When it comes to health insurance options, many Medicare beneficiaries are turning to Medicare Advantage in Florida. Private insurance companies sell Medicare Advantage plans, also known as Medicare Part C plans, and handle the details of claims processing and customer service.
The Centers for Medicare and Medicaid Services writes the guidelines for Medicare Advantage plans. To be eligible for Medicare Advantage, you must pay your Medicare Part B premium. If you opt for a Medicare Advantage plan, you cannot buy additional coverage through Medicare Supplement insurance (Medigap).
Medicare Advantage offers cost-saving opportunities, flexible coverage options, and more benefits compared to traditional Medicare coverage. Read on to find out if Medicare Advantage in Florida is right for you.
What is Medicare Advantage in Florida?
When you choose health insurance through a Medicare Advantage plan in Florida, it doesn’t mean that you’re losing your Medicare benefits. It just means that an insurance company will handle the details rather than the federal government. Here are the highlights of a Florida Medicare Advantage plan:
- Becoming more popular each year
- Covers all of the services that Original Medicare (Medicare Part A and Part B) covers
- Most require you to use network providers, have copayments or coinsurance, and might require specialist referrals
- Many include prescription drug coverage
- Frequently include extra benefits such as SilverSneakers, dental, and wellness programs
What is the best Medicare Advantage plan in Florida in 2022?
One of the advantages of Medicare Advantage is its flexibility in coverage. Medicare beneficiaries can choose from several options.
Best network freedom: Medicare Advantage PPO
- Larger network of healthcare providers
- No referrals required
- Monthly premiums range from $0 to $100 per month.
- Free to go out of network but at a higher cost
Best for lowest out-of-pocket: Medicare Advantage HMO Plan
- Lower out-of-pocket cost because it uses the HMO referral network
- Frequently has no deductibles and low copays
- Premiums generally $0 per month
Best for low income or health conditions: Medicare Advantage D-SNIP
- Eligibility based on income
- Must meet one of the designated health conditions
- Can have Medicare and Medicaid to lower out-of-pocket costs such as copays
What Medicare Advantage plans are available in Florida?
Recent statistics show that 48% of Floridians have a Florida Medicare Advantage plan. The health plans vary by county, but here’s an overview of the plans available statewide:
- Local HMO: 207
- Local PPO: 40
- Regional PPO: 6
How much does Medicare Advantage cost in 2022?
What you’ll pay for a Florida Medicare Advantage plan varies by county and whether it’s a PPO or HMO. On average, here’s what Floridians can expect to pay:
- Lowest premium: $0
- Average premium: $8.28
- Average premium for MA prescription drug plans: $13.17
When can I make changes to my Medicare Advantage plan?
The Annual Election Period, also known as Open Enrollment Period, is the most common time for beneficiaries to make changes to their Medicare Advantage plan. Unless you qualify for a special enrollment period, you’re locked into your plan from Jan. 1 to Dec. 31. The Annual Election Period runs from Oct. 15 to Dec. 7 and provides the chance to change from one plan to another based on your health care needs.
When can I enroll in a Medicare Advantage plan in Florida for 2022?
To join Medicare Advantage, you must meet these conditions:
- Be enrolled in Medicare Part A and Medicare Part B
- Live in the service area of the plan
- Stay current on your Part B premiums once enrolled
Initial Enrollment Period
Your Initial Enrollment Period is when you’re first eligible for Medicare benefits.
- You turn 65: Seven-month span that starts three months before your birthday month and ends three months after your birthday month
- Eligible due to disability: Seven-month span that starts three months before and ends three months after the month you’ll receive your 25th disability payment
- Eligible due to disability and you turn 65: Seven-month span that starts three months before your birthday month and ends three months after your birthday month
- You have Part A and enrolled in Part B between Jan. 1 – March 31: April 1 to June 30
Open Enrollment Period – AKA Annual Election Period
Open enrollment runs from Oct. 15 to Dec. 7. During open enrollment you can:
- Switch from Medicare Advantage to Original Medicare
- Switch from Original Medicare to Medicare Advantage
- Change Medicare Advantage plans (with or without Medicare Part D coverage)
Medicare Advantage Open Enrollment Period
The Medicare Advantage Open Enrollment Period runs from Jan. 1 to March 31. This is when you can:
- Change to another Medicare Advantage plan (with or without drug coverage)
- Change from Medicare Advantage to Original Medicare and buy a Part D plan
Special Enrollment Periods
When life changes your circumstances, you can still qualify for Medicare Advantage in Florida. Following are a few of the most common situations that qualify for a Special Enrollment Period (SEP):
- You move out of the plan’s service area.
