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New to Medicare in Florida? Your Complete Beginner’s Guide (2026)
If you’re turning 65 or becoming eligible for Medicare, you probably have questions — and you’re not alone.
Every year, thousands of Florida residents enroll in Medicare for the first time. Understanding your options early can help you avoid penalties, reduce healthcare costs, and choose coverage that fits your needs.
This guide explains how Medicare works, what it costs in 2026, and how to enroll the right way.
What Is Medicare?
Medicare is a federal health insurance program for:
- Individuals age 65 and older
- Certain people under age 65 with disabilities
- Individuals diagnosed with End-Stage Renal Disease (ESRD) or ALS
Original Medicare is administered by the federal government, while private insurance companies offer additional coverage options approved by Medicare.
There are Four Parts to Medicare
Medicare consists of four parts, each covering different aspects of health care.
Medicare Part A (Hospital Insurance)
Coverage Includes:
- Inpatient hospital stays
- Care in a skilled nursing facility (following a qualifying hospital stay)
- Hospice care
- Limited home health care.
Costs:
- Most people pay $0 premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.
- Part A hospital deductible for 2026: $1,736 per benefit period
- Coinsurance may apply for extended hospital or skilled nursing stays.
Medicare Part B (Medical Insurance)
Coverage includes:
- Doctor and specialist visits
- Outpatient services
- Preventive screenings
- Durable medical equipment
- Some home health services
Costs (2026):
- Standard Part B premium: $202.90 per month
- Annual deductible: $283
Higher-income individuals may pay an income-related monthly adjustment amount (IRMAA).
If your modified adjusted gross income is less than $106,000 (single) or $212,000
(married filing jointly), you will typically pay the standard Part B premium of
$202.90 per month. Higher-income beneficiaries pay adjusted premiums set by Medicare,
commonly known as IRMAA.
See detailed costs here.
Medicare Part C (Medicare Advantage)
Coverage:
Medicare Advantage plans are offered by private insurance companies approved by Medicare.
These plans include all benefits covered under Part A and Part B and often include:
- Prescription drug coverage (Part D)
- Dental, vision, and hearing benefits
- Fitness or wellness programs
Costs:
Costs vary by plan and may include:
- Monthly premiums
- Copayments
- Coinsurance
- Annual maximum out-of-pocket limits for medical services
Medicare Part D (Prescription Drug Coverage)
Coverage:
Helps cover the cost of prescription medications.
Costs and Important 2026 Update:
- Monthly premiums vary by plan.
- Deductibles and copayments vary.
-
NEW: Medicare Part D now includes a
$2,100 annual out-of-pocket maximum
for covered prescription drugs.
Once you reach this limit, you pay $0 for covered medications
for the remainder of the year.
Medicare Eligibility – When you are eligible?
You are eligible for Medicare if you:
- Are age 65 or older, or
- Are under age 65 with certain disabilities, or
- Have End-Stage Renal Disease (ESRD) or ALS.
You must also be:
- A U.S. citizen, or
-
A legal resident who has lived in the United States continuously for at least
five years.
Enrollment Periods – When to enroll!
Choosing the correct enrollment period helps avoid penalties and coverage delays.
Initial Enrollment Period (IEP)
Your Initial Enrollment Period is a 7-month window:
- Begins 3 months before your 65th birthday month
- Includes your birthday month
- Ends 3 months after your birthday month
Coverage Start (Current Rule):
Coverage generally begins the month after you enroll.
Example:
If your 65th birthday is in June, your IEP runs from March 1 through September 30.
This is when most people enroll in Medicare Parts A and B.
General Enrollment Period (GEP)
January 1 – March 31 each year
For individuals who missed their Initial Enrollment Period and do not qualify for a Special Enrollment Period.
- Coverage begins the month after enrollment.
- Late enrollment penalties may apply.
Special Enrollment Period (SEP)
A Special Enrollment Period allows enrollment without penalty after certain qualifying events.
Common examples include:
- Loss of employer group health coverage
- Retirement
- Moving out of a plan’s service area
- Other qualifying life events
Employer Coverage Example:
If you delay Medicare because you have employer coverage, you typically receive an
8-month SEP to enroll in Part B beginning when:
- Employment ends, or
-
Employer coverage ends
(whichever occurs first)
How to Apply for Medicare
- Online:
- You can apply online at the Social Security website: www.ssa.gov/medicare.
- By Phone:
- Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778).
- In Person:
- Visit your local Social Security office. You can find your local office at www.ssa.gov/locator.
- By Mail:
- Complete a paper application and mail it to your local Social Security office.
Documents You May Need
- Your Social Security number.
- Proof of U.S. citizenship or legal residency.
- Information about your current health insurance (if any).
- Employment information (if applicable).
Medicare Options Available in Florida
Florida residents typically choose between:
- Original Medicare + Supplement (Medigap) + Part D
- Medicare Advantage (all-in-one plans)
The best option depends on:
- Doctors you want to keep
- Prescription medications
- Travel habits
- Budget and healthcare usage
Why Work With a Local Florida Medicare Agent?
Working with a licensed local Medicare advisor can help you:
✅ Compare plans available in your county
✅ Avoid costly enrollment mistakes
✅ Understand provider networks
✅ Review prescription coverage
✅ Receive ongoing yearly plan reviews
There is no additional cost for using a licensed Medicare agent — plans pay agents directly.
Get Help Choosing the Right Medicare Plan
New to Medicare and still feeling a little overwhelmed? You don’t have to navigate it alone.
Our friendly, knowledgeable, and hassle-free agents are here to guide you every step of the way.
We begin by helping you understand the basics of Original Medicare so you can feel confident in your coverage.
That understanding is essential when it comes to choosing the supplemental coverage that’s right for you as you get started with Medicare.
Best of all – our service is completely free and 100% unbiased.
Discover the difference of having Nisona on your side.
👉 Request a Free Medicare Consultation
- Review your Medicare options
- Compare plans side-by-side
- Get answers to your questions
📞 Call: 888-564-2326
📍 Serving Vero Beach, Sebastian, Melbourne, and surrounding Florida communities.
Medicare Disclaimer
This information is for educational purposes only and is not a complete description of benefits.
Medicare plan availability and costs may vary by county.
Contact a licensed Medicare agent for plan details.
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Nisona serves the insurance needs of the Treasure and Space Coast.