Medicare in Florida

Seniors in the United States have the option of getting comprehensive health coverage from the federal government through a program called Medicare. This program is open to eligible seniors and other adults with qualifying disabilities. In 2020, more than 61 million Americans depended on it for at least some of their health coverage. Florida, with its relatively high population of older adults, is home to more than 4.6 million Medicare participants. The number of people enrolled in Medicare has been steadily increasing for years, with more than 80 million Americans expected to enroll in the program by 2030.

Medicare divides its coverage into two main ways to get care: Original Medicare and Medicare Advantage. Original Medicare is likewise split into three parts, known as A, B and D. Medicare Part A is the inpatient hospital benefit. This is provided at no monthly cost for most beneficiaries, and it helps with most of the cost of hospital services. Part B is Original Medicare’s outpatient benefit, which includes office visits and transportation costs. Part B is offered as a voluntary benefit with a monthly premium. In 2022, the Part B premium is $170.10 a month for most participants. Part D is Medicare’s prescription drug benefit. These plans are offered by private insurers and come in a variety of packages.

Medicare Advantage, also known as Part C, is also offered through private insurance companies. Part C plans combine the coverage of Parts A and B, along with some extra benefits, such as vision, hearing and dental services. Most Part C plans often come with prescription benefits and an annual out-of-pocket maximum that helps protect seniors with limited budgets.

This guide provides helpful information about Medicare for Florida seniors. It offers an overview of plan options, along with enrollment data and a list of resources to help seniors make 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)

Original Medicare is administered by the Centers for Medicare & Medicaid Services and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

Over half of Florida’s seniors choose to get their Medicare coverage through Part C, or Medicare Advantage, in 2021. Medicare Advantage plans are issued through private insurance companies that agree to meet minimum Medicare coverage standards. Plans cover nearly all Part A benefits, except hospice care, and Plan B benefits. Many plans also provide prescription drug coverage, over-the-counter assistance and extra benefits not included under Original Medicare, such as dental and vision care. Some Part C plans also help with the cost of non-emergency medical transportation and may come with an annual out-of-pocket cap, both of which Original Medicare lacks.

Medicare Advantage plans come in four basic types: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) plans and Special Needs Plans (SNPs). Each of these has its own rules for how to get care, referrals to specialists and primary care. 

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 California 

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 April 2022. Visit our page on Medicare Advantage Plans in Florida for more information.

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 2022 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.