Medicare Advantage Plans in Florida

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital insurance) and Part B (medical insurance), and most also include Part D (prescription drug coverage). Many Medicare Advantage (MA) plans also offer extra benefits such as dental, vision, hearing, fitness programs, and telehealth.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first enroll in Original Medicare Parts A and B. Most people become eligible for Medicare enrollment at age 65, though individuals with certain disabilities, ALS, or ESRD may qualify earlier. Florida residents should be aware of enrollment windows to avoid penalties:

• Initial Enrollment
• General Enrollment
• Special Enrollment

What Types of Medicare Advantage Plans Are Available in Florida?

Florida offers the following types of MA plans:

• Health Maintenance Organizations (HMOs): Require in-network care and referrals for specialists. These plans typically have lower costs but more restrictions.
• Preferred Provider Organizations (PPOs): Allow both in-network and out-of-network care (at higher costs), and usually don’t require referrals.
• Private Fee-for-Service (PFFS) Plans: Allow visits to any provider who agrees to the plan’s terms; some plans have a provider network.
• Special Needs Plans (SNPs):
  • C-SNPs: For people with chronic conditions such as diabetes, cancer, or heart disease.
  • I-SNPs: For those living in institutions or needing nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For individuals eligible for both Medicare and Medicaid. These often include care coordination, drug coverage, and dental.
• Medical Savings Accounts (MSAs): Combine a high-deductible health plan with a medical savings account funded by the insurer to pay for qualified expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans in Florida include Part D drug coverage. If your plan doesn’t include drug benefits:

• You may enroll in a standalone Part D plan (available only with certain plan types like PFFS).
• You may incur a late enrollment penalty if you delay obtaining creditable drug coverage.

Always check a plan’s formulary to ensure your medications are covered.

How Do You Choose a Medicare Advantage Plan?

Before choosing a plan, understand Medicare Advantage costs and compare:

• Premiums: Many MA plans in Florida offer $0 premiums, though others may charge a monthly fee.
• Deductibles, Coinsurance & Copays: These determine how much you’ll pay for services.
• Out-of-Pocket Maximums: Caps on annual spending for covered services.
• Extra Benefits: Some plans include vision, dental, fitness programs, telehealth, and hearing aids.

Use this information to compare plan types and choose coverage that fits your healthcare needs and preferences.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during the following specific enrollment periods:

• Initial Enrollment: Begins 3 months before your 65th birthday month and ends 3 months after.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop a Medicare Advantage plan.
• General Enrollment (Jan 1–Mar 31): For those enrolling in Medicare Part B for the first time.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Allows changes between MA plans or switching back to Original Medicare.
• Special Enrollment Periods: May be triggered by:
  • Moving to a new service area
  • Gaining or losing Medicaid or employer coverage
  • Plan contract termination
  • Qualifying health conditions (e.g., C-SNP eligibility)

What If You Want to Change Your Medicare Advantage Plan?

You can switch your Medicare Advantage plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Plan changes typically take effect the first of the following month.

Understanding Medicare Advantage Star Ratings

The CMS star ratings help you compare MA plans by quality. Ratings are updated yearly and based on performance metrics:

• 1 star: Poor
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings apply to both MA plans and MA-PD (Medicare Advantage with drug coverage) plans.

What Are Medicare Resources in Florida?

Florida offers several helpful programs for Medicare beneficiaries:

• SHINE Program (Serving Health Insurance Needs of Elders): Provides free Medicare counseling and plan selection support.
• Florida SMP Program: Educates Medicare beneficiaries on preventing healthcare fraud.
• Florida Department of Financial Services: Handles insurance complaints.
• Florida Medicaid (AHCA – Agency for Health Care Administration): Assists low-income individuals with healthcare costs. Call 1-866-762-2237.

Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also known as Medigap, help pay out-of-pocket costs that Original Medicare doesn’t cover, such as copays, deductibles, and coinsurance.

• You must have Medicare Parts A and B to enroll.
• The six-month Medigap Open Enrollment Period begins once you’re enrolled in Part B.
• Medigap does not include drug coverage—you’ll need a separate Part D plan.
• There are 10 standardized plans; Plans F, G, and N are the most popular. Medicare Supplement Plan G had the highest enrollment in 2023 and is growing quickly.
• Plan F is not available to new Medicare beneficiaries after 2020.

Learn more about Medicare Supplement plans in Florida.

Next Steps

If a Medicare Advantage plan in Florida fits your healthcare needs, start comparing plans in your area. Review provider networks, out-of-pocket costs, and added benefits to make an informed choice—then enroll during the appropriate period.