- You move within your plan’s service area but have additional plan options.
- You lose your current coverage (group, employer, or Medicaid).
- The insurance company’s contract with Medicare ends.
Our agents can review your circumstances and tell you whether an SEP applies.
5-star Special Enrollment Period
The Center for Medicare and Medicaid Services assigns a star rating to Medicare Advantage plans. Plans with a 4-star rating or higher are considered top-quality insurance plans. (Florida Blue has a 4-star rating.) If a 5-star plan comes to your service area, you can switch from your current plan to a 5-star plan between Dec. 8 and Nov. 30.
Special Enrollment Periods if you get “Extra Help”
If you become eligible for Medicare and Medicaid, you can enroll in, switch, or drop your Medicare Advantage plan once during the following times:
Are Medicare Advantage Plans bad in Florida?
Medicare Advantage plans in Florida offer very good coverage. Nationally, enrollment in Medicare Advantage is up 9.6% from last year. In Florida, enrollment increased 7% since 2020. Here’s how the numbers stack up:
- Total Medicare enrollment: 4.638 million
- Number enrolled in Medicare Advantage: 2.231 million
- Percentage of Medicare beneficiaries enrolled in Medicare Advantage: 48%
- Number enrolled by plan:
Local HMO: 1,297,063
Local PPO: 310,658
Regional PPO: 301,746
- Total Medicare enrollment: 61.212 million
- People enrolled in Medicare Advantage: 23.467 million
- Percent of Medicare beneficiaries enrolled in Medicare Advantage: 38%
FAQ's Frequently Asked Questions about Medicare Advantage in Florida
What's the downside to Medicare Advantage plans?
Medicare Advantage in Florida is good, but it does have some drawbacks:
- Network restrictions can limit your choice of healthcare providers. HMOs frequently require a referral from a PCP for specialty care.
- Less financial predictability because while premiums might be lower than Medicare Supplement plans, you’ll have more out of pocket costs.
- Requires you to be actively involved to make sure that you stay in network, pay copayments, and research and possibly change plans as your health care needs change.
- Less long-term stability because plans typically change every year and have new requirements for benefits, copays, drug coverage, and networks. Medigap insurance is standardized and does not change.
What are 4 types of Medicare Advantage plans in Florida?
The majority of Medicare beneficiaries enroll in one of the following:
- Preferred Provider Organization (PPO plans): no specialist referrals or primary care physician (PCP), wide access to providers, out-of-network services covered but higher cost
- Health Maintenance Organization (HMO plans): uses provider network, exception made for out-of-network emergency care, PCP and specialist referrals required
- Private Fee for Service (PFFS): may or may not have provider network, no PCP or referrals required
- Special Needs Plan (SNP): limited to beneficiaries who have specific diseases/diagnoses, typically has provider network and requires PCP and referrals, Part D coverage included
There are a few other types of plans available. If one of these don’t fit your needs, our agents can provide information on other options.
What are the top 3 Medicare Advantage plans?
Here are the top three Medicare Advantage plans based on nationwide enrollment in 2022:
- United Healthcare: 26%
- Humana: 18%
- Blue Cross Blue Shield: 15%
What Are Medicare Special Needs Plans?
Special Needs Plans are limited to those who have a certain disease or diagnosis:
- Tailored to meet the needs of a specific group
- Have network providers you must use
- Typically requires a PCP or health care coordinator
- Usually require referrals for specialists
You can join an SNP at any time if you:
- Live in a nursing center or require care at home
- Are dual eligible for Medicare and Medicaid
- Have a specific chronic disease such as end-stage renal failure or diabetes
Does Medicare Advantage cover drugs?
Most Medicare Advantage plans in Florida are “MAPD” plans ( Medicare Advantage Drug plans). That means the plan includes drug coverage as well as health coverage. Here’s a look at Florida’s prescription drug plans for 2021:
- Rank 4th nationally
- 64% have a 4+ star rating
- Average monthly premium is $13.17
- Average deductible of $110.80
Do Medicare Advantage plans use the Silver Sneakers program in Florida?
Many Medicare Advantage plans, such as Florida Blue, do include SilverSneakers in their benefit package. While some insurance companies might not cover SilverSneakers, they might offer something similar. If you’re interested in fitness benefits, talk with one of our insurance agents. We’ll find the plan that’s right for you.
Florida Medicare Resources
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