Sam Swartz, Author at Senior Health Insurance Professionals

Your Medicare Annual Review: 5 Reasons to Shop Your Plan Every Year

If your car insurance premium went up and you never checked the market, you would probably feel pretty foolish. The same logic applies to Medicare — and every year, starting October 15, you get a fresh window to do something about it.

What Is the Medicare Annual Enrollment Period?

The Medicare Annual Enrollment Period — commonly called AEP — runs from October 15 through December 7 every year. It is the one time when all Medicare beneficiaries have a guaranteed, no-questions-asked opportunity to change their coverage for the coming year.

If you are currently enrolled in a Medicare Advantage plan or a Medicare Part D prescription drug plan, this is your annual window to reassess. Even if you are on Original Medicare with a Supplement plan, the period matters for Part D decisions and for checking whether your coverage still fits.

Brian Barrett, a licensed Medicare insurance advisor in Cape Coral with 25 years of experience in education before becoming an insurance advisor, has guided hundreds of Lee County residents through this process. “Most people set their plan and forget it,” he says. “But plans change every year — and so do your health needs.”

Here are five reasons to take this window seriously.

1. Your Plan’s Premium, Deductible, and Out-of-Pocket Costs Can Change Every Year

This is the most straightforward reason to review your coverage annually. Medicare Advantage plans and Part D prescription drug plans file their changes with CMS each year, and those changes take effect on January 1.

What might be different next year?

Your monthly premium may increase — or decrease
Your prescription drug deductible may reset
Your out-of-pocket maximum (the most you pay before plan coverage kicks in fully) can change
Your coinsurance and copay amounts for specific services may be adjusted

These may sound like small numbers individually, but taken together, they can add hundreds of dollars to your annual healthcare spending. A Medicare Advantage plan in Southwest Florida that looked good in January 2025 may no longer be the most cost-effective option for your situation in 2026.

During AEP, you can compare the actual cost structures of every available plan in Lee County — not just the one you currently hold. That comparison is the only way to know whether you are paying more than you need to.

2. Your Doctors and Medications May No Longer Be Covered the Same Way

Medicare Advantage plans in Florida operate with defined provider networks. These networks can change from one plan year to the next — a specialist you see regularly might leave the network, or a hospital in your area might no longer be in-network for your specific plan.

The same applies to prescription drug coverage. Each Medicare Part D plan has a formulary — a list of covered drugs — that is updated annually. A medication you take regularly might move to a higher cost tier, or it might be removed from your plan’s formulary entirely and replaced with a different covered alternative. These changes are not optional or negotiable; they are the plan’s terms for the coming year.

If you had surgery, received a new diagnosis, or started seeing new specialists over the past year, your network coverage may no longer be the right fit. A Medicare Advantage plan that covered your doctors well in 2025 may not do so in 2026 — unless you make a change during AEP.

Before the December 7 deadline, confirm that your current plan still covers your pharmacy, your prescriptions, and the providers you actually use.

3. New Plans Enter the Market and Old Ones Exit

Every year, insurance carriers introduce new Medicare Advantage and Part D plans — and some plans are discontinued. A carrier that did not serve Lee County last year may now offer a plan in your zip code. A plan you have held for several years may have been discontinued or significantly restructured.

This is not hypothetical. In 2025 and 2026, multiple national carriers reduced their Medicare Advantage footprint in Florida counties, leaving some beneficiaries needing to find new coverage. If you missed a notification that your plan was exiting the market, you may be defaulting to a different plan structure — or finding yourself without the coverage you expected.

Reviewing what is available during AEP means you choose your plan with full information, rather than being assigned one by default.

4. Your Health Situation Has Probably Changed — Your Plan Should Reflect That

Medicare is used by people with evolving health needs. A plan that was appropriate two years ago may no longer fit your current situation.

Consider what might have changed over the past year:

A new diagnosis that requires regular specialist visits or specific medications
A planned surgery or procedure where you want to understand your hospital and rehab coverage
Increased or decreased usage of prescription drugs that changes which Part D tier makes the most financial sense
A change in your ability to manage out-of-pocket costs that makes a lower-premium/higher-deductible plan less attractive

Nobody knows your health situation better than you do. If your circumstances have shifted, that is a reason to sit down with an independent Medicare agent and look at your options honestly — not a reason to simply re-enroll in the same plan out of habit.

5. Medicare Advantage vs. Original Medicare + Supplement: Your Needs May Have Shifted

One of the most important decisions in Medicare is choosing between Medicare Advantage vs. Original Medicare with a Supplement. This decision deserves revisiting every few years, and AEP is the right time to do it.

