What Medicare Costs and Does Not Cover in Florida

Hi, I am Bradley Stone. I am an independent insurance broker, and I spend my days helping Central Florida neighbors make sense of Medicare, the same way I would for someone who knocked on my door with a stack of mail and a worried look.

Two questions come up more than any others. What is this going to cost me, and what does it actually cover? Both deserve a straight answer with nothing hidden behind it, so this guide takes them together, because you cannot really answer one without the other.

Here is the most important idea to start with. The real cost question is not "what is the monthly premium." It is "what is my total yearly exposure." Two plans can carry the same premium and leave you in very different places when the bills arrive. Once you can see the pieces, the whole picture gets a lot clearer.

The four parts, in about a minute

Medicare gets talked about as if it were one big thing. It is really four pieces that fit together.

Part A is hospital coverage. Inpatient stays, skilled nursing after a qualifying hospital stay, some home health care, and hospice.

Part B is medical coverage. Doctor visits, preventive care, lab work, durable medical equipment, and outpatient services.

Together, Part A and Part B are what people mean when they say "Original Medicare." That is the coverage that comes straight from the federal government, and it is the foundation everything else builds on.

Part C is Medicare Advantage. A private way to receive your Part A and Part B benefits, usually bundled with extras.

Part D is prescription drug coverage. The piece that helps with what you pick up at the pharmacy.

That is the whole alphabet. Now let us talk about what each one actually costs you.

What Part A costs

Most people do not pay a monthly premium for Part A. If you or your spouse paid Medicare taxes through your working years for long enough, you have already earned it, which surprises a lot of people in a pleasant way.

But premium free does not mean cost free. Part A still carries a hospital deductible that applies each time you are admitted, and on a long stay you can start owing a daily amount once you pass a certain number of days. Most hospital trips are short, so you may never see those daily charges, but the structure is there, and on a serious illness it adds up.

What Part B costs

Part B carries a monthly premium for nearly everyone, plus an annual deductible you meet before coverage kicks in fully. For most folks that premium is paid quietly in the background, often deducted right from a Social Security benefit, so you may never write a check for it.

Here is the piece that catches people off guard. After you meet the deductible, Part B does not pay everything. You cover your portion of each covered service, every time. Which brings me to the biggest exposure in the whole system.

The gap that worries me most

Original Medicare, on its own, has no yearly cap on what you might pay out of your own pocket.

Think about the coverage you carried during your working years. There was almost certainly a yearly maximum, a worst case number, a point where the plan started paying everything. Original Medicare does not work that way. There is no ceiling. If you have a serious health year, your share of the bills can keep adding up with no stopping point.

I am not telling you that to frighten you. For someone who stays healthy, it may never matter. But it is the single reason almost everyone adds something to Original Medicare rather than leaving it bare, and it is why comparing true yearly cost matters so much more than comparing premiums.

If reading this far has already raised a few questions, that is normal. Call me at 407.878.8277 or request a free quote at our contact page. There is never any pressure, and the conversation is free.

What Original Medicare does not cover

The missing yearly maximum is the big one, but it is not the only gap. Original Medicare generally does not cover:

• Routine dental, vision, and hearing care, including hearing aids
• Most prescription drugs on their own
• Long term custodial care
• Routine foot care
• Cosmetic procedures
• Most care outside the United States

Let me take those one at a time, because not every gap matters to every person.

Dental, vision, and hearing

Cleanings, eyeglasses, and contact lenses usually fall to you. Hearing aids deserve a specific mention, because people are often caught off guard here. Original Medicare generally does not pay for hearing aids, and it usually does not pay for the routine exams needed to fit them either. For a lot of my clients these are everyday needs, so it is worth planning for them rather than being surprised at the counter.

Long term care

Original Medicare can help with a limited stretch of skilled nursing care after a qualifying hospital stay, but that help is short and comes with conditions. What it does not cover is long term custodial care, the daily help with bathing, dressing, and meals that many families eventually need. This one catches people badly, because it is a large potential cost that Medicare was simply never designed to carry. Better to know now and plan than to scramble later.

Routine foot care

This matters for a lot of us here in Florida. Everyday nail trimming and callus or corn care generally fall to you. There is an important exception. When foot care is tied to a medical condition, diabetes being the most common example, Medicare can step in, because at that point it is treating a real health risk rather than handling routine grooming. If you have a condition that affects your feet, mention it and we will keep it in mind.

Cosmetic procedures

Generally not covered, with the exception of work tied to an injury or a clear medical need, such as repair after an accident or surgery. Purely elective cosmetic work is on you.

Care outside the United States

If you travel, take note. Original Medicare offers very limited coverage abroad. There are two practical paths if travel is part of your life. Some Medicare Supplement plans include a limited foreign travel emergency benefit, so the specific plan you pick matters here. You can also buy separate travel medical insurance for a trip, which is a common move for snowbirds heading out of the country and for anyone taking a cruise. Tell me if travel is part of your life and we will factor it in.

Prescription drugs and what Part D costs

Original Medicare, meaning Parts A and B, does not cover most prescriptions you pick up at the pharmacy. That coverage comes through Part D, which has its own monthly premium and its own cost sharing.

What you pay depends heavily on the specific medications you take, because every plan covers drugs a little differently and places them on different tiers. The right plan for your neighbor may be the wrong plan for you for that reason alone.

