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Medicare Advantage Plans in Florida

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Medicare beneficiaries in Florida that are enrolled in Original Medicare , Part A and Part B, have the option of enrolling in a Medicare Advantage plan that offers the same coverage as Original Medicare with the potential for additional benefits. Additional benefits may include vision, dental, or prescription drug coverage. These plans are offered through private insurance companies, so costs and coverage may vary depending on your location in Florida.

Medicare Advantage plan coverage in Florida

Medicare Advantage (MA) plans in Florida are required to offer at least the same benefits as Original Medicare. Certain plans may also offer additional coverage. There are four main types of MA plans available to Florida beneficiaries who qualify:

  • Health Maintenance Organization (HMO) plans require the use of pharmacies and doctors in the plan’s network, as well as referrals from a primary care physician to see a specialist.
  • Preferred Provider Organization (PPO) plans pay for more of the costs of care if a beneficiary goes to a physician or hospital in the plan’s network. Beneficiaries may pay more out-of-pocket if they use out-of-network providers.
  • Private Fee-for-Service (PFFS) plans determine how much they will pay health care providers and how much a beneficiary will pay for services when they receive care.
  • Special Needs Plans (SNPs) are limited, specific plans for people with certain characteristics or chronic conditions.

Medicare Advantage plan costs in Florida

Medicare Advantage plans in Florida may require certain out-of-pocket costs, including premiums, deductibles, copayments, and coinsurance payments. In addition to paying your Part B premiums, you may or may not be responsible for paying a separate premium for your MA plan. Some plans also charge deductibles, which are costs that you must pay out-of-pocket before the plan begins its coