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Medicare Options in Florida

Medicare is a health insurance program for the elderly and disabled that the federal government funds. Both the federal government and private insurers can provide you with Medicare insurance.

88% of Florida’s Medicare enrollees qualify because of their age, but only 12% qualify due to a disability. In the US overall, 86% of Medicare recipients are eligible because of their age, while 14% are eligible because of their disability. Considering how Florida has the second-highest number of 65 and older residents in the country, this makes sense.

It is important to understand all your options when it comes to deciding on a Florida Medicare plan. To make an informed decision, you should do your own research and discuss your options with a licensed Medicare insurance agent.

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Original Medicare

These are the standard Medicare benefits provided by the federal government. Original Medicare includes Parts A, and B. Medicare Part A provides hospital insurance. It covers inpatient care at a hospital, hospice center, or skilled nursing facility.

Part B covers medical insurance. This includes outpatient care at a hospital or skilled nursing facility and preventive healthcare services like vaccinations. It also includes immunization and screening that helps prevent diseases.

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Florida Medicare Advantage Plans (Part C)

Florida draws in more pensioners than other states, which explains why Medicare Advantage is so popular. In 2018, 43% of Florida Medicare users chose private Medicare Advantage plans. The national average was 34%, so Medicare Advantage has always been more prevalent in Florida than it has been in the rest of the country.

By the end of 2021, more than half of Florida’s Medicare beneficiaries will be enrolled in private Medicare plans. Most of these beneficiaries were on Medicare Advantage, while a few were on Medicare Cost Plans. The increase in Medicare Advantage participation in Florida is consistent with the national trend toward Medicare Advantage enrolment.

Medicare Advantage (Part C) benefits are provided by private insurance firms and are a complete substitute for original Medicare. Every benefit from sections A and B are included in these programs along with a few more advantages.

There are four types of Medicare Advantage plans in Florida:

Health Maintenance Organization (HMO)

Most HMOs mandate that you use only in-network providers for all healthcare services:

  • You require a PCP (primary care physician), specialist referrals, and prior approvals for certain procedures and prescriptions.
  • Plans typically provide drug coverage.
  • You can’t purchase separate drug coverage.
  • Costs are lower if you stick to the provider network.

Preferred Provider Organization (PPO)

MedicarePPO plans have a recommended network of providers, but you can always choose out-of-network doctors or healthcare facilities for a higher price.

  • No PCP or specialist referral requirement.
  • Most plans cover prescriptions.
  • You cannot purchase drug coverage separately.
  • Higher out-of-network charges and premiums.

Private Fee-For-Service (PFFS)

PCPs and specialist referrals aren’t necessary under PFFS programs:

  • You can consult any Medicare-approved doctor or healthcare facility, provided they align with the plan’s terms.
  • Drug coverage may be included or purchased separately.
  • You’ll pay more to consult a provider who doesn’t agree with the plan

Special Needs Plan (SNP)

SNPs are only available to people with certain medical conditions, and they feature care coordination and benefits that are specifically designed to match their specific needs:

  • You require a PCP and specialist recommendations.
  • Plans always include drug coverage.
  • Anybody who meets the eligibility criteria can join SNPs at any point in time.


Medicare Supplement (Medigap) Plans in Florida

Medicare Supplement or Medigap plans in Florida cover some or all the out-of-pocket expenses that enrollees would pay under the Original Medicare. Medicare Supplement plans are widely available in Florida, even if most eligible Medicare enrollees choose Medicare Advantage. As of 2021, you can select from 12 different Medicare Advantage plans, depending on where you reside.

Those under 65 and qualified for Medicare because of a disability are not guaranteed access to a Medigap plan under federal standards. However, Florida is one of several states that have implemented laws to assure that those under 65 eligible for Medicare in Florida have access to at least some Medigap policies.

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Florida Medigap for People Younger than 65

Florida’s Medigap insurance must be available to Medicare members of all ages, regardless of their age. Beginning in 2009, residents under 65 have had access to guaranteed-issue Medigap coverage for six months starting after enrolling in Medicare Part B.

Enrollees under the age of 65 normally pay higher premiums, but they have an additional enrollment window after they turn 65, allowing them to switch to less expensive Medigap coverage.

