Medicare in Florida
Resources for Florida Medicare Beneficiaries
Want to find out about the many parts of Medicare, how to sign up, enrollment periods and applications or how to compare and choose a Medicare plan? You’ve come to the right place. Check out our information about the different parts of Medicare, how to enroll, and how to pick the right Medicare plan for your needs.
Medicare Basics Choosing the Right Medicare Plan Enrolling in Medicare
Getting advice can be helpful while choosing Medicare options. The State Health Insurance Program (SHIP), known as the Florida Serving Health Insurance Needs of Elders (SHINE), is one of the numerous resources available to Floridians for assistance. Floridians can get information on Medicare through SHINE counselors who work with neighborhood nonprofits, public health organizations, and Area Agencies on Aging (AAAs) specific to your county.
Medicare Plan Options in Florida
If you reside in Florida, you have a variety of Medicare options to pick from. Individuals that are 65+ and those with disabilities that qualify for Medicare can apply for Original Medicare. A Medicare Advantage program might be a better option if you desire more comprehensive coverage. Some Medicare plan options include prescription drug plans or Medicare supplemental insurance.
Original Medicare (Parts A & B)
Your foundational Medicare program is Original Medicare. It has two parts: Medicare Part A is for hospital insurance, and Medicare Part B is for medical insurance. Medicare Part A covers hospital stays, skilled nursing facilities, home health care, and hospice care. Medicare Part B covers doctor’s visits, outpatient care, lab testing, and preventive services, such as cancer screenings, flu shots, and yearly wellness visits. Medicare Part A and Part B have different deductibles that apply for different services. For example, Part A has an inpatient hospital deductible per benefit period (each time you are admitted), and Part B has an annual deductible before Original Medicare starts to pay. Things to consider if keeping Original Medicare:
- If you want the flexibility to choose and access healthcare providers who accept Medicare anywhere in the United States, Original Medicare in Florida is a great option.
- If you don’t require a lot of health care or prescription drugs, know that there is no cap on what you may pay out of pocket. Stand-alone prescription drug plans are available for these scenarios.
Medicare Advantage (Part C)
Medicare Part C, also called Medicare Advantage, is an alternative to Original Medicare, which private insurance companies offer. These plans cover, at minimum, what Medicare Part A and Medicare Part B would. Most services are administered by a network of providers, who may require you to have a primary care doctor, a referral to see a specialist, and prior approval for certain services, treatments, and prescriptions before you get them. Medicare Advantage is a good choice if:
- You prefer your health care and drug benefits in one plan and don’t mind being limited to a network of providers you can choose from.
- You only want to carry one ID Card. Present your chosen Medicare Advantage plan’s ID card to your doctor and pharmacy at the time of service.
- You want the financial protection of an annual cap on how much you can spend out-of-pocket Medicare-covered costs.
To learn more about Medicare Advantage, explore our Medicare Part C Resource Page.
Medicare Prescription Drug Plan (Part D)
Prescription Drug Plans (PDP) coverage is available to all Medicare enrollees. There may be a late enrollment penalty if you wait to sign up after becoming eligible for Medicare. Original Medicare does not automatically include Part D prescription coverage but be aware that many Medicare Advantage plans already include Part D prescription drug coverage. Private insurance companies that Medicare has approved to offer Medicare Part D coverage on their own, called stand-alone Prescription Drug Plans. Many Medicare Advantage in Florida automatically includes Part D coverage. Depending on the plan chosen, there may be a deductible, copayment, or coinsurance associated for each prescription drug.
- Part D is a great pick if you have Original Medicare, Medicare Savings Account (MSA) or a Private Fee for Services (PFFS) plan that doesn’t include prescription drugs.
- If you wait to sign up for a Part D plan, you may be assessed a late enrollment penalty unless you already have other creditable coverage, such as an employer-sponsored group plan, retiree plan or military coverage to name a few.
- If you don’t need any medications right now, it is recommended to still sign up for a low premium cost Part D plan to avoid late enrollment penalties.
Medicare Supplement Insurance (Medigap)
Some Medicare beneficiaries in Florida choose to buy Medigap, aka Medicare Supplement Insurance. These plans aim to help provide coverage for any gaps left by Original Medicare. For example, a few of these gaps include Part A and Part B deductibles and coinsurance and coverage for medical care outside of the United States.
You should know that a Medigap plan doesn’t pay for anything related to Medicare Advantage; you cannot have both a Medigap policy and a Medicare Advantage plan simultaneously. If you currently have a Medicare Advantage plan and wish to purchase a Medigap policy, your Medigap policy effective date should start after your Medicare Advantage plan ends. Have no fear:
- Medigap is an excellent choice if you have Original Medicare and want help paying for out-of-pocket costs when you use your Medicare Part A and Medicare Part B benefits.
- You pay a set monthly premium for a policy that will cover most of your out-of-pocket costs associated with Medicare-covered services. So, you have the peace of mind and no unexpected medical expenses.
- You have flexibility, let’s say you need a lot of health care services and want to be able to see any Medicare provider you want, as long as they accept Medicare-approved care that you can count on.
Medicaid is a state agency that offers coverage and coordinates care with the federal government to offer medical insurance to eligible low-income individuals that qualify. Medicaid in Florida was created to help those who might not otherwise have access to affordable health care.
How and when to sign up for Medicare in Florida
Medicare is a government-run insurance program for people who qualify that is paid for by the federal government. People often call Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) “Original Medicare.” The majority of Americans enroll in Medicare when they turn 65. But the following also triggers Medicare eligibility:
- You qualify for disability benefits from the Railroad Retirement Board or Social Security, are under 65 and permanently disabled and have received disability benefits for at least 24 months from Social Security.
- You have been diagnosed with End Stage Renal Disease (ESRD).
- You have been diagnosed with Lou Gehrig’s disease, often known as Amyotrophic Lateral Sclerosis (ALS).
Medicare Advantage Enrollment Periods in Florida and nationwide
Here is a quick overview of the Medicare enrollment periods and enrollment timeframes in which you can elect or change your Medicare Advantage plan.
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Want a few fun facts about Medicare coverage in Florida?
- Florida has the second-highest percentage of residents 65 and older in the nation. Can you also believe that 21% of these beneficiaries live in a county where at least 60% are enrolled in a Medicare Advantage plan?
- By late 2022, 56% of Florida residents are enrolled in Medicare Advantage plans.
- Over 922,000 Floridians are covered by Medigap policies. In Florida, Medigap insurers are required to provide disabled policyholders under the age of 65 with at least Medigap Plan A.
- And because we promised you a fun fact: one of the most famous actors, Sidney Poitier, famously born in Florida…almost wasn’t a Floridian at all. His family was on vacation in Miami from their home in the Bahamas when his mother went into premature labor, automatically making him a US citizen.
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