Medicare Advantage plans bundle your hospital, medical, and often drug coverage into a single plan — sometimes with additional benefits like dental, vision, and hearing. They typically have lower monthly premiums than buying Supplement plans separately, but they come with prior authorization requirements, provider network restrictions, and yearly coverage limits.

Original Medicare plus a Supplement (Medigap) plan gives you broader access to any provider that accepts Medicare — which is the vast majority of providers nationwide — without network restrictions or prior authorization for most services. However, you will need a separate Part D plan for prescription drugs, and the combined monthly premium is typically higher.

If you enrolled in Medicare Advantage during a previous AEP but have since grown frustrated with network limitations, or if you have been on Original Medicare and Supplement for years and wonder whether Advantage might now make sense, AEP gives you the chance to explore that switch with full information.

Frequently Asked Questions

When is the Medicare Annual Enrollment Period?
The AEP runs from October 15 through December 7 every year. Any changes you make during this window take effect on January 1 of the following year.

Do I have to change plans during AEP if I am happy with my current coverage?
No. If your current plan still meets your needs and the costs have not changed significantly, you are not required to make changes. However, reviewing your plan is always recommended — your health needs and the plan’s terms can shift year to year without notice.

What can I change during the Annual Enrollment Period?
You can switch from one Medicare Advantage plan to another, switch from Medicare Advantage back to Original Medicare, add or drop a Part D prescription drug plan, or change Part D plans. You cannot make Medigap enrollment changes during AEP — that is governed by different rules.

How do I know if my current plan is still the best option for me?
Comparing plans requires looking at your specific doctors, medications, and anticipated healthcare needs for the coming year — not just the premium. That is exactly what an independent Medicare agent does. Brian Barrett offers complimentary Medicare reviews in Cape Coral with no sales pressure.

Can I get help reviewing my Medicare options in Cape Coral?
Yes. Brian Barrett is a licensed independent Medicare agent in Cape Coral, serving Lee County and Southwest Florida. He works with multiple carriers and can show you the full picture — not just one company’s options.

Talk to Brian Barrett, Cape Coral’s Medicare Advisor

If any of the five reasons above resonated with you, this is the right time to act. The Annual Enrollment Period closes December 7 — and planning ahead means you have time to make a thoughtful decision, not a rushed one.

Brian Barrett offers a free, no-pressure Medicare review for residents of Cape Coral, Fort Myers, and Lee County. He will go through your current coverage, explain what has changed, and show you what other options look like — without pitching a single plan until you have the full picture.

Get a free Medicare review — call 239-980-8599 or visit srhealthinsurancepros.com.

Brian Barrett is a licensed independent Medicare insurance advisor serving Cape Coral and Lee County, Florida. License #W483785.

We are not connected with or endorsed by the U.S. Government or the federal Medicare program. We do not offer every plan available in your area. Currently we represent [X] organizations which offer [Y] products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.

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.

Medicare Part D Drug Coverage Florida: What You Need to Know in 2026

Prescription medication costs are one of the most common concerns among Florida seniors on Medicare. If you are turning 65 — or if you are already on Medicare and reviewing your coverage — understanding how Medicare Part D works is essential to avoiding unexpected costs and making informed decisions about your healthcare.

This article explains Part D in plain terms: what it covers, how it is structured, how the coverage gap works, and what Florida residents need to know about enrolling.

What Medicare Part D Is — and What It Is Not

Medicare Part D is the voluntary outpatient prescription drug benefit available to all Medicare beneficiaries. It is offered by private insurance companies that are approved by Medicare — not by the federal government directly.

It is important to understand what Part D is not. Part D does not cover medications administered in a hospital or clinic setting (those are covered under Medicare Part A). It covers prescriptions you pick up at a retail pharmacy or through a mail-order arrangement with a participating plan.

Part D is available in two ways:

Medicare Advantage plans that include drug coverage. Most Medicare Advantage plans in Florida include Part D as part of their bundled offering. If you are enrolled in a Medicare Advantage plan, your drug coverage is typically built in; though you should always verify that your specific medications are on the plan’s formulary before enrolling.
Standalone Medicare Part D plans. If you have Original Medicare (Parts A and B) and want prescription drug coverage, you can purchase a standalone Part D plan from a private insurer. These plans work alongside your Original Medicare coverage.

Both options provide the same basic Medicare-approved drug coverage — the difference is whether you receive it bundled with your other Medicare benefits or as a separate plan.

