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Medicare is a federal health insurance program for Americans who reach the age of 65, or younger people who qualify due to having a disability. When it’s time to enroll, you can choose between Original Medicare (also called Part A and Part B), or go with a Medicare Advantage Plan (known as Part C, or MA). Medicare Advantage is still an approved Medicare plan, but it is provided by private health insurers.
If you’re eligible for Medicare, you can browse the available Medicare Advantage plans in Florida to see if there is a plan that offers better coverage options than Original Medicare. Florida has been known to offer competitive Medicare Advantage plans for its older population, so here’s what you need to know about choosing a plan in the Sunshine State.
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
With 369 Medicare Advantage Plans available in Florida, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
A higher percentage of Floridians choose Medicare Advantage Plans than in any other state (except for Minnesota, which is tied with Florida at 48%). There are many Medicare Advantage Plans from which to choose in Florida, forcing providers to offer competitive premiums and coverage. The average number of Medicare Advantage Plans available to eligible residents across all of Florida’s counties is 40, tied for the third-highest among the states.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Florida Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
Florida-wide Medicare Advantage Resources
|Resource||Contact||How they help|
|Florida MyBenefits – Medicare Advantage and Prescription Drug||Connect online||Florida MyBenefits is a website which aggregates all of the insurance companies that offer Medicaid Advantage plans along with their contact information.|
|Florida Department of Health||Phone: 850-245-4444
Email: [email protected]
Address: 4052 Bald Cypress Way, Tallahassee, FL 32399
|They help Floridians of all ages with disabilities in all of the Department of Health’s programs and activities for health promotion, disease prevention, wellness, and disaster preparedness.|
|Florida Department of Elder Affairs – Insurance, Medicare and Medicaid||Phone: 850-414-2000||The Department of Elder Affairs offers free, unbiased counseling to help seniors understand their health insurance options.|
Federal Medicare Advantage Resources
|Resource||Contact||How they help|
|CMS.gov – Medicare Advantage Applications||Phone: 1-800-MEDICARE||This page provides important information on the application process for Part C Medicare Advantage plans.|
|Medicare.gov – Medicare Advantage Plans||Phone: 1-800-633-4227||This government website provides information on the Medicare Advantage program.|
|American Hospital Association – Medicare Advantage||Phone: 1-800-424-4301||The AHA provides education for health care leaders and is a source of information on health care issues and trends.|