Speak with a licensed agent: 1-888-414-4547

Medicare Eligibility in Florida

Medicare eligibility in Florida is confusing.  Learn who’s eligible, how to enroll, how much Medicare cost’s, and what plan options you have.

The Centers for Medicare & Medicaid Services reports that more than 4.6 million people (21% of Floridians) are eligible and enrolled in Medicare in Florida. Understanding how the program works and the coverage options are the first steps toward peace of mind and financial protection from the ever-increasing cost of health care.

Find Plans in Your Area

Who Qualifies for Medicare in Florida?

Here are several categories that help determine your eligibility for Medicare in Florida.

Florida eligibility requirements:

  • You’re 65 or older and a U.S. citizen or permanent resident who’s lived in the U.S. for at least 10 years.
  • You’re 65 or older and receiving or eligible for Social Security or Railroad Retirement benefits.
  • You’re a government employee or retiree (or your spouse is a government employee or retiree) who hasn’t paid into Social Security but have paid Medicare payroll taxes while you worked.
  • You’re under 65 and have received Social Security disability for at least 24 months.
  • You’re under 65 and have end-stage renal disease or ALS.
  • You’re under age 65 and receiving a Railroad Retirement disability pension and meet certain requirements.

If you don’t qualify for Medicare benefits through one of the above scenarios, you can buy coverage when you turn 65.

When you buy coverage, you have to:

How to Apply for Medicare in Florida

Once you’ve determined you are eligible for Medicare in Florida, you can then understand how the process works.

Medicare enrollment is automatic for some. Others have to apply.

Automatically signed up:

  • You’re under 65 and already receiving Social Security benefits.
  • You start getting Social Security or Railroad Retirement benefits four months before you turn 65.
  • You have ALS (Lou Gehrig’s Disease).

Have to apply:

  • If you’re not getting Social Security or Railroad Retirement benefits four months before you turn 65
  • You have end-stage renal disease.

To apply for Medicare, you can contact your nearest Social Security office or apply online.

When to apply for Medicare in Florida

If you’re not automatically signed up for Medicare benefits, you have several opportunities to enroll:

  • Initial Enrollment Period: three months before your birthday, your birthday month, and three months after
    This is the best time because you won’t face any penalties.
  • General Enrollment Period: Jan. 1-March 31 each year
    Your premium amount will include a late enrollment penalty.
  • Special Enrollment Period: anytime with no penalty as long as you or your spouse are still working and you have group health coverage
    If your employment or group health coverage ends, you have eight months to enroll in Medicare without penalty.

Cost of Medicare in Florida

The Medicare program, like many Medicare Plans in Florida, is not completely free. Although you might not have to pay a monthly Part A premium now, you actually prepaid it during the years you worked.

The different “parts” of the Medicare program have cost-share amounts for which beneficiaries are responsible. Your Medicare costs also depend on whether you choose Original Medicare or a Medicare Advantage plan.

In general, here’s what to expect in Medicare costs:

  • Monthly premiums
  • Deductibles (what you pay out-of-pocket before Medicare pays)
  • Coinsurance (the percentage you pay for medical services)
  • Copays (a fixed amount you pay for a particular service or prescription)

Medicare Part A Cost

Most Medicare beneficiaries who are eligible in Florida won’t pay a Medicare Part A premium.

If you buy Part A coverage, your 2022 premium depends on how long you worked:

  • Less than 30 quarters: $471
  • 30-39 quarters: $259

Part A coverage has two cost-shares: a deductible and coinsurance.

  • Deductible of $1,556 each benefit period
  • Coinsurance of $0 each benefit period days 1-60
  • Coinsurance of $389 a day for days 61-90 of each benefit period
  • Coinsurance of $778 a day for each “lifetime reserve” day over 90 of each benefit period (up to 60 lifetime days)
  • All costs beyond your lifetime reserve days

Medicare Part B Cost

Part B covers outpatient medical services and preventive care.

Here’s what you’ll pay in 2022:

  • Premium of $170.10 (might be higher based on income)
  • Deductible of $233
  • Coinsurance (20% of Medicare’s approved amount) for doctor services (inpatient or outpatient), durable medical equipment, and outpatient therapy

Medicare Part D Prescription Drug plan cost

Prescription drug premiums vary depending on which plan you choose, your income, and the insurance companies selling these Medicare Plans in Florida. (Florida premiums range from $7 to $172 a month for 2022.) The same goes for copayments and deductibles. Location also affects the monthly premium.

If you don’t enroll in a Part D plan when you’re first eligible for Medicare in Florida, you will have to pay a late enrollment penalty. The cost of the penalty depends on how long you went without coverage.

What is the income limit for Medicare in Florida?

Your income in 2021 determines how much you’ll pay for Medicare Part B in 2022.

Here’s how it works:

  • Base rate is $148.50 (what most people pay)
  • Varies based on filing status (individual, married filing jointly, or married with separate returns)
  • Ranges from $148.50 to $504.90

What Medicare Plans are Available in Florida?

Their are several types of Medicare Plans in Florida, the first one is a Medicare Supplement, Medicare Advantage, and low-income plans. Each plan fits different needs. The Florida Shine program assists seniors with questions relating to Medicare, Medicaid, and other health insurance.

Medicare Supplement

  • Premium ranges from $125-$250 a month
  • Higher cost but national coverage
  • No networks or referrals
  • Good for travelers going out of state
  • Has no annual plan change opportunity

Medicare Advantage Plans

  • PPO monthly premiums range from $0 to $100
  • HMO monthly premiums typically $0
  • Larger network and no referrals with PPO option
  • HMO options have smaller networks and require referrals

Medicare Advantage D-SNIP

Another Medicare Plan in Florida is a Dual eligible Special Needs Insurance Plan, these are good for individuals who are low-income or have chronic health conditions such as end-stage renal disease. Dual eligible means you have Medicare and Medicaid.

Here are the Florida eligibility requirements:

  • You have Medicare Part A and Part B
  • You live in the service area of the plan
  • You have one of the 15 eligible chronic conditions
  • You live in a nursing center or require nursing care at home

Ready to Learn More?

If you’re a beneficiary of Medicare in Florida or if you’re going to be signing up soon, we can help you compare insurance plans and look for the best rates. Call us today to talk to one of our licensed insurance agents so that we can explain your plan options and help you choose a company with a 5-star rating.

Need Help?

Call to speak with a licensed insurance agent now.

(888) 414-4547