How the Medicare Part D Standard Benefit Works

All Medicare Part D plans follow a structure set by Medicare, though specific costs: deductibles, premiums, and copayments vary by plan. Here is how the standard benefit works at a conceptual level:

Annual deductible: Many Part D plans have an annual deductible: an amount you pay out of pocket before the plan begins to cover your medications. Some plans waive the deductible for certain drug tiers, which can reduce your upfront costs.

Initial coverage phase: After you meet your deductible (or if your plan waives it), you enter the initial coverage phase. During this phase, you pay a copayment or coinsurance for each prescription, and the plan pays its share. How much you pay depends on the drug tier your medication falls under and whether your pharmacy is in the plan’s network.

The coverage gap (sometimes called the “donut hole”): Once the total cost of your medications; what you pay plus what the plan pays, reaches a certain threshold set by Medicare for that year, you enter the coverage gap. In the coverage gap, you are responsible for a larger share of your medication costs. This gap has been gradually closing under the Affordable Care Act, but out-of-pocket costs during this phase are still higher than in the initial coverage phase. Understanding whether your medications are likely to put you into the coverage gap is an important part of planning for annual drug costs.

Catastrophic coverage: Once your out-of-pocket spending reaches another threshold in a given year, you exit the coverage gap and enter catastrophic coverage. During this phase, the plan pays the majority of your drug costs for the rest of the year, and your cost-sharing drops significantly.

The exact dollar amounts for each phase change annually. Before enrolling or comparing Part D plans for any given year, check the current-year parameters on Medicare.gov or speak with a licensed advisor.

Florida Part D Plan Landscape

Florida has a robust Medicare Part D market. Multiple private insurance companies offer both standalone Part D plans and Medicare Advantage plans with drug coverage throughout the state. Plan availability, premiums, and formulary design (which drugs are covered at which tiers) vary by county.

What does not vary is the basic requirement: any Medicare beneficiary can enroll in a Part D plan, regardless of income or health status, during the appropriate enrollment window. Missing that window, however, can result in a permanent late enrollment penalty added to your premium — one of the most avoidable yet common mistakes Florida seniors make.

When to Enroll in Medicare Part D

Timing matters enormously with Part D. There are three main enrollment windows:

Initial Enrollment Period (IEP): When you first become eligible for Medicare — typically when you turn 65 — you have a seven-month window to enroll in Part D (three months before your birthday month, your birthday month, and three months after). If you enroll during this window, you pay the standard Part D premium with no late penalty.

Annual Enrollment Period (AEP): From October 15 through December 7 each year, you can join, switch, or drop a Part D plan. Changes take effect January 1 of the following year. If you are already enrolled in Part D but want to compare plans for the coming year, AEP is the time to do it.

Special Enrollment Periods (SEP): Certain life events — such as moving, losing current coverage, or qualifying for Extra Help (the Part D Low-Income Subsidy) — may qualify you for a Special Enrollment Period outside the standard windows.

One common misconception: some Florida seniors believe they do not need Part D because they do not currently take many medications. This can be a costly assumption. The late enrollment penalty is permanent — it does not go away once you eventually enroll. Even if you are healthy and take few prescriptions now, the IEP window only comes once.

Part D and the Extra Help Program in Florida

Medicare’s Extra Help program (also called the Part D Low-Income Subsidy) assists Medicare beneficiaries with limited income and resources pay for Part D premiums, deductibles, and prescription copayments. In Florida, many seniors may qualify for Extra Help and not realize it.

The eligibility thresholds for Extra Help change annually. If you are on a fixed income, it is worth checking whether you qualify — even partial Extra Help can meaningfully reduce your drug costs throughout the year. Your local Florida SHIP (State Health Insurance Assistance Program) office can help you determine whether you qualify and how to apply.

Frequently Asked Questions: Medicare Part D in Florida

Q: Do all Medicare Advantage plans in Florida include prescription drug coverage?
Most do, but not all. Some Medicare Advantage plans — particularly those designed for seniors who already have credible drug coverage through another source (such as VA benefits) — are offered as medical-only plans without drug coverage. Always verify whether drug coverage is included before enrolling in any Medicare Advantage plan.

Q: How do I know if my medications are covered by a Part D plan?
Each Part D plan publishes a formulary — a list of covered medications organized by tier. Plans may also have utilization management requirements such as prior authorization or step therapy for certain medications. Before enrolling in a Part D plan, confirm that your specific medications are on the plan’s formulary and check whether any restrictions apply.

Q: What happens if I miss my Initial Enrollment Period for Part D?
You can still enroll during the Annual Enrollment Period (October 15–December 7), but you may pay a permanent late enrollment penalty added to your monthly Part D premium. The penalty is calculated based on how long you went without Part D or other creditable drug coverage after you were first eligible. There are exceptions for beneficiaries who have credible coverage through another source.