You can discuss your plan options with your Medicare insurance agent to make sure you pick one that’s most beneficial for you.

People under the age of 65 might expect their Medigap premiums to be significantly more expensive than those who are over 65. As a result, many Medicare beneficiaries with a disability choose to enroll in a Medicare Advantage plan till they turn 65.

Florida Medicare Part D

Medicare Parts A and B do not cover outpatient prescription medication. Medicare enrollees can obtain prescription coverage through Medicaid plans, their employer, or through Medicare Part D. More than 2.3 million Part D beneficiaries in Florida are covered by Medicare Advantage, which accounts for 49% of the state’s total Medicare beneficiaries.

As of the end of 2021, 1.45 million Florida enrollees were registered in stand-alone Medicare Part D plans. Medicare enrollees in stand-alone Part D plans account for 38% of all Medicare beneficiaries overall. However, just 30% of those eligible for Medicare are enrolled in Part D in Florida.

There are now 22 stand-alone Part D plans offered in Florida for 2022 coverage, with monthly premiums ranging from $8 to $174. If you’d want to enroll in a Medicare Part D plan, you can do so during the fall enrollment period for Medicare Advantage plans.


A Medicare insurance agent talking to clients
A Medicare insurance agent talking to an elderly couple

Comparing Medicare Advantage Plans in Florida

By 2020, 2,407,550 Florida residents had enrolled in Medicare Advantage, accounting for nearly 43% of the state’s total population. With so many options available, you want to make sure you choose one that covers all your healthcare needs.

Discuss the following factors with your Medicare insurance agent when evaluating your Medicare options:

Provider Network

Some Medicare plans require that you only use providers that are part of the plan’s network. Any other option would mean paying for your own medical treatment, resulting in higher costs than using the provider network exclusively. Find out if your insurance plan covers your doctors and hospitals.

Amount of Coverage Required

Think about the benefits that you cannot do without.  In addition to the original Parts A and B, Medicare Advantage and Medigap plans include additional coverage for dental, vision, and hearing treatments. Compile a list of essential benefits to pick a plan that fulfills them all.

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Check Plan Ratings

Comparing policies can get complicated, with so many plans offering similar coverage and pricing. Every year, the Centers for Medicare & Medicaid Services (CMS) publishes performance data for Part C and Part D. Before the open enrollment period begins, make sure you review these ratings.

Out-of-Pocket Expenses

These are the costs that, as the name implies, come out of your pocket. This includes deductibles, coinsurance, and copayments. You want to keep these as low as possible since they affect your monthly cash flow. You can use our Medicare plan finder tool to learn more about the pricing of different Medicare plans in your area.

Monthly Premium

Premiums for Medicare Advantage and Supplement plans are an additional expense because you must pay the Part B deductible regardless of whether you use your coverage. So, it is important to have at least one zero-premium plan with decent prescription coverage in your area.

When choosing between Medicare Part C and Medigap policies, beneficiaries under the age of 65 should take this into consideration. Your Medicare insurance representative can help you decide between the two options since the latter have higher premiums.

Drug Coverage

Check the policy’s formulary to see if your medications are covered and what their prices are. A generic version of a drug that isn’t on the list may be available, so be sure to ask your doctor about it.

Deductibles, Coinsurance & Copays

These are the expenses that come with using your Medicare benefits. Before signing up for a health insurance plan, make sure you know all its hospital and medical coverage details. This covers everything from doctor’s appointments to treatments and medication.

Freedom to Travel

Florida residents who frequently travel outside of the state prefer travel plans that offer travel courage. Medicare plans often require that you stick to their provider network, while Medigap policies allow you to receive treatment anywhere. Find out how much travel coverage you need before deciding on a plan.


An elderly person shaking hands with a Medicare insurance agent

Medicare Eligibility in Florida

You must be at least 65 years old to enroll in Medicare. In Florida, beneficiaries under 65 are also eligible for Medicare supplement policies. Patients with chronic or incurable conditions, such as end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS), can enroll in Medicare at any age.

Medicare Enrollment in Florida

If you’ve received four or more Social Security or Railroad Retirement Board payments before your 65th birthday, Medicare will enroll you automatically. In any other case, you have the option of applying online or via mail to your local Social Security Administration office. As a time-saving option, we recommend enrolling online.

