Medicare Advantage Plans in Florida

Medicare Advantage is also referred to as Medicare Part C. If you are eligible for Medicare and live in Florida, there are many Part C plans for you to choose from. Not every plan is available in every county or zip code. Read on to learn about Medicare Advantage options for Floridians.

Medicare Advantage plans are a popular alternative to Original Medicare in Florida. You can purchase a Medicare Advantage plan directly from a private insurer, or through an independent licensed insurance agent, like the ones at GoHealth.

Medicare Advantage plans cover everything Original Medicare does. Many plans also cover extras that may be important to you and your overall health. Some things that Medicare Advantage plans in Florida may cover include:

• Preventive services
• Prescription drugs
• Doctor’s appointments, including specialists and primary care physicians
• Mental health treatments
• Smoking cessation programs
• Dental services
• Vision care and eyeglasses
• Acupuncture
• Chiropractic adjustments
• Hearing care
• Gym memberships (SilverSneakers)

In Florida, you will find several types of Medicare Advantage plans to choose from. The offerings available to you and their costs will vary based on the insurance company and type of plan you choose. Prices for Part C plans in Florida can also differ from one county or zip code to another.

The Part B monthly premium typically applies, though some plans may offer to pay all or part of this cost. The standard Part B premium in 2023 is $164.90. You may pay more if the modified adjusted gross income on your tax return two years ago is above a certain amount. The maximum you can expect to pay monthly for Part B in 2023 is $560.50.

In some instances, you may also pay a premium for Part A, although Part A is premium-free for most people.

Some of the types of Medicare Part C plans available in Florida are:

Health Maintenance Organizations (HMOs)

HMOs require you to use a specified network of providers. They also typically require referrals from your primary care physician (PCP) before you can see a specialist.

HMOs are an affordable Part C option. Many have $0 monthly premiums, $0 deductibles for healthcare and drugs, and $0 copays for PCPs and specialists.

Preferred Provider Organizations (PPOs)

PPOs have a network of health care providers you can see for healthcare treatment. Unlike HMOs, PPOs also pay for health care services you receive out of network, but at a reduced rate.

Some PPO plans may be more expensive than some HMOs, but you can find affordable options throughout the state of Florida. Many have a $0 monthly premium. Some plans feature $0 copays for PPO appointments but require a copay of $35 or more for specialist visits. You may also have deductibles you’ll have to meet, both in and out of network.

If your plan includes drug coverage, you may have an annual deductible to meet for your prescriptions.

To get Medicare Advantage in Florida, you must be eligible for Original Medicare. Before you apply, make sure you meet one of these eligibility criteria:

• You’re 65 years old or older
• You are living with a disability
• You are living with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS)

You must also have already signed up for Original Medicare (Medicare Part A and Part B). You will need a Medicare ID number before you can purchase a Medicare Advantage plan.

To buy Medicare Part C in Florida, you must list Florida as your primary state of residence. Many people spend the cold weather months in Florida but also have homes in other places. If you are a snowbird, look for a plan with a national network rather than a regional plan. Regional plans serve only one state or a specific group of states that Medicare determines.

Many Medicare Advantage plans in Florida include prescription drug (Part D) coverage. Not every plan covers the same medications, however.

If you choose a Medicare Advantage plan that includes coverage for prescription drugs, it will have a specific formulary you can look at. A formulary is a list of the brand name and generic drugs that the plan covers.

Each formulary is divided into tiers. Your plan may have two, three, four, or more tiers. Each tier includes drugs that have the same or similar copays.

Every formulary must cover at least two medications within the categories most commonly prescribed. They may not, however, cover a specific medication that you need or wish to continue taking. For example, the plan may cover a generic version of the brand-name drug you currently use. When you compare Medicare Advantage plans, make sure your preferred medications are included in the formulary of the plan you choose.

You can sign up for Medicare Advantage plans during one of these timeframes:

Initial Enrollment Period (IEP): Initial enrollment starts when you’re first eligible for Medicare. If this is due to age, your initial enrollment period includes your birth month, plus the three months before and after, for a total of seven months.

Medicare Open Enrollment Period: You can join, switch, or drop a plan from October 15  to December 7 each year.

Medicare Advantage Open Enrollment Period: If you currently have Original Medicare or a Medicare Advantage plan you don’t love, you can change to a new plan in Florida from January 1 to March 31 each year.