Medicare has four parts. Part A covers hospital care. Part B covers outpatient medical care. Part C (Medicare Advantage) is a private-insurer alternative that bundles A and B and usually D. Part D covers prescription drugs. Most people need Parts A and B at minimum, plus either Medigap or Part C for protection against out-of-pocket costs.
Medicare isn't one thing — it's four. Part A covers hospital care. Part B covers doctor visits and outpatient care. Part C (Medicare Advantage) is a private-insurer alternative that replaces A and B. Part D covers prescription drugs. Figuring out which of these you need is the first real decision you'll make about Medicare.
If you’re approaching 65 in Jacksonville or helping a parent sort through the mailers stacking up on their kitchen table, here’s the clean version — what each part actually does, what it costs, and which ones most people in Northeast Florida actually need.
Costs, thresholds, and enrollment rules in this article reflect official CMS figures as of April 24, 2026. Medicare premiums, deductibles, and income thresholds are updated annually — verify current amounts on medicare.gov or with a licensed broker before making enrollment decisions. See Sources at the end for CMS references.
What’s the difference between Medicare Parts A, B, C, and D?
Medicare is divided into four parts because it evolved in stages, not because the division is intuitive. The easiest way to remember what each one does:
- Part A — things that happen in a hospital
- Part B — things that happen in a doctor’s office
- Part C — a private-insurance replacement for Parts A and B (optional)
- Part D — prescription drugs (separate from A and B)
Parts A and B together are called “Original Medicare.” Part C is an alternative to Original Medicare, not a supplement to it. Part D is always needed separately — either as a standalone plan alongside Original Medicare, or bundled inside a Part C plan (then called MAPD — Medicare Advantage Prescription Drug plan).
That’s the whole system in six sentences. Everything else is detail.
Medicare Part A — Hospital Insurance
What it covers: inpatient hospital stays, skilled nursing facility care following a qualifying hospital admission, hospice care, and some home health care.
What it doesn’t cover: doctor visits (that’s Part B), outpatient procedures, prescription drugs taken at home, long-term custodial nursing home care.
What it costs in 2026:
- Premium: $0 for most people. If you or your spouse paid Medicare taxes for at least 10 years (40 quarters), Part A is premium-free for life. If you didn’t earn 40 quarters, you can buy into Part A — $311/month in 2026 if you have 30–39 quarters, or $565/month if you have fewer than 30 quarters.
- Inpatient hospital deductible: $1,736 per benefit period in 2026. A benefit period starts when you’re admitted and ends after you’ve been out of the hospital or skilled nursing facility for 60 consecutive days.
- Coinsurance: $0/day for days 1–60 of a hospital stay after the deductible, rising for longer stays.
When to enroll in Part A
If you’re already receiving Social Security benefits when you turn 65, you’re automatically enrolled. Otherwise, enroll during your Initial Enrollment Period — the 7-month window that starts 3 months before the month you turn 65 and ends 3 months after.
Because Part A is premium-free for most people, there’s rarely a reason to delay it. The only exception: if you have an HSA-compatible employer health plan, enrolling in Part A disqualifies you from continuing HSA contributions. That’s a narrow situation worth checking on before you enroll.
Medicare Part B — Medical Insurance
What it covers: doctor visits, outpatient care, preventive services, durable medical equipment, mental health services, some outpatient prescription drugs administered in a clinical setting.
What it doesn’t cover: routine dental, vision, or hearing care; most prescription drugs you pick up at the pharmacy; long-term care.
What it costs in 2026:
- Standard premium: $202.90/month in 2026. This rises annually.
- IRMAA (high-income surcharge): if your modified adjusted gross income from two tax years ago exceeds $109,000 (single) or $218,000 (married filing jointly), you pay an income-related adjustment on top of the standard premium. The surcharge scales up across six tiers.
- Annual deductible: $283 in 2026.
