How Does Medicare Work in Florida? 

In Florida, there are over 4.6 million Medicare enrollees. Forty-eight percent of those Medicare recipients have coverage through a Medicare Advantage (Part C) plan, while approximately thirty-two percent have Original Medicare alone. Twenty percent have Original Medicare plus Medicare Supplement insurance (Medigap). 

Medicare is a federal health insurance program, so every state has the same eligibility requirements for enrollment. You can enroll in Original Medicare Part A (hospital insurance), Part B (medical insurance), a Medicare Advantage (Part C) plan, and/or a Medicare prescription drug (Part D) plan if you are a U.S. citizen or have been a legal resident for five continuous years. You need to meet one of the following requirements:

  • You are 65 years old or older. 
  • You are under 65 with a qualifying disability and you’ve been receiving Social Security or Railroad Retirement Board disability benefits for at least 24 months. 
  • You have end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS). 

If you live in Florida and enroll in Medicare, your coverage functions the same as it does in other states. Here’s a look at what you may expect from your benefits. 

When can you enroll in Medicare in Florida?

When you first become eligible for Medicare you can enroll during your Initial Enrollment Period (IEP). Most Medicare recipients get coverage when they turn 65. Your seven-month IEP begins three months before the month of your 65th birthday and ends three months after your 65th birth month. 

Millions of people under 65 are eligible for Medicare due to a qualifying disability. If you’re already receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare (either by turning 65 or having a qualifying disability), the Social Security Administration enrolls you automatically in Medicare Parts A and B.

During your IEP, you can switch your coverage from Original Medicare to a Medicare Advantage plan without penalty. Medicare Advantage (MA) plans are offered by private insurance companies as an alternative to Original Medicare. MA plans are required to provide at leats the same Part A and Part B benefits as Original Medicare, but most plans include additional coverage such as prescription drugs, dental and vision care, and fitness programs. 

The General Enrollment Period (GEP) runs from January 1st to March 31st every year. During the GEP, you can enroll in Medicare if you neglected to enroll during your IEP, however, you may have to pay late enrollment penalties. Beginning in 2023, if you sign up for Medicare during the GEP, your coverage will kick in the month after you enroll. 

Special Enrollment Periods are available for those who qualify. If you have a qualifying life event such as moving to the U.S. from abroad, moving to a different service area, or losing comparable health insurance (such as group coverage), you may be able to enroll in a Medicare plan during a Special Enrollment Period. 

Compare your Medicare options

During the Medicare enrollment periods mentioned above, you can sign up for Original Medicare or you can enroll in a Medicare Advantage plan from a private insurance provider. As mentioned, Medicare Part C is an alternative way to receive the same benefits as Original Medicare Parts A and B. Most Part C Medicare Advantage plans also include prescription drug coverage and extra benefits like routine hearing, vision, and dental care – benefits that Original Medicare doesn’t offer. 

You can also purchase a stand-alone prescription drug (Part D) plan if you have Original Medicare. These plans are offered by private insurance companies. While providers are required to include a range of medications most commonly used by Medicare recipients, plans can vary in costs. Each plan will also have its own list of covered drugs, known as the plan formulary. 

When you enroll in a Part C or Part D plan, you must choose one that offers coverage in your area of residence. If you move to another service area, you can switch to a different plan during a qualifying enrollment period. 

What is Medigap?

If you choose to get your benefits through Original Medicare, you may consider purchasing a Medicare Supplement (Medigap) plan. When you turn 65 and have Part B, you will have a six month Medigap Enrollment Period. During this time, you’ll be able to buy any Medigap plan sold in your state. Unfortunately, if you wait until after this period ends to buy a Medigap plan, you may be subject to medical underwriting. You may be charged more or refused coverage based on pre-existing conditions. It’s important to note that you can’t have a Medigap plan with Medicare Advantage.

What special programs are available for Medicare recipients in Florida? 

The Florida Department of Elder Affairs has a senior health program known as Serving Health Insurance Needs of Elders (SHINE). If you are entitled to Medicare enrollment or are already enrolled, you can access this valuable program to get answers to questions about Medicare insurance. 

The Department of Elder Affairs also runs a variety of programs to help the elderly age at home, maintain well-being, and get information and education on health and health care services. You can contact them to find a program in your area by calling or visiting the official website. 

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