Medicare in Florida

Eligible seniors or younger adults with qualifying disabilities can enroll in Medicare, a comprehensive health care plan administered through the federal government. Medicare offers two programs to receive care: Original Medicare and Medicare Advantage. Original Medicare encompasses two main parts: Part A for inpatient care and Part B for outpatient care and medical equipment. It also has an optional Part D for prescription drug benefits. Medicare Advantage, commonly called Part C, is a private insurance option to access Medicare benefits. It combines Parts A and B, and typically also bundles Part D into one policy, along with other benefits. Original Medicare beneficiaries can see Medicare-approved providers nationwide whereas Medicare AdvantagePlans often require individuals to see in-network professionals.

In 2023, 4,867,207 Floridians enrolled in Medicare, equating to nearly 22% of the total state population. As a result of this higher-than-average population enrolled in Medicare, Florida also spends more than most states on Medicare, which cost the state nearly $29 billion in 2021. This equates to an average of $12,170 per enrollee per year based on 2021 data. These figures are likely to increase, with 2022 costs estimated to be around 4.3% higher and with the Centers for Medicare & Medicaid Services (CMS) expecting a 5.4% increase annually through 2031.

As of July 2023, 4,995,869 individuals in Florida were eligible for Medicare Advantage, with a participation rate of 55%, or 2,767,725 people. This rate is among the highest in the nation, surpassing the national enrollment rate of 48%. Some 2.86% more people became eligible for Medicare Advantage in 2023 compared to 2022, slightly higher than the national figure of 2.66%. Overall, Florida saw a 6.98% increase in enrollees from 2022 to 2023, equating to an additional 4% of eligible enrollees opting for a Medicare Advantage Plan. In comparison, nationally, there was a 9.75% increase in enrollees, with a 6.9% growth in eligible enrollees selecting Medicare Advantage coverage.

This guide outlines important information about Medicare for Florida seniors, including detailing plan options and enrollment data. It also contains a list of resources to assist seniors in making informed coverage decisions.

Options for Medicare Coverage in Florida

Original Medicare helps 2.4 million Florida seniors pay for their medical care, but it isn’t the only option available. Another 2.2 million seniors in the Sunshine State get their benefits through Medicare Advantage, and many Original Medicare participants choose to supplement their benefits with a Medigap or other supporting insurance plan. Choosing between these various options can get complicated, and it’s helpful to know what’s available.

Original Medicare (Parts A & B)

Seniors aged 65 and older or younger adults with certain disabilities or end-stage kidney disease may enroll in Original Medicare. Part A provides coverage for inpatient hospital care, nursing homes, skilled nursing care, home health care and hospice. This is available for a set annual deductible of $1,600 for the first 60 days of admission plus daily coinsurance payments for longer stays. Part B coverage pays for medically necessary services, including mental health services and preventative care for an income-based premium starting at $164.90 and a deductible of $226. After the deductible, beneficiaries have a 20% co-pay.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Private insurance companies issue Medicare Advantage Plans subject to approval by Medicare and follow specific regulations about minimum coverage standards. While all plans must meet a minimum, there is no maximum coverage cap, and many providers offer additional benefits such as wellness services, vision and dental benefits or bundle Part D coverage. Some plans may also offer annual out-of-pocket caps, which Original Medicare doesn’t provide.

Medicare Advantage Plans take four major forms: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) plans and Special Needs Plans (SNPs). Each has its own rules for accessing care and referrals.

Who Should Consider Medicare Advantage 

Medicare Advantage may be a good option for those who: 

• Want more control over out-of-pocket medical expenses 
• Need additional benefits such as prescription drug coverage and dental care 
• Are generally healthy and may benefit from low premiums 
• Are comfortable with managed care 

The Top 10 Medicare Advantage Plans in Florida

Florida seniors have access to a number of highly rated Medicare Advantage packages. The table below lists the top providers in the state, based on the number of enrollees in each. Price data is also included that is accurate as of August of 2023. Visit our page on Medicare Advantage Plans in Florida for more information.

Name	Total Enrollment	Medicare Star Rating	Monthly Cost Range	Plan Types
Humana	677,817	4	$0 – $95	PPO, HMO
UnitedHealthcare	3387,327	3.5	$0 – $197	PPO, HMO
Aetna Medicare	290,785	3.5	$0	PPO, HMO
Blue Cross Blue Shield of Michigan	203,862	3.5	$0	PPO
HMSA Akamai Advantage	201,821	3	$0	HMO
Florida Blue	93,169	3	$0 – $109	PPO
Florida Blue HMO	89,829	3.5	$0 – $34	HMO
Simply Healthcare Plans, Inc.	61,835	4.5	$0	HMO
Freedom Health, Inc.	61,527	4.5	$0 – $50	HMO
Optimum HealthCare, Inc.	59,695	5	$0	HMO

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Florida

Picking through the many Medicare coverage options in Florida can be difficult, and seniors can struggle to get the best coverage to fit their needs. Fortunately, state and private nonprofit agencies are available to help Florida’s older adults put together a combination of benefits that includes the coverage they need. These resources can help seniors find benefits they’re entitled to, submit a successful application for coverage and manage any appeals that may be necessary.