Q: Can I use mail-order pharmacy with a Part D plan in Florida?
Most Part D plans offer mail-order pharmacy options, which can be convenient for maintenance medications you take regularly. Mail-order typically allows you to receive a 90-day supply of a medication for a lower cost-share than three 30-day fills at a retail pharmacy. Check whether your plan offers this option and whether your medications are eligible.

Q: Will my Part D coverage change from year to year?
Plan details — including formularies, tiers, pharmacy networks, and costs — can change annually. This is why reviewing your Part D coverage during the Annual Enrollment Period each year is a smart practice. A plan that was the best fit last year may no longer serve your needs the following year.

Talk to Brian Barrett About Medicare Part D in Florida

Have questions about how Medicare Part D works, whether a Medicare Advantage plan with drug coverage makes sense for your situation, or how to avoid the Part D late enrollment penalty? Brian Barrett is an independent Medicare insurance advisor in Cape Coral, Florida, with deep experience helping Florida seniors understand their Medicare options.

Call 239-980-8599 or visit srhealthinsurancepros.com to schedule a free, no-pressure consultation. Serving Medicare beneficiaries across Lee County and the broader Florida market.

Ready to get started? Contact Brian Barrett today.

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Medicare Advantage vs. Supplement Florida: Which Is Right for You?

If you have been researching Medicare coverage in Florida, you have probably run into a question that does not have a simple answer: Should you go with Medicare Advantage or Medicare Supplement?

Both are alternatives to Original Medicare. Both are sold by private insurance companies. And both are available to Florida residents eligible for Medicare. But that is where the similarities end.

These two paths work in fundamentally different ways, and the difference matters enormously when you are trying to predict your healthcare costs, choose your doctors, and sleep well at night knowing you are covered. This article walks through what every Florida resident approaching Medicare eligibility needs to understand before making that choice.

How the Two Paths Start the Same — and Then Diverge

Every Medicare beneficiary starts in the same place: Original Medicare, which includes Part A (hospital insurance) and Part B (outpatient and physician services). Medicare pays its share of your covered care — typically 80% — and you are responsible for the remaining 20% with no annual out-of-pocket cap.

That 20% gap is where the two paths diverge.

Medicare Supplement plans (also called Medigap) are designed to fill those gaps. They are standardized by the federal government — a Plan G from one company covers exactly the same services as a Plan G from any other company. What varies is the premium you pay and the financial strength of the insurer. With a Supplement, Original Medicare remains your primary coverage. You present your Medicare card first, and your Supplement pays what Medicare does not.

Medicare Advantage plans (known as Part C) take a different approach. Instead of supplementing Original Medicare, they replace it. A private insurer takes over your Medicare coverage entirely. You receive your hospital, outpatient, and typically your prescription drug benefits through that company’s plan. Most Medicare Advantage plans also bundle in dental, vision, and hearing coverage — though the scope of those benefits varies significantly by plan and carrier.

Same starting point. Two completely different structures after that.

Medicare Supplement in Florida: What Makes It Different

One of the most important things to understand about Medicare Supplement plans in Florida is how they are regulated and how that affects your coverage.

Medigap plans in Florida are federally standardized. That means when you compare Plan G or Plan N across any number of insurance companies, the benefits are identical. What changes is the premium, and premiums in Florida can vary substantially between carriers for the same plan letter. Shopping around matters in a way that is unique to the Supplement market.

Because Supplements work with Original Medicare, your coverage is accepted anywhere in the United States that Medicare is accepted. There are no networks to check, no referrals to manage, and no geographic restrictions. If you split your time between Florida and another state, or travel frequently, this nationwide coverage is a significant practical advantage.

Florida residents have a particularly important window for Medicare Supplement enrollment. Under federal law, you have a guaranteed-issue right to purchase a Medigap plan during your Medicare Open Enrollment Period — the six months that start when you are both 65 or older AND enrolled in Medicare Part B. During this window, insurers cannot deny you coverage or charge you higher premiums based on your health history. If you wait past this window, Florida insurers can use medical underwriting, which means your health history could affect your eligibility or your premium. This makes the initial enrollment decision particularly consequential in Florida.

The most popular Medigap plans for Florida residents are Plan G (which covers nearly everything Medicare does not, except the Part B deductible) and Plan N (which has slightly lower premiums in exchange for small copays at doctor and emergency room visits).

Medicare Advantage in Florida: Scale, Networks, and Extras

Florida is one of the most competitive Medicare Advantage markets in the country. The state’s large senior population, and the growth trajectory of that population, means major national carriers actively compete for Florida Medicare beneficiaries. That competition creates more plan options, which can be both an advantage and a source of confusion.