- Coinsurance: generally 20% of the Medicare-approved amount for most services, with no annual out-of-pocket cap. That lack of a cap is why most people pair Part B with either a Medigap supplement or a Medicare Advantage plan — 20% of an expensive procedure can be a catastrophic bill.
When to enroll in Part B
Same Initial Enrollment Period as Part A — 7 months around your 65th birthday. This is where most of the penalty risk sits. Part B has a 10%-per-year late-enrollment penalty that’s permanent. Delay Part B by 3 years without qualifying employer coverage, and you pay 30% extra every month for the rest of your life.
The main exception: if you or your spouse have active employer health coverage past 65 at a company with 20+ employees, you can delay Part B without penalty and enroll later during a Special Enrollment Period. Retiree coverage and COBRA do not count as active employer coverage for this purpose.
Medicare Part C — Medicare Advantage
What it is: a private-insurer alternative that replaces Original Medicare. Under a Medicare Advantage plan, you still technically have Parts A and B, but a private insurer administers the coverage and sets its own rules within federal guidelines.
What it covers: everything Original Medicare covers, plus typically prescription drugs (MAPD plans) and often extras like dental, vision, hearing, fitness memberships, and sometimes transportation or OTC allowances.
How it differs from Original Medicare:
| Aspect | Original Medicare (A + B) | Medicare Advantage (Part C) |
|---|---|---|
| Who pays claims | Medicare directly | Private insurer |
| Provider access | Any provider nationwide accepting Medicare | Plan network (HMO/PPO), usually regional |
| Referrals for specialists | Not required | Often required (HMO plans) |
| Prescription drug coverage | Separate Part D plan required | Usually bundled in (MAPD) |
| Dental / vision / hearing | Not covered | Often included |
| Out-of-pocket maximum | None (unless you add Medigap) | Required by law — capped annually |
| Monthly premium beyond Part B | $0 plan premium; pay Medigap + Part D separately | Frequently $0 in Florida |
What it costs in 2026: you still pay the Part B premium ($202.90/month) no matter what. The Medicare Advantage plan premium on top is frequently $0 in Duval County — Jacksonville’s market is competitive enough that many plans absorb the premium cost. Point-of-service copays, coinsurance, and deductibles apply when you actually use care.
When Part C makes sense
Medicare Advantage works best for people who stay regional, want bundled benefits (especially DVH), are generally healthy, and are comfortable with a network. It works less well for frequent travelers, people with specialists outside the network, or people who want total predictability of out-of-pocket costs.
Medicare Part D — Prescription Drug Coverage
What it is: Medicare’s prescription drug benefit. Delivered by private insurers either as standalone plans (PDPs) that work alongside Original Medicare, or bundled into Medicare Advantage plans (MAPDs).
What it covers: most prescription drugs, organized into tiers that determine your cost. Each plan publishes a formulary — the specific list of drugs it covers and what tier each drug is in.
What it costs in 2026:
- Monthly premium: varies widely — $0 to $70+ in Florida depending on plan
- Annual deductible: up to a federally set maximum ($615 in 2026, though many plans use a lower amount or $0)
- Copays/coinsurance: set by tier, with costs rising from Tier 1 (preferred generics) through Tier 5 (specialty drugs)
- 2026 improvement: Starting in 2026, annual out-of-pocket costs for covered Part D drugs are capped at $2,100. This cap replaces the old coverage-gap (“donut hole”) structure and meaningfully protects beneficiaries taking expensive maintenance medications.
When to enroll in Part D
Enroll when you first become Medicare-eligible, even if you don’t currently take prescription drugs. Medicare Part D has a separate late-enrollment penalty — approximately 1% of the national base beneficiary premium ($38.99 in 2026) for every month you went without creditable drug coverage — added permanently to your future Part D premium for life.
The main exception: if you have creditable drug coverage through an employer or retiree plan, you can delay Part D without penalty and enroll later during a Special Enrollment Period. Your plan should send you an annual notice of creditable coverage — keep it.