There is one more thing worth knowing about how Part D works across a year. Your drug costs move through phases as your spending adds up, so what you pay at the pharmacy in January can look different from what you pay later on. The good news is that the old coverage gap, the stretch many people called the donut hole where costs used to jump, has gone away. In its place there is now a yearly cap on what you pay out of pocket for covered drugs, so once you reach that point your covered prescriptions are taken care of. That ceiling did not used to exist, and it gives a lot of people real peace of mind.

A few minutes of careful comparison here saves real money over a year. I go deeper on this in my guide to Medicare Part D in Florida.

IRMAA, when higher earners pay more

Now the piece almost nobody hears about until it shows up. If your income is above a certain level, you pay an income related surcharge on top of your Part B and Part D premiums. It is called IRMAA, the income related monthly adjustment amount.

Here is the part that settles most people down. The large majority of folks I sit with are comfortably under the income line and never pay IRMAA at all. If you are a higher earner, though, it is worth planning for so it does not catch you by surprise.

A few things matter. IRMAA is based on a past tax return, usually from two years back, so the income that triggers it may not reflect what you earn today. It applies to both Part B and Part D. And it is tied to thresholds that move, so you cannot judge it on old numbers. If you had a big income year from selling a property or a business, or if your income has since dropped because you retired, that is worth a conversation, because there are situations where you can ask for an adjustment.

Late enrollment penalties, a cost that follows you

There is one cost I always want people to understand before they decide anything, because it is the kind of mistake that is hard to undo.

If you wait to sign up for Part B or Part D when you are first eligible, and you do not have other qualifying coverage in the meantime, you can be charged a late enrollment penalty. The important thing to know is that it is not a one time fee. It gets added onto your premium and it follows you for as long as you carry that coverage, month after month. The longer you wait, the larger it grows.

I am not telling you this to scare you. I am telling you because it is avoidable. If you are still working and have solid coverage through an employer, you may have a perfectly good reason to delay, and the rules account for that. The danger is delaying without a plan and without qualifying coverage to bridge the gap. If timing is on your mind, my Medicare timeline for people turning 65 in Florida lays out the windows that matter.

Two ways to fill the gaps

Now the reassuring part. Every gap above is well understood, and there are two established paths to close them.

Path one is a Medicare Supplement, also called Medigap. It sits alongside Original Medicare and pays many of the costs Medicare leaves behind, the deductibles and the ongoing cost sharing, which makes your out of pocket spending far more predictable. With this path you would also typically add a standalone Part D plan for prescriptions. I break down how these are structured in my guide to Medigap plans in Florida, and if you have narrowed it to the two most common letters, Plan G versus Plan N goes deeper.

Path two is a Medicare Advantage plan, which is Part C. You get your Part A and Part B through a private plan that bundles in extra benefits, often folds in drug coverage, and importantly does include a yearly out of pocket maximum, which fills the gap I described earlier.

Here is the trade off in one breath. A Medigap plan lets you see any doctor who takes Medicare, in exchange for a higher monthly cost. A Medicare Advantage plan usually costs less monthly, but it works within a network and can ask you to follow referral rules to see a specialist. Networks also vary quite a bit by county, so what is available in Orange County may look different from Lake, Seminole, or Polk.

Neither path is better in the abstract. The right one depends on your doctors, your medications, your budget, and how you like to receive care. I put together a full side by side at Medicare Advantage vs Supplement in Central Florida.

Your real yearly cost, added up

When you put it all together, your true yearly Medicare cost is the combination of premiums, deductibles, your share of each service, drug costs, any supplement or Advantage premium, any late enrollment penalty you got stuck with by waiting, and IRMAA if it applies to you.

I never quote a figure off the top of my head, because the current figures change every year and the rules around them shift. What I do is sit down with you, look at your health, your prescriptions, and your income picture, and show you the real total for each option side by side.

If you are worried about affording your share, there are programs that help, and I walk through those in my guide to Medicare Savings Programs in Florida.

How I can help

Every gap above is a real hole, but not every hole matters for every person. Someone who never leaves Florida does not need to lose sleep over foreign travel coverage. Someone who wears hearing aids and sees a podiatrist twice a year absolutely does. My job is to work out which of these are likely to land on your kitchen table as a surprise bill, and to close those specific ones before they do.

Because I am independent, I can compare a wide range of carriers and match the plan to the gaps that are actually yours, rather than a generic checklist. Hidden costs are what people fear most about Medicare, and my whole job is making sure there are none for you. You will not find a surcharge or a share of cost that I did not show you first.

That sorting only works in conversation, so let us have one. We will walk through your medications, your doctors, your travel habits, and your budget, and I will show you exactly where Original Medicare would leave you exposed and what each option would really cost. Call me at 407.878.8277 or request a free quote at our contact page. It costs you nothing, since the carriers pay me, and you will walk away knowing your real total before you decide anything.

I am right here in Central Florida, and I take this at your pace. You can ask the same question three different ways until it clicks. You can also see how I approach all of this on my Medicare services page.

Original Medicare is a strong start. Once you understand where it stops and what it costs, filling the gaps becomes a calm and manageable decision. I am here to make that part easy.

Stone Financial Partners is an independent insurance agency. We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or 1 800 MEDICARE to get information on all of your options.

Stone Financial Partners is not connected with or endorsed by the federal Medicare program. This guide is educational information, not official government material.