Medicare has four parts — A, B, C, and D — and each one covers something different. If you are approaching 65 or helping a parent navigate enrollment in Cape Coral or Lee County, understanding what each part does (and does not do) is the foundation for every good decision that follows.
The alphabet soup can feel overwhelming at first. But once you see how the parts fit together, it becomes much clearer — and so does the reason why many Floridians choose to add a Medicare Supplement or Advantage plan on top of Original Medicare.
This guide breaks down each part in plain English. No jargon, no assumptions, no pressure. Just a clear picture of how Medicare is structured so you can make informed choices.
For context on how Medicare works overall in the state, see How Does Medicare Work in Florida?
Medicare Part A: Your Hospital Coverage
Part A is often called hospital insurance. It covers:
- Inpatient hospital stays — care you receive after you have been formally admitted as a hospital inpatient
- Skilled nursing facility (SNF) care — short-term rehabilitative care following a qualifying hospital stay of at least three days
- Home health services — limited medically necessary care provided in your home
- Hospice care — comfort-focused care for those with a terminal diagnosis
What You Pay With Part A
Part A has a deductible that applies per benefit period — not per year. A benefit period begins when you are admitted and ends 60 days after you have been out of the hospital or SNF. If you are hospitalized again after that 60-day gap, a new benefit period (and a new deductible) begins.
After a certain number of days in a hospital stay, daily coinsurance costs kick in. For skilled nursing, there is no cost-share for the first 20 days, followed by a daily coinsurance amount for days 21–100. After 100 days, Medicare stops covering SNF care entirely for that benefit period.
Most people do not pay a premium for Part A if they or their spouse worked and paid Medicare taxes for at least 40 quarters (10 years). This is sometimes called “premium-free Part A.”
The coverage gap to know about: Part A does not cover long-term custodial care — help with bathing, dressing, and daily activities that you need indefinitely. That is a separate category that Medicare does not address.
Medicare Part B: Your Outpatient Coverage
Part B covers medically necessary outpatient services, including:
- Doctor visits — primary care and specialist appointments
- Outpatient surgery and procedures
- Lab work and diagnostic imaging
- Preventive services — annual wellness visits, certain screenings, and vaccines
- Durable medical equipment (DME) — wheelchairs, walkers, CPAP machines
- Mental health services — outpatient therapy and counseling
- Ambulance services
What You Pay With Part B
Part B has a standard monthly premium. For 2026, the standard Part B premium is $185.00 per month. Higher-income beneficiaries pay more through a surcharge called IRMAA (Income-Related Monthly Adjustment Amount).
There is also an annual Part B deductible. Once you meet that deductible, Medicare pays 80% of covered services. You pay the remaining 20% — and there is no out-of-pocket maximum under Original Medicare alone.
That 20% coinsurance with no cap is one of the most important facts in all of Medicare. If you have a serious illness or a major surgery, 20% of a very large bill is still a very large number. This is the gap that Medicare Supplement plans are designed to address. Learn more about Medicare Supplements and how they work alongside Part B.
Part B enrollment is not automatic for everyone. If you are not receiving Social Security benefits when you turn 65, you need to actively enroll. Missing your enrollment window can trigger permanent premium penalties.
Medicare Part C: Medicare Advantage
Part C is not a separate set of benefits — it is a delivery mechanism. Medicare Advantage plans are offered by private insurance companies that have contracted with Medicare to provide your Part A and Part B benefits (and usually Part D drug coverage) in a bundled product.
When you enroll in a Medicare Advantage plan, you are still in Medicare — but you receive your care through the private plan rather than directly through Original Medicare.
Key Characteristics of Medicare Advantage
- Plans typically operate with network restrictions (HMO or PPO structures)
- Most plans include prescription drug coverage (Part D) bundled in
- Plans may include extra benefits not covered by Original Medicare, such as dental, vision, hearing, and fitness programs
- Plans have their own cost-sharing structures — copays, deductibles, and an annual out-of-pocket maximum
- The out-of-pocket maximum is a meaningful protection that Original Medicare lacks on its own
Each plan sets its own cost-sharing rules. Some plans have very low or $0 additional monthly premiums (you still pay your Part B premium regardless). Others have higher monthly premiums in exchange for lower copays or richer benefits. The plan’s formulary determines which drugs are covered and at what cost.
Medicare Advantage plans are reviewed and can change their benefits, networks, and premiums each year. An annual review is important to make sure your plan still meets your needs.
Medicare Part D: Prescription Drug Coverage
Part D covers prescription drugs. It is offered through private insurance companies and can be purchased as a standalone plan alongside Original Medicare (and a Medigap policy), or it comes bundled inside most Medicare Advantage plans.
How Part D Works
Each Part D plan has a formulary — a list of covered drugs organized into tiers. Lower-tier drugs (generics) typically have lower copays. Higher-tier drugs (brand-name, specialty) cost more. Not every drug is on every plan’s formulary, and plans can change their formularies from year to year.
Part D plans have a deductible, then move through coverage phases. In recent years, federal legislation has changed the structure of Part D, including placing a cap on annual out-of-pocket drug costs for Medicare beneficiaries. The specifics of each plan’s cost structure vary — comparing formularies during open enrollment is essential if you take regular medications.
Important: If you do not enroll in Part D when you first become eligible, and you do not have other creditable drug coverage, you may face a permanent late enrollment penalty. This penalty is added to your monthly Part D premium for as long as you have Medicare.
The Gap That Supplements Fill — and Why It Matters
Original Medicare — Parts A and B — covers a great deal. But it leaves real financial exposure:
- Hospital deductibles per benefit period
- Daily coinsurance after extended hospital stays
- The unlimited 20% coinsurance on Part B services with no out-of-pocket cap
- Part A deductibles for skilled nursing
Medicare Supplement plans (Medigap) are designed to fill these gaps. They are standardized by the federal government, meaning a Plan G sold by one company covers exactly the same services as a Plan G from any other company. What differs is the monthly premium.
For Cape Coral and Lee County seniors who want the predictability of knowing what their healthcare will cost, a Supplement alongside Original Medicare and a Part D plan is a powerful combination. For others, a Medicare Advantage plan (Part C) that bundles all the coverage together may be the right fit.
There is no universal answer. The right structure depends on your health, your doctors, your medications, and your financial priorities. Contact us to talk through your specific situation.
Frequently Asked Questions: Medicare Parts Explained
Do I have to enroll in all four parts of Medicare?
No. Part A enrollment is usually automatic if you are receiving Social Security. Part B requires active enrollment, and you can delay it under certain circumstances (such as when you have qualifying employer coverage). Parts C and D are optional, though declining Part D when first eligible — without other creditable coverage — can trigger penalties.
If I enroll in a Medicare Advantage plan (Part C), do I still need Part D?
Most Medicare Advantage plans already include Part D drug coverage. Check your specific plan. If your Advantage plan does not include drug coverage, you may need a standalone Part D plan, though this is less common.
What is the difference between Medicare and Medicaid?
Medicare is a federal health insurance program based on age (65+) or disability. Medicaid is a joint federal-state program based on income. Some people qualify for both — called “dual eligibles” — and can receive coordinated benefits. The eligibility rules are separate.
Can I change my Medicare Advantage plan or drug plan each year?
Yes. The Annual Enrollment Period (AEP), which runs from October 15 through December 7 each year, allows you to switch Medicare Advantage plans, switch Part D plans, or return to Original Medicare with a Supplement.
Talk to an Independent Medicare Advisor in Cape Coral
Have questions about your Medicare options? Brian Barrett has been helping Cape Coral and Lee County seniors navigate Medicare since 2018. Call 239-980-8599 or visit srhealthinsurancepros.com to schedule a free, no-pressure consultation. Serving Cape Coral, Fort Myers, Bonita Springs, and all of Lee County, FL.
Brian Barrett is a licensed insurance agent. 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.