Which parts do you actually need?
Most Jacksonville Medicare beneficiaries end up with one of two combinations:
Combination 1: Original Medicare + Medigap + Part D
Combination 2: Medicare Advantage (MAPD)
Which combination fits you depends on your doctors, your budget, your health status, and how often you travel — covered in depth in The Complete Medicare Guide for Jacksonville, FL.
Medigap and Medicare Advantage cannot coexist. Enrolling in a Medicare Advantage plan makes any Medigap policy unable to pay toward your costs, and Medigap insurers cannot legally sell you a new policy while you're on Advantage. You choose one path or the other — not both.
How to enroll in the parts you need
Parts A and B — through Social Security
If you're already receiving Social Security, you're automatically enrolled in A and B the month you turn 65. If not, enroll online at ssa.gov/medicare, by phone, or at your local Social Security office.
Part D or Medicare Advantage — through a carrier
These are sold by private insurance companies. You can enroll directly with a carrier, through Medicare.gov's Plan Finder, or through an independent broker who compares across carriers on your behalf.
Medigap — through a carrier (timed carefully)
Your best window to buy Medigap is a one-time 6-month guaranteed-issue period that starts the month you are 65 or older and enrolled in Part B (whichever is later). During this window, carriers can't deny you or price you based on pre-existing conditions. Missing this window has long-term consequences.
Ready to sort through the parts for your situation?
Knowing what the four parts of Medicare do is the easy part of this. Knowing which combination fits your doctors, your prescriptions, and your budget in Jacksonville — that’s the work. And that work is specific to you: two people turning 65 on the same day in Duval County often land on very different plans based on which doctors they want to keep and which drugs they take.
A consultation with an independent broker maps your actual situation onto the plans available in Northeast Florida. No cost, no pitch for a specific carrier, just side-by-side comparisons.
Book a Medicare consultation → · Call 904-217-8368
Sources
- 2026 Medicare Parts A & B Premiums and Deductibles — CMS
- Final CY 2026 Part D Redesign Program Instructions — CMS
- 2026 IRMAA Sliding Scale Tables (HI 01101.020) — SSA POMS
- Fact Sheet: 2026 Medicare Costs — Medicare.gov
Key takeaways
Frequently asked questions
Do I need both Medicare Part A and Part B?
Most people need both. Part A is premium-free for anyone with 10+ years of Medicare-taxed work history, so there's rarely a reason to skip it. Part B has a monthly premium but covers doctor visits, outpatient care, and preventive services. Skipping Part B while eligible usually triggers a permanent late-enrollment penalty.
Is Medicare Part C the same as Medicare Advantage?
Yes — they are the same thing. Part C is the Medicare program designation; Medicare Advantage is the marketing name carriers use. Both refer to private insurance plans that replace Original Medicare (Parts A and B) and usually bundle in prescription drug coverage. In Florida, most Medicare Advantage plans have a $0 monthly premium.
Do I need Part D if I don't take prescription drugs?
Usually yes — even if you take no medications today. Skipping Part D when you're first eligible triggers a late-enrollment penalty that adds roughly 1% of the national base premium to your future premium for every month you went without creditable drug coverage. The penalty is permanent, so the math usually favors enrolling.
Does Medicare cover everything if I have all four parts?
No. Even with A, B, a Medigap supplement, and Part D, Medicare doesn't cover routine dental, vision, or hearing care; long-term custodial nursing-home care; or care outside the United States in most cases. Medicare Advantage plans often add limited DVH benefits, but gaps remain.
Can I have Medicare Advantage and Medigap at the same time?
No. Medigap only works with Original Medicare (Parts A and B). If you enroll in a Medicare Advantage plan, Medigap insurers cannot legally sell you a policy and any existing Medigap policy won't pay toward your Advantage plan costs. You choose one path or the other — not both.
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