Medicare Advantage Plans in Florida
Key Takeaways
- To buy Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). in Florida, it must be your primary state of residence.
- Many Medicare Advantage plans include coverage for prescription drugs.
- Not every plan is available in every county or ZIP code.
- You must sign up for Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). before you can get a Medicare Advantage plan.
- Some Part C plans include extras, such as dental and vision coverage, plus gym memberships.
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.
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Florida Medicare Advantage Plan Coverage
Medicare Advantage plans are a popular alternative to Original Medicare in Florida. All Florida residents with Medicare have access to a Medicare Advantage plan. You can purchase a plan directly from a private insurer or through an independent licensed insurance agent.
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)
FL Medicare Advantage Plan Costs
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 2024 is $174.70. You may pay more if the modified adjusted gross income on your tax return two years ago is above $103,000 (or $206,000 for married couples filing jointly).
In some instances, you may also pay a premium for Part A, although Part A is premium-free for most people.
In 2024, the average monthly premium for a Medicare Advantage plan in Florida is $10.38. Everyone in the state with Medicare has access to a plan with a $0 premium.
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.
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Medicare Advantage Plan Eligibility and Enrollment in Florida
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)
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.
Are There Florida Medicare Advantage Plans with Prescription Drug Coverage?
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.
When Can I Sign Up for Medicare Advantage in Florida?
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.
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Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- An Overview of Medicare. KFF.
- FACT SHEET. CMS.gov.
- Joining a Health or Drug Plan. Medicare.gov.
- What Medicare Part D Drug Plans Cover. Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.