Medicare Advantage plans in Florida come primarily in two network structures:

HMO (Health Maintenance Organization): You choose a primary care physician and need referrals to see specialists. Your care is coordinated within a defined network. Services outside the network are generally not covered except in emergencies.
PPO (Preferred Provider Organization): You have more flexibility to see providers outside the plan’s network, though you will pay more for out-of-network care. Referrals are typically not required.

The network structure matters enormously in Florida, where some snowbird residents spend part of the year outside the state. An HMO plan with a strong Florida network may not cover care in another state at all outside of emergencies. A PPO provides more geographic flexibility but usually at a higher premium and higher cost-share.

Most Medicare Advantage plans in Florida include Part D prescription drug coverage bundled into the plan. This is one of the practical appeals of Medicare Advantage for many beneficiaries, having hospital, outpatient, and drug coverage in a single plan with a single monthly premium, often with no additional premium beyond what you already pay for Medicare Part B.

Many Medicare Advantage plans in Florida also advertise additional benefits: routine dental cleanings, eyeglass allowances, hearing aid coverage, and gym memberships. These extras vary by plan and change annually, they should not be the primary factor in your decision, but they are worth comparing once you have narrowed down the core coverage fit.

Comparing the Real Cost Picture for Florida Residents

Both paths can make financial sense depending on your health status, how often you uses healthcare, and what you can afford in monthly premiums.

With Medicare Supplement:
– You typically pay a higher monthly premium, often in the range of $150–$300 per month in Florida depending on the plan letter, your age, and the carrier
– Your out-of-pocket costs are more predictable: once you pay your premium and your Part B deductible, you have minimal exposure to additional cost-sharing
– You can budget for healthcare without worrying about surprise medical bills

With Medicare Advantage:
– Many plans have low or no additional monthly premium beyond your Part B premium ($185.00/month standard in 2026 for most beneficiaries)
– You pay cost-sharing as you use services: copays for doctor visits, coinsurance for procedures, and deductibles that may apply
– There is an annual out-of-pocket maximum under Medicare Advantage, which caps your total exposure, but that cap varies by plan and carrier

The lowest premium plan is not always the least expensive over the course of a year. If you have chronic conditions, see specialists regularly, or anticipate needing hospital care, the predictable cost structure of a Supplement may actually cost you less in total. If you are generally healthy and want to keep your monthly cash outlay low, Medicare Advantage may be the better fit.

Frequently Asked Questions: Medicare Advantage vs. Supplement in Florida

Q: Can I have both Medicare Advantage and a Medicare Supplement at the same time?
No. Medicare Supplement plans are designed to work with Original Medicare; they pay the gaps that Medicare leaves behind. Medicare Advantage replaces Original Medicare entirely. You cannot use a Medigap policy to cover costs under a Medicare Advantage plan. These are separate, mutually exclusive coverage paths.

Q: If I choose Medicare Advantage in Florida, can I switch to a Supplement later?
You can apply to switch at any time, but after your Medicare Open Enrollment Period closes, Florida insurers can use medical underwriting. Depending on your health history, you may be declined or charged a higher premium. If you are considering Medicare Advantage now but think you may want a Supplement later, discuss that trajectory with a licensed advisor before you enroll — the initial decision deserves long-term thinking.

Q: Are Medicare Supplement premiums in Florida the same for all companies?
No. The benefits under each standardized plan letter are identical, but premiums vary by company, your age at enrollment, and the pricing method the company uses (attained-age rating, issue-age rating, or community rating). Comparing premiums across carriers for the same plan letter is one of the most practical steps you can take to manage your Medicare costs in Florida.

Q: Do Medicare Advantage plans in Florida cover prescription drugs?
Most do, bundled into the plan as Part C. But you should always verify that your specific medications are on the plan’s formulary before enrolling. Formularies change annually, and what is covered on one plan may not be covered the same way on another.

Talk to Brian Barrett About Your Florida Medicare Options

Have questions about Medicare Advantage and Medicare Supplement options available to you in Florida? Brian Barrett is an independent Medicare insurance advisor serving Cape Coral, Fort Myers, and all of Lee County and the broader Florida market. With 25 years of experience — 10 as a teacher and 15 as a school principal — Brian brings a patient, educator-first approach to helping you understand your options with no sales pressure.

Call 239-980-8599 or visit srhealthinsurancepros.com to schedule a free consultation. Serving Medicare beneficiaries across Florida.

Ready to get started? Contact Brian Barrett today.

What Does Medicare Cover? A Plain-English Guide for Cape Coral Seniors

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.