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Enrollment in Medicare is open during the following time frames:

Initial Enrollment

This is a 7-month window beginning three months before your 65thbirthday and ending three months after it. Coverage for enrollees younger than 65 will begin during their birthday month. If you receive disability benefits, this period will begin three months before or three after your 25th payment.

General Enrollment

If you missed the initial enrollment window, you get another opportunity to sign up for Medicare Parts A, B, C, and D from January 1 to March 31. If you enroll later than the deadline, you may be charged a late fee.

Open Enrollment

A three-month window each year, from October 15 to December 7, allows you to switch between Original Medicare and Part C Plans or adjust your current plan. During this time, you can also register for Medicare Part D coverage.

Tip: This is the best time to enroll in Florida Medicare supplement plans since you get to register without giving out any information regarding your health conditions. Once this period expires, you may be denied coverage due to pre-existing conditions.

Special Enrollment

If you lose your insurance coverage or your eligibility changes due to unforeseen circumstances (job loss, relocation, etc.), you may be eligible for a special enrollment period.


A senior enrolling for Medicare online

The Enrollment Periods for Arizona

Initial Coverage Election

This refers to when you become eligible for the first time. The period includes three months beforethe person’s 65th birthday, their birthday month, and the following three months. In the case of disability qualification, the period commences three months after and before thetwenty-fifth month of getting the benefits.

Annual Election

This period extends from October to December, during which you can switch to a Medicare Advantage Plan from the Original Medicare. Those already registered in Medicare Advantage can switch in the said time period.

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Open Enrollment Period

The open enrollment period from January to March allows you to go back to your Original Medicare or switch between the Medicare Advantage Plans.

Check with reliable Medicare insurance agents in Arizona to learn about special enrollment periods for rare situations, like if you move out of the insurance carrier’s area or lose your health coverage because you lost employment.

Medicare Advantage Plan vs. Medigap

If you’re on original Medicare, private insurance companies’Medicare supplement plans (Medigap) can help you cover costs like copays and coinsurance. You’ll experience some significant bills in your case despite having Parts A, B, and D. In such cases, speaking to a Medicare insurance agent in Arizona will help you get more customized help. They can help you learn about Medigap, which helps gap the bridge for certain expenses that might be covered by one kind of Medigap insurance. However, Medigap isn’t a standalone service and acts as a supplement to Medicare. If Medicare doesn’t work with your current service provider, Medigap won’t work as well.

Moreover, the benefits of Medigap insurance are governed at the federal level as per federal regulations. They’re consistent across all insurers and states (except for three states with waivers allowing them to change how they standardize plans).

Medicare enrollees have a six-month opportunity to enroll in Medigap plans under federal laws that guarantee them an issue. This process begins once they turn 65 and sign up for Medicare Part B. However, federal regulations do not guarantee access to Medigap insurance for anyone under 65 enrolled in Medigap due to a disability.

Moreover, guaranteed issue rights vary from state to state. Make sure to speak with one of our certified Medicare Insurance Agents. They will investigate and inform you whether you fall under a given guideline.


Why Should You Choose Medicare Hope Insurance Agents?

The Medicare Insurance Agents at Integrity Now Insurance Brokers are certified annually by America’s Health Insurance Plan (AHIP). With years of experience and expertise, our team can handle all your Medicare Insurance needs. The elderly, disabled children, and others in need of support with their health expenses are among the many groups we serve.

With dozens of similar insurance plans for seniors constantly entering the market and existing plans being updated or removed entirely, there’s a lot to keep track of. Our Medicare insurance agents keep tabs on the market, so you don’t have to.

A Medicare insurance agent shaking hands with elderly clients

A Medicare insurance agent in Florida will review your healthcare needs and weigh all your options. This includes figuring out if a Medicare Supplement Plan or a Medicare Advantage Plan is best for you.

Once you applied for Original Medicare and received your Medicare card, reach out to our team. With our guidance, you can compare quotes and find a Medicare insurance plan that covers your needs at an affordable price.

Call us to speak with one of our representatives and get started on debt-free and stress-free living today!

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