Florida Medicare Advantage Plans | Care in the Sunshine State

What Are Medicare Advantage Plans in Florida?

Thinking about Medicare coverage in Florida? Medicare Part A and B, or Original Medicare, doesn’t cover all your medical bills and won’t limit your out-of-pocket costs. Medicare Advantage (MA) plans, or Medicare Part C, are offered by private insurance companies mandated to follow Medicare guidelines. Most plans include Medicare Part D, or prescription drug coverage.

What You Need to Know

Medicare Advantage plans are required to include Medicare Part A and B coverage.

Most plans include coverage for prescription drugs. 

Some MA plans are zero-premium, while others have a monthly cost.

What Types of Medicare Advantage Plans Are Available in Florida?

You can choose from several different MA plans:

• HMO: Health maintenance organization, which limits members to a contracted provider network. You generally need to choose a primary care provider (PCP) and must get a referral to see a specialist.
• PPO: Preferred provider organization, offering a wider network than an HMO but at increased cost. You don’t need to choose a PCP and don’t need a referral to see a specialist.
• SNP: Special needs plans, for those who need more specialized care. These come in three types:
  • Chronic condition (C-SNP):¹ For those who have ongoing medical issues such as diabetes or cancer. 
  • Dual eligible (D-SNP):² For those who are eligible for both Medicare and Medicaid.
  • Institutional (I-SNP):³ For those who need care in a nursing home or other long-term facility.
• PFFS: Private fee-for-service.⁴ Services are offered by a contracted provider group at preset rates. You won’t need to choose a PCP.
• MSA: Medicare medical savings account, a mix of a medical savings account and a high-deductible plan.⁵

What Are Prescription Drug Options with Medicare Advantage?

For MA plans in Florida, there are two options for prescription drug coverage: a separate plan or as part of the MA plan. 

If there are specific medications you need, check your plan’s formulary, or list of covered medications, to make sure yours are included.

Under an MA-PD plan, most Medicare Advantage HMO and PPO plans in Florida provide prescription drug coverage. 

How Do You Choose Medicare Advantage Plans in Florida?

Consider the costs of the plan as well as the type of coverage you want.

Your premium is the amount you pay for the plan each month. There are zero-premium plans available, though you’d still pay the Medicare Part B premium ($170.10 in 2022). However, your other out-of-pocket costs may be higher with a zero-premium plan.

Other costs include:

• Coinsurance, the percentage that you pay for services (usually 20%) after meeting your deductible.  
• Copays, a standard amount you pay for most services.
• Deductibles, the yearly amount you pay before your coverage begins.
• Maximum out-of-pocket, which in 2021 is $7,550 for in-network services.⁶

Plan benefits include:

• Vision, including eye exams and glasses or contact fittings.
• Dental, including exams and cleanings.
• Telehealth, including medical office visits and psychotherapy.
• Other perks, including access to fitness programs and hearing aids.

When Can You Enroll in Medicare Advantage?

You’re eligible for Medicare Advantage as soon as you’re eligible for Original Medicare. Your Initial Enrollment Period runs from the three months before you turn 65 years old to the three months after you turn 65.

The Medicare Annual Election Period, or Open Enrollment Period, runs October 15 through December 7. 

The Medicare Advantage Open Enrollment Period is from January 1 to March 31. During this time you can switch to a different Medicare Advantage plan or switch back to Original Medicare. 

The General Enrollment Period runs January 1 to March 31. Your coverage begins on July 1.

You may qualify for a Special Enrollment Period in certain situations, including:

• Relocation
• Loss of coverage, or losing Medicaid eligibility
• Gain of coverage, or qualifying for employer or union coverage
• Plan changes, such as Medicare termination of a current plan’s contract
• Being diagnosed with a chronic condition that would be best served by another plan

How Much Do Medicare Advantage Plans Cost in Florida?

In 2020, the Florida average⁷ was $8.05. In downtown Miami, costs range from $0 to $105. In downtown Tampa, costs range from $0 to $146.80.⁸

What If You Want to Change Your Medicare Advantage Plan?

If you’re already enrolled in Medicare Advantage, you can join the plan you want during the corresponding enrollment period.

What Are Alternatives to Medicare Advantage?

Alternatives to an MA plan in Florida include:

• PACE: Programs of All-Inclusive Care for the Elderly.⁹ These are medical and social services for a specific group of beneficiaries who must meet the following conditions:
  • 55 or older
  • Nursing home care eligibility
  •  Ability to live safely in a community
  • Live in a PACE service area
• Original Medicare. If Medicare Part A and B offer enough coverage for you, you can stick with it. 
• Medicare Supplement. Also known as Medigap, these policies help pay costs not covered by Original Medicare.
• Medicare Supplement with a Part D plan. You’ll likely need separate prescription drug coverage with a Medigap policy

  What Are Medicare Resources in Florida?

• The Florida Department of Elder Affairs SHINE Program¹⁰ provides a comprehensive look at Medicare.
• Medicaid¹¹ helps pay medical costs for those with low income or disability. 

State Medicare Advantage Data in Florida

Next Steps

If a Medicare Advantage plan best fits your needs, reach out to an enrollment agency or to Medicare to find an insurance company. Make sure you’re picking the level of coverage and the costs that are right for you before you sign up.