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Medicare in Florida

October 6, 2016

If you’re a Medicare beneficiary in Florida, you may have various insurance options available to you through Medicare. The federal fee-for-service program is called Original Medicare, Part A and Part B, which together cover hospital and medical insurance. Various Medicare plan options may be available where you live, including prescription drug coverage. 

Original Medicare for Florida beneficiaries

Here’s a brief overview of Original Medicare, Part A (hospital insurance) and Part B (medical insurance), which works the same way in Florida as in the rest of the United States.

You’re eligible for Original Medicare, Part A and Part B, if you’re a U.S. citizen or permanent legal resident of five continuous years or longer, and any of the following is true:

  • You’re age 65 or older.
  • You have been receiving disability benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB) for 24 months in a row.
  • You have end-stage renal disease.
  • You have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).

Read about when you may be automatically enrolled in Original Medicare.

What if you’re not automatically enrolled in Medicare? In Florida, as in other states, you can apply for Medicare through the SSA or RRB. You can apply:

  • Online at the Social Security website. Individuals applying for Medicare only (as opposed to applying for SSA retirement benefits as well) can use this application.
  • By calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778). SSA representatives can be reached Monday through Friday, from 7AM to 7PM.
  • In person at a local Social Security office. To look up office locations in Florida, click here.

As a Florida resident, you may enroll in Original Medicare, Part A and/or Part B, during the following enrollment periods. The same is true in every state.

  • Initial Enrollment Period: Your IEP begins three months before you turn 65, includes your birthday month, and ends three months after that date.
  • General Enrollment Period: If you miss your IEP, you can sign up for Medicare from January 1 to March 31 annually, and the effective date of your coverage would be July 1. However, you will probably have to pay a late-enrollment penalty in the form of higher monthly premiums because you missed your Initial Enrollment Period.
  • Special Enrollment Period: If you delayed your enrollment in Medicare Part A and/or Medicare Part B (for example, because you had coverage through an employer), you may be able to sign up for Medicare during a Special Enrollment Period, when your employee coverage ends. You generally won’t have to pay a late-enrollment penalty if you sign up for Original Medicare during a Special Enrollment Period.

For Florida residents, as for those living in other states, you won’t have to pay a monthly premium for Medicare Part A if you worked at least 10 years (40 quarters) while paying Medicare taxes. Medicare Part A coverage includes, but is not limited to, the following health services:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Limited home health services

Medicare beneficiaries in Florida (as in all states) are generally also eligible for Medicare Part B, which has a standard monthly premium. Medicare beneficiaries with a higher annual income may have to pay a higher premium. Medicare Part B may cover the following services and supplies (this is not a complete list):

  • Outpatient doctor visits
  • Outpatient hospital services (such as outpatient surgery)
  • Laboratory services
  • Radiological services (such as x-ray)
  • Ambulance services
  • Durable medical equipment
  • Mental health services
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs 

Medicare plan options in Florida

Medicare beneficiaries in Florida (as in other states) may be able to receive their Medicare benefits through the Medicare Advantage (Medicare Part C) program. The government requires Medicare Advantage plans to cover all Original Medicare (Part A and Part B) benefits except hospice care, which Part A covers directly. Some Medicare Advantage plans also offer coverage not available under Original Medicare, like routine dental benefits, for example. You may want to compare all Medicare Advantage plans available in your part of Florida and choose the one that includes the benefits you need – just enter your zip code where indicated above to get started. Read more about Medicare Advantage plans in Florida.

Many Medicare Advantage plans in Florida include prescription drug coverage. Known as Medicare Advantage Prescription Drug plans, they combine health and prescription drug coverage into one single plan. However, you still have to stay enrolled in Original Medicare and continue paying your Medicare Part B premium along with any premium the Medicare Advantage plan may charge.

If you’re a Florida resident eligible for Original Medicare, Part A and Part B, you may also enroll in a Medicare Part D stand-alone Prescription Drug Plan. Plan costs and availability in Florida vary. Find out about stand-alone Medicare Part D Prescription Drug Plans in Florida.

If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Get more information about Medigap plans in Florida.

Medicare beneficiaries in Florida may have access to various Medicare plan options, depending on the county in which they live. For example, a resident of Miami in Dade County may have different Medicare plan offerings than a resident of Orlando in Orange County. Considering the various Medicare insurance plans available in Florida, it may be a good idea to customize your search for plans based on your own health and prescription needs.

 

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.