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Medicare Advantage Plans in Florida

Recent studies reveal that almost 1.8 million of the state’s Medicare beneficiaries have chosen to enroll in Medicare Advantage plans in Florida. This number accounts for 42% of every Floridian qualified for Original Medicare. Some folks may decide that they will do best with Medicare Part C because they have concerns about coinsurance and co-payments included in Medicare Part A and Part B. Take a moment to compare several of the best Medicare Advantage plans in Florida in order to figure out if they will offer the best balance of benefits and premiums.

Medicare Advantage Plans in Florida: When Can You Enroll?

Most Floridians who have enrolled in Medicare Part A and Part B, usually called Original Medicare, can choose to enhance their coverage with a Medicare Advantage plan. On the other hand, there are only certain times when you can join a new plan, enroll in a Medicare Advantage plan for the first time, or drop a plan.

This explains when you can enroll and/or disenroll in a Medicare Advantage plan in Florida:

  • Initial Coverage Election Period: For most Floridians, the Initial Coverage Election Period starts three months before the month the beneficiary will turn 65 and lasts for three more months. Young, disabled Medicare recipients or people who delay Part B because they already have health insurance get three months before and after the first of the month that they first take Medicare Part A and Part B.
  • Annual Election Period: The Annual Election Period lasts for several weeks from October 1 until December 7. This is the best time to compare the best Medicare Advantage plans in Florida and make changes that will become effective on January 1.
  • Special Election Period: Some life circumstances may trigger a Special Election Period that will allow enrollment in a new MA or MAPD plan. Common events that can trigger an SEP would include moving away from a plan’s network area or losing other health insurance because of retirement.
  • Medicare Advantage Disenrollment Period: This period starts on January 1 and lasts for six weeks. Medicare Advantage plan members may drop their plan but remain enrolled in Medicare Part A and Part B. If needed, they can also get a new Part D drug plan.

Best Choices for Medicare Advantage Plans in Florida

Most Florida beneficiaries will have these choices of typical Medicare Advantage plans:

Health Maintenance Organization HMO plans

An HMO is the strictest kind of Medicare replacement insurance because it will usually only cover in-network providers. Members have to have a primary care doctor, or PCP, make referrals to visit specialists. They generally only make exceptions to network rules in case of emergencies.

Preferred Provider Organization PPO plans

A PPO offers more flexibility but may charge higher premium rates than an HMO. There’s no need for a specialist referral. Out-of-network charges can still be covered but are generally more expensive.

End Stage Renal Disease ESRD

Typically, a beneficiary who suffers from ESRD cannot enroll in a typical Medicare Advantage plan in Florida. There are special Medicare Advantage plans in Florida that have been tailored to help patients manage this health condition.

Special Needs Plans SNPs

Typically, these Special Needs plans are MA HMOs that have been customized to help people manage chronic health conditions or institutional conditions. You might find Special Needs plans in your area that have tailored benefits for people with specific illnesses or who are in a nursing home.

Dual-Eligible plans

Some people qualify for both Florida Medicaid and Medicare Part A and Part B, and they qualify for dual-eligible Medicare Advantage plans.

Enrollment Figures for Florida Medicare Advantage Plans

These statistics demonstrate how many people choose Medicare Advantage plans in Florida:

  • Floridians with a Florida Medicare Advantage plan: 1,793,258
  • The overall percentage of people on Original Medicare who choose a Medicare Advantage plan: 42%

These are the high-population Florida counties:

  • Miami-Dade County, FL: 2,751,796
  • Broward County, FL: 1,935,878
  • Palm Beach County, FL: 1,471,150
  • Hillsborough County, FL: 1,408,566
  • Orange County, FL: 1,348,975

How Medicare Advantage Plans in Florida Cover Prescriptions

Medicare Part A and Part B will not cover most prescriptions, but Medicare Part C plans in Florida often do. There are two ways to get Medicare insurance that offers prescription coverage:

  • Medicare Advantage Prescription Drug plans MAPDs: Most Medicare Advantage plans in Florida include Medicare Part D.
  • A stand-alone Medicare Part D Prescription Drug Plan: If you choose a plan that doesn’t come bundled with Medicare Part D, you can also purchase Medicare Advantage Prescription Drug plans on their own.

Note that each Medicare Part D Prescription Drug Plan will have its own formulary, or listing with covered medicine and Prescription Drug tiers. Prescriptions in various tiers may have different copayments or deductibles. During the Initial Coverage Election Period and later enrollments, it’s important to make sure that the Medicare Part D plan that you choose will help you save money on the medicine that you need. Like other network HMOs or PPOs, these Medicare Advantage Prescription Drug plans may have in-network pharmacies.

Network Restrictions for Medicare Advantage Plans in Florida

Most of the MA or MAPD plans in Florida that have low or even a $0 premium will have you choose your doctor and hospital from the insurance company network. They will make some rare exceptions to their network requirements, but any non-emergency care should get written approval in advance.

A few PPOs may have nationwide provider networks, but they may charge the highest rates. Most plans with a very low or 0 premium will rely upon local healthcare networks. If you move away, you will need to tell your insurance company and will probably need to switch plans. Moving away from your original plan’s service area will trigger a Special Enrollment Period that you can use to get another plan.

Attractive Benefits of Medicare Advantage Plans in Florida

Few Floridians rely only upon Medicare Part A and Part B. This is because Original Medicare leaves recipients with many gaps in coverage. Medicare Part C plans in Florida can limit out-of-pocket expenses and help members control and predict their costs.

In addition, a Medicare Advantage plan in Florida may also offer some benefits that you cannot find included in Original Medicare. These might include hearing services, coverage for routine vision and dental services, and even such wellness programs as memberships to local health clubs.

Florida Medicare Resources

These authority resources in Florida can help you uncover more information about your Medicare benefits:

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