annual Enrollment Period (October 15 – December 7). Major life changes — a new diagnosis, a move, losing employer coverage, or a change in your plan’s network — are all reasons to review sooner. A free consultation with a licensed Medicare advisor can help you understand whether your current coverage still fits.
Questions About What Medicare Covers for Your Situation?
Medicare coverage decisions are personal. What covers one person’s situation well may not fit another’s — and that is exactly why options exist. Whether you are approaching 65 for the first time or reviewing your current coverage, understanding the differences between what Medicare covers under each part is the first step to making a confident decision.
Brian Barrett is a licensed Medicare insurance advisor in Cape Coral, serving Lee County and Southwest Florida. He offers free, no-pressure consultations where he walks through your specific situation — your doctors, your medications, your health history — without pitching a plan until you understand all your options.
Call 239-980-8599 or visit srhealthinsurancepros.com to schedule a free consultation.
Brian Barrett is a licensed Medicare insurance advisor in the state of Florida. License #W483785.
Language assistance services and auxiliary aids are available free of charge to individuals with disabilities and to those with limited English proficiency. To request language assistance or an auxiliary aid, please contact us at 239-980-8599.
