is an alternative way to get your Medicare Part A and Part B coverage. Instead of getting your Medicare benefits through Original Medicare, the government-run program of managed health care, you’ll get them administered through a Medicare Advantage plan, such as an HMO or PPO. In addition to having all of the same benefits you’d have under Original Medicare, many Medicare Advantage plans also give you the opportunity to get extra benefits not covered under the federal program, including prescription drug coverage.
Medicare beneficiaries living in Florida have the option to sign up for Medicare Advantage once they are enrolled in Original Medicare, Part A and Part B. The additional benefits offered depends on the Florida zip code you live in and the Medicare Advantage plan that you enroll in.
How Medicare Advantage works in Florida
As in the rest of the United States, Medicare Advantage in Florida is required by the government to offer at least the same hospitalization and medical benefits as Original Medicare, Part A and Part B. The exception is hospice care, which is still covered under Part A of Original Medicare. Some Medicare Advantage plans in Florida may also offer additional benefits, like routine vision, hearing, routine dental, and wellness programs . Many Medicare Advantage plans in Florida offer prescription drug coverage as well, also known as Medicare Advantage Prescription Drug plans.
Florida residents wishing to enroll in Medicare Advantage must already be enrolled or be eligible to enroll in Original Medicare, Part A and Part B. In addition, they must live in the service area of a Medicare Advantage plan and not have end-stage renal disease (with some exceptions).
You are first able to join Original Medicare during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. If you qualify for Medicare because of disability, this period starts three months before your 25th month of disability benefits, includes the 25th month, and ends three months later.
If you don’t sign up for Medicare during your Initial Enrollment Period, you may subject to a late-enrollment penalty for as long as you remain enrolled in Medicare. You may enroll in Original Medicare at a later date, during the annual General Enrollment Period, which runs from January 1 to March 31, but be aware that you would still have to pay the late-enrollment penalty fee. Please note that in some situations, you may be eligible to delay Medicare enrollment and enroll through a Special Enrollment Period later on without paying a penalty (for example, if you’re still working and have employer-based health coverage).
Once you’re enrolled in Medicare Part A and Part B, you may also be eligible for Medicare Advantage if you meet the other eligibility criteria (living in the service area of a plan and not having end-stage renal disease). Your Initial Coverage Election Period is when you’re first eligible to enroll in a Medicare Advantage plan and usually coincides with the same seven-month period as your Initial Enrollment Period.
If you’re enrolled in a Medicare Advantage plan in Florida and decide to switch to another Medicare Advantage plan, you can do so during the Annual Election Period, also called the Fall Open Enrollment, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year. You can also use this period to enroll in a Medicare Advantage plan for the first time or disenroll from your plan and return to Original Medicare.
In some cases, you may be allowed to switch Medicare Advantage plans in Florida during Special Election Periods if you go through certain life-changing events. Those events include, among others, the loss of your current coverage (such as losing your Medicaid eligibility) or moving to a new address where your old plan may not be available. Special Election Periods vary according to your qualifying situation.
In Florida, you’re allowed to switch from Medicare Advantage to Original Medicare, Part A and Part B, during the Medicare Advantage Open Enrollment Period, which runs annually from January 1 to March 31 each year. If you use this period to disenroll from your Medicare Advantage plan, you can also enroll in a stand-alone Medicare Prescription Drug Plan for your prescription drug coverage (since prescription benefits under Original Medicare are limited). You also can use this period to switch from one Medicare Advantage plan to another.
Types of Medicare Advantage plans in Florida
Prior to enrolling in a Medicare Advantage plan, you may want to review the types of plans available in Florida. Medicare Advantage plans in Florida may include the following:
- Health Maintenance Organizations (HMOs): Under an HMO, you’re required to visit doctors, health-care providers, and hospitals listed in your plan’s network to be covered, except for emergency or urgent services. You may also need a referral from your primary care doctor to receive coverage for certain health services.
- HMO Point-of-Service (HMO-POS): If you choose an HMO-POS plan, you will generally enjoy more flexibility than you would under an HMO. Many HMO-POS plans sometimes let you go out-of-network for certain health services, but at a higher fee.
- Preferred Provider Organization (PPO*): A PPO offers even greater flexibility than an HMO-POS plan. Under such a plan, you may generally choose your own doctors, health-care providers, and hospitals, but at a higher out-of-pocket cost. If you use providers within the plan’s preferred provider network, your copayments and coinsurance costs will be lower. You don’t need referrals for specialist care with a PPO.
- Private Fee-for-Service (PFFS): A PFFS plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense. Any provider you use must agree to accept the plan’s terms and conditions on a case-by-case scenario and agree to treat you. Just because a provider has treated you in the past doesn’t mean he or she will agree to see you in the future. Some PFFS plans have provider networks of doctors and hospitals that have contracted with the plan to always treat you.
- Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account. You may use the money that the plan deposits into your savings account to pay for your health-care expenses before reaching the deductible.
- Special Needs Plan (SNP): If you have certain chronic or disabling health conditions, live in an institution, or qualify for both Medicare and Medicaid, then a Medicare SNP may be the right choice for you. These types of plans are tailored to suit the specific needs of each beneficiary, and they may include plans for patients with certain chronic or disabling diseases (such as HIV/AIDS or chronic heart failure), people with Medicare and Medicaid (also known as dual eligibles), and those who live in institutions (such as nursing homes or other types of long-term care).
- Medicare Advantage Prescription Drug (MAPD) plan: With an MAPD plan, you will receive health and prescription drug coverage (also available separately through Medicare Part D) under the same insurance plan. Any of the above types, with the exception of MSA plans, may include prescription drug coverage.
Comparing Medicare Advantage plans available in Florida
As a Medicare beneficiary in Florida, you may find it useful to compare all Medicare Advantage plan options available in your area.
The availability and cost of Medicare Advantage plans generally varies depending on your state and county of residence. It’s common for premiums of a Medicare Advantage plan with the same coverage and benefits to vary between different counties within the state of Florida. You may find that some Medicare Advantage plans in Florida offer premiums as low as $0; but always keep in mind that you must continue paying your Medicare Part B premiums, no matter which Medicare Advantage plan you choose, in order to keep your Medicare insurance coverage.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, so you will need to determine exactly what kind of coverage you may require, plus whether or not you want prescription drug coverage with your Medicare Advantage plan through a Medicare Advantage Prescription Drug plan. With all these options available in Florida, you can understand why it can be a good idea to compare plans with the benefits and costs best suited to your personal health needs.
To start comparing Medicare Advantage plan options in Florida today, enter your zip code in the plan finder tool on this page for a customized list of plan options available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.
For further information on Medicare coverage in Florida, view the following resources:
With all the Medicare Advantage plan options available in Florida, it may be smart to get help choosing the health plan that works best for your needs. If you’d like personalized assistance with your Medicare questions, just give us a call at the phone number on this page to speak with a licensed insurance agent.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether the plan will cover an out-of-network service, you or your provider are encouraged to ask for a pre-service organization determination before you receive the service. Please call the plan’s customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.