Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
As of 2020, over 4.6 million seniors in Florida are enrolled in the federal Medicare health insurance program in 2020. Of these, 2.2 million choose to get their benefits through a Medicare Advantage plan. Medicare Advantage is a privately issued program, often called Part C, that combines the benefits of Original Medicare Parts A and B into a single plan with one monthly premium. Part C plans offer nearly all of the same benefits as A and B, plus a few extra covered benefits, which might include vision, dental and some prescription assistance. Some plans also include coverage for additional needs such as non-emergency medical transportation and senior health sessions.
Because Medicare Advantage plans stack multiple benefits into a highly customizable single plan, their beneficiaries generally don’t need a traditional Medicare supplement. Most Part C plans also come with an annual out-of-pocket maximum, which Original Medicare does not, making this an attractive option for seniors on a fixed income. Nationally, roughly 42% of Medicare recipients have opted into Part C, in place of the Original Medicare they would otherwise be eligible for. In Florida, nearly 48% of Medicare participants have enrolled in Medicare Advantage, according to the data from 2020.
This guide gives an overview of Medicare Advantage plans in Florida. It goes over the most popular plans in the state, eligibility requirements for participation in them and what kind of benefits they offer. It also has helpful information about how to apply for a plan in the Sunshine State.
The Top 10 Medicare Advantage Plans in Florida
Several companies in Florida offer Medicare Advantage plans. As a result, Medicare-eligible seniors in the state have a wide range of options available to them for getting effective health coverage. In the table below, 10 of the most popular plans are shown with their associated price data. Because these companies offer multiple plans, their rates are shown as a range, rather than as a single average figure. In order to get the most useful information, we’ve added together all of the enrollment data available to develop participation numbers. The figures in this table are accurate as of April 2022, though more up-to-date information is available online from Medicare.gov.
CarePlus Health Plans, Inc.
Florida Blue HMO
Freedom Health, Inc.
Simply Healthcare Plans, Inc.
Optimum HealthCare, Inc.
How Medicare Advantage Plans Work in Florida
Seniors in Florida have to be careful when picking out a Medicare Advantage plan. Because these plans are offered through private companies, they can be organized in different ways to maximize coverage. Plans are available as health maintenance organizations (HMOs), preferred provider organizations (PPOs) and special needs plans (SNPs). Different types of plan have different rules for how to get referrals, whether you need a primary care provider and the difference between in- and out-of-network coverage. The four most common plan types are listed below.
What Medicare Advantage Plans Cover in Florida
Medicare Advantage plans in Florida provide nearly all of the same benefits as Original Medicare Parts A and B, except for hospice care, which is always covered by Medicare Part A. Medicare Advantage plans also pay for preventive health screenings, X-rays ordered by a doctor and lab tests. Services delivered during an inpatient stay in the hospital also fall under the umbrella of Medicare Advantage plans. In addition to combining benefits under one monthly premium, Part C plans also typically offer valuable extra services. These include vision care, dental services and hearing aids.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Florida
In order to sign up for a Medicare Advantage plan in Florida, seniors have to meet a number of eligibility criteria. These include U.S. citizenship or legal residence and enrollment in an Original Medicare plan. It’s also necessary to live in a geographic area where a specific plan is offered.
As is common for senior health insurance policies, Medicare Advantage plans have limited open enrollment periods for new participants. People who enroll during one of these periods cannot be declined or charged more for pre-existing conditions. They can be charged a penalty rate, however, if the application is submitted outside of the usual window. Look over the list below for helpful information regarding enrollment periods and the windows when you can first enroll or make changes to your coverage.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
Three Months Before 65th Birth Month
Three Months After 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Florida
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Florida’s Serving Health Insurance Needs of Elders (SHINE) program is a free Medicare counseling service administered through the Florida Department of Elder Affairs and delivered through local Area Agencies on Aging. A network of SHINE volunteers provide free, unbiased information about area Medicare Advantage plans, pricing and coverage options through one-on-one counseling appointments and workshops. Seniors who have questions about Medicare or need help choosing the best Medicare Advantage plans for their particular needs can book an appointment with a SHINE counselor.
Seniors can connect with their local SHINE provider by calling the Florida Department of Elder Affairs at 1-800-963-5337.
Florida Senior Medicare Patrol (FL-SMP)
Florida’s Department of Elder Affairs helps protect seniors against Medicare Advantage fraud, misuse and over-billing through the Senior Medicare Patrol program. Administered in conjunction with the SHINE program, the FL-SMP is available to seniors who have questions or concerns about their MA plan. SMP workers will assess every report made, and issues that need to be escalated are referred to the appropriate local, state or federal authorities. SMP volunteers also deliver free workshops on Medicare fraud prevention at senior centers throughout the state.
Seniors, family members and caregivers can contact the FL-SMP through the Florida Department of Elder Affairs by calling 1-800-963-5337. FL-SMP services are also available through local Area Agencies on Aging, also known as Aging and Disability Resource Centers (ADRCs).
Florida seniors aged 60 and older can schedule a free telephone consultation with an approved attorney or paralegal through the statewide Senior Legal Helpline. Geared towards low-income seniors, this service can help seniors navigate legal issues related to Medicare Advantage coverage, as well as other civil matters. If Senior Legal Helpline callers require legal services beyond the free telephone consultation, they will be given the help they need to find a free or low-cost legal provider in their community.
Seniors can call the Senior Legal Helpline toll-free at 1-888-895-7873.
Medicare Savings Program (MSP)
The Medicare Savings Program is a state-sponsored subsidy program for low-income seniors who have difficulties covering the cost of Medicare. MSP consists of four separate programs that help seniors pay for their Medicare premiums, coinsurance, co-payments and deductibles. Eligibility is based on income, resources and medical expenses.
For more information on Florida’s Medicare Savings Programs, seniors can call the Elder Helpline at 1-800-963-5337. Seniors can also book a one-on-one appointment with a SHINE counselor through their local Area Agency on Aging.
The Senior Connection Center is the Aging and Disability Resource Center for Hardee, Hillsborough, Highlands, Manatee and Polk counties. Seniors, adults with disabilities and caregivers can access free and low-cost services, such as evidence-based health and wellness workshops and fall prevention classes. The center also hosts the local SHINE program to help seniors learn about the various Medicare options, including which Medicare Advantage plans are offered in the area. SHINE volunteers can also assist with Medicare billing issues and advise seniors about financial aid programs to reduce out-of-pocket Medicare costs.
To learn more about services at the Senior Connection Center, seniors can call 1-800-963-5337.
Seniors First is a nonprofit organization thatprovides community-based services to seniors aged 60 and older throughout Orange County. Services are designed to help seniors remain in their own homes as long as possible, in order to delay or prevent institutionalization. Low-income seniors with Medicare Advantage may qualify for case management, personal care and homemaker services. The organization also operates a medical equipment bank for seniors and disabled adults living in Osceola, Seminole and Orange counties.
For more information about Seniors First programs and services, seniors can call 1-407-292-0177 in Orlando or 1-863-534-5320 in Bartow.
The Sunshine Center of St. Petersburg is a city-owned multi-service center that offers a variety of services for seniors aged 55 and older. The center is focused on health and wellness programming, advocacy and educational opportunities. Seniors can access free information on local social service agencies and resources, such as senior nutrition programs, barrier-free transportation and financial aid. The center also offers unbiased Medicare counseling, including assistance with local Medicare Advantage plans.