Medicare Plans in Florida
The good news is that Floridians have Medicare options to choose from, but, sorting through the plans to find the right level of coverage can feel daunting. We’ve created this guide to help you compare your options and find the coverage that fits your needs.
Who’s eligible for a Medicare Plans in Florida?
Medicare is a federally sponsored program that provides healthcare benefits to people who qualify based on either age or disability. Generally, people first qualify for Medicare plans in Florida once they reach 65 years of age. If you’re under 65 years of age, having Amyotrophic Lateral Sclerosis (ALS), having End Stage Renal Disease (ESRD), or having received Social Security Disability Insurance (SSDI) for 24 months can also qualify you for Medicare.
In order to qualify for Medicare, you must be a citizen or permanent resident, having lived in the US for the past 5 years. You or your spouse must also have worked for 10 years in a job that paid into Medicare via Social Security deductions.
You can view the plans available in your area online or talk to a licensed insurance agent by calling the number above.
What are the Medicare Plans in Florida?
Orginial Medicare Part A & Part B
Original Medicare the federal portion of Medicare and is made up of two separate parts:
Part A (Hospital Insurance) covers inpatient services, like hospital care, hospice care, and skilled nursing home care (as long as custodial care isn’t the only care needed).
Part B (Medical Insurance) covers outpatient services, like ambulance services and mental health care, and durable medical equipment, like walkers and blood sugar monitors. Part B also covers some preventive services, like flu shots, cardiovascular screenings, and diabetes screenings.
It’s important to point out that Original Medicare doesn’t cover everything. Services and supplies generally not covered by Original Medicare may include:
- Long term care (custodial care)
- Most outpatient prescription drugs
- Hearing aids
- Eye exams and eyeglasses
- Most dental care and dentures
- Routine foot care
- Cosmetic surgery
Original Medicare isn’t designed to cover 100% of your medical bills. Medicare beneficiaries still pay a portion of their healthcare costs through coinsurance, deductibles and copays. However, Medicare beneficiaries in Florida have options available through private insurance companies to find the right level coverage for their individual needs.
Medicare Advantage Plans (Part C)
Medicare Advantage plans are available from private insurance companies contracted with Medicare and provide the same coverage as Original Medicare Parts A and B, except for hospice which remains covered by Part A. These plans can also include additional benefits, like dental and vision coverage. There are also Medicare Advantage plans, called Medicare Advantage Prescription Drug (MAPD) plans, that also include prescription drug coverage.
You must first be enrolled in both parts of Original Medicare to qualify for an Advantage plan. In addition to the premium charged by the Part C plan selected, you’ll have to continue paying your Part B premium if you enroll in a Medicare Advantage plan.
For more information about Medicare Advantage plans, click here.
Medicare Prescription Drug Plans (Part D)
Prescription drug coverage is generally not included in Original Medicare Parts A or B, or Medigap plans. Medicare Part D, also known as Medicare Prescription Drug plans, are available through private insurance companies that have been approved by Medicare to provide this coverage. These plans set a certain copay/coinsurance for each medication using a tiered system. A drug formulary is provided by each plan, which allows you to see which tier(s) your medications are in. This enables you to select the plan with the best overall value for your particular needs.
You can get Medicare Part D coverage with a stand-alone Medicare Prescription Drug Plan if you’re enrolled in Original Medicare, or, with a Medicare Advantage Prescription Drug Plan (MAPD). A MAPD is a Medicare Advantage plan that provides prescription drug coverage. Different insurers offer different types of plans, so your monthly plan premium and out-of-pocket expenses for prescription drugs will vary from plan to plan.
For more information about Medicare Part D plans, click here.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans are designed to provide more comprehensive coverage to Original Medicare Parts A and B by filling gaps in coverage. Medigap plans are provided by private insurance companies, contracted with Medicare, and work alongside Original Medicare. Medigap plans can help reduce out-of-pocket expenses by paying for things that Original Medicare doesn’t cover, such as deductibles, copays, and coinsurance.
For more information about Medicare Supplement plans, click here.
When Can I Enroll In A Plan?
Medicare Advantage and Medicare Prescription Drug Plans
You’re first eligible to sign up for Medicare plans in Florida during your Initial Enrollment Period (IEP). This period starts three months before your 65th birthday month and continues through the following three months. This means you have a total of 7 months to enroll.
You can then enroll in a Medicare Advantage or Medicare Prescription Drug plan during the Annual Election Period (AEP). This period runs from October 15th to December 7th every year.
Medicare Initial Enrollment Period
7-Month Initial Enrollment Period | Begins 3 months before the month you turn 65
*Signing up for Parts A and B during months 5,6, and 7 may result in delayed coverage.
KEY FACT: The General Enrollment Period provides you an opportunity to enroll in Original Medicare if you missed your IEP. This period occurs every year from January 1st to March 31st. Then, you’ll have an opportunity to select a Medicare Advantage Plan from April 1st through June 30th.
Additional Medicare Resources in Florida
Florida has a program called Serving Health Insurance Needs of Elders (SHINE) that provides free, confidential counseling and resources to Medicare beneficiaries and their representatives.
Sources: Medicare.gov; www.floridashine.org