FAQs
What is a Medicare Advantage Plan (Part C)?
A Medicare Advantage Plan (like an HMO or PPO) is a Medicare health plan choice you may have as part of Medicare. These plans, sometimes called “Part C,” are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. These plans may also offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
What is Medicare Prescription Drug Coverage (Part D)?
Medicare offers prescription drug coverage to everyone with Medicare. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or you don’t get Extra Help (a Federal program to help with your prescription costs based on income), you’ll likely pay a late enrollment penalty.
To get Medicare prescription drug coverage, you must join a plan that is run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
What is a Medigap policy?
A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that’s designed to supplement original Medicare. This means that it helps pay some of the health care costs (“gaps”) that original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you have original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share.
A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans are ways to get Medicare benefits, while a Medigap policy only supplements your original Medicare benefits.
What is long term care insurance?
Long term care insurance (LTCi) is a type of coverage available for people who potentially may require extended custodial health care. It is insurance that helps pay for the costs associated with caring for an individual who cannot care for him or herself, such as activities of daily living (ADLs) or less “formal” activities like cooking and cleaning, helping with laundry, etc.
There are six different ADLs: eating, bathing, dressing, toileting, transferring, and continence. If you have an LTCi policy, the benefits may be triggered (meaning the policy will pay) when you are not self-sufficient in at least two of the six activities of daily living, or if you have a severe cognitive impairment AND you have met the “waiting period” you choose in your policy. Long term care insurance covers things that health insurance does not and can also protect your income (and assets indirectly).
When you purchase an LTCi policy, it can substantially reduce the burden on your children or other loved ones who provide care for you. These policies typically cover such things as nursing homes and adult care, but they can also sometimes cover things such as home care and assisted living. The policies of today don’t have to be expensive and are very customizable to what you can afford, based on how much coverage you purchase and other factors.
If you need long term care but do not have an LTCi policy, you will probably have to pay for it out of your own savings. If you’re legally impoverished, government programs like Medicaid may cover your nursing home care (and/or possibly some limited degree of home health care). Medicare and virtually all health insurance programs may only cover LTC for a short time (less than 100 days) and then, only in part. For everything else, the bill will come to you.
The need for long term care can happen to anyone. As we get older, all of us need help. A stroke, Alzheimer’s, or even a bad fall can leave you debilitated and unable to care for yourself. Long term care insurance is assurance that your income and family will not be depleted while trying to care for you.
What is Life Insurance?
Life insurance is a contract between an insurance policy holder and an insurer, where the insurer promises to pay a designated beneficiary sum of money (the “benefits”) upon the death of the insured person. Depending on the contract, other events such as terminal illness or critical illness may also trigger payment. The policy holder typically pays a premium, either regularly or as a lump sum.
Life insurance may be divided into three basic classes:
- Temporary (term)
- Permanent (whole life)
- Universal Life (UL)
What is Final Expense or Burial Insurance?
Final expense insurance is an insurance policy used to pay for funeral services and a burial when the named insured dies. These policies help ease the financial burden placed on a family when this event occurs. Planning in this way can relieve your family of significant stress and uncertainty over arrangements.
If you never purchased a life insurance policy when you were younger and you are now trying to plan for a funeral or leave a legacy to your named beneficiaries, but have been denied traditional life insurance coverage, your best option is to apply for a final expense life insurance policy. It may be easier to qualify for and obtain a final expense policy than it would be for traditional life insurance. Final expense policies merely ask health-related questions instead of going through a paramed exam and the applications are not processed through full underwriting. Final expense insurance can prove to be extremely beneficial when a potential insured has been declined coverage with an insurance company, who processes applications utilizing an underwriting process, but coverage may cost a little more than a fully underwritten policy.
Medicare help in New York and Florida
Who can help me with Medicare in New York and Florida?
Theresa Cangemi, CSA, CLTC, of Retirement Health Plans Made Simple is a licensed, independent Medicare insurance specialist serving both New York and Florida. She provides consultation, advocacy, and enrollment services at no cost — comparing Medicare Advantage, Medicare Supplement, and Part D plans from multiple insurance companies. Call or text 315-727-4933.
Does it cost anything to use a Medicare specialist?
No. Independent Medicare agents are compensated by the insurance companies whose plans they offer. Your premium is the same whether you enroll through an agent or directly with the carrier — the agent adds plan comparison, enrollment help, and ongoing support at no extra charge.
Is Medicare the same in New York and Florida?
Original Medicare works the same nationwide, but the states differ in important ways. New York Medigap policies are community-rated and available year-round regardless of health history. Florida Medigap policies are issue-age-rated and may require health underwriting outside protected windows. Medicare Advantage and Part D plan options also vary by county.
Cancer policies in Florida
What is a cancer insurance policy?
A cancer policy pays a fixed cash benefit, often a lump sum of $5,000 to $50,000 or more, if you’re first diagnosed with internal cancer. The money is paid directly to you and can be used for anything: copays, deductibles, travel to treatment, or household bills. It supplements Medicare; it doesn’t replace it.
Why would someone on Medicare buy a cancer policy in Florida?
Medicare covers cancer treatment, but not your share of the costs or your living expenses. On many Medicare Advantage plans, chemotherapy is billed at 20% coinsurance until you reach your plan’s out-of-pocket maximum, which resets every January. A lump-sum cancer benefit helps absorb those costs plus travel, lodging, and caregiving.
Can I get cancer insurance if I’ve had cancer before?
Usually only after you’ve been cancer-free for the insurer’s lookback period, commonly 5 to 10 years. Rules vary by company, so an independent agent can check several Florida carriers for you.
Hospital indemnity in Florida
What is hospital indemnity insurance?
Hospital indemnity insurance pays you a fixed cash amount for each day you’re admitted to the hospital, for example, $300 per day. Benefits are paid directly to you regardless of what other insurance pays, and most Florida buyers use them to cover Medicare Advantage daily hospital copays.
Why do Medicare Advantage members need hospital indemnity?
Many Florida Medicare Advantage plans charge daily copays, often a few hundred dollars per day, for the first several days of every inpatient stay. A five-day stay can cost well over $1,000 in copays. A hospital indemnity policy with a matching daily benefit covers that exposure for a modest monthly premium.
Does hospital indemnity cover observation stays?
Not always. Observation is billed as outpatient care, so base policies that pay only on inpatient admission may not pay. Many insurers offer an observation benefit or rider, ask for it specifically when comparing policies.
Paying copays in Florida
Are hospital copays covered by Medicare?
Not fully. In 2026, Original Medicare charges a $1,736 hospital deductible per benefit period, plus daily coinsurance for long stays; Medicare Advantage plans charge their own copays. Coverage for those amounts comes from supplemental insurance, Medigap or hospital indemnity, or from the QMB program for people with limited income.
How can I get help paying Medicare copays in Florida?
Five options: a Medigap policy (covers most cost-sharing under Original Medicare), hospital indemnity insurance (cash per hospital day), a cancer or critical illness policy (lump sum at diagnosis), Florida’s QMB Medicare Savings Program (pays cost-sharing for limited-income beneficiaries), and Extra Help (lowers drug copays). A licensed agent can help you compare them.
Is there a limit on prescription drug costs in 2026?
Yes. Out-of-pocket spending on covered Part D prescription drugs is capped at $2,100 in 2026. After you reach the cap, covered drugs cost $0 for the rest of the calendar year. The Medicare Prescription Payment Plan can also spread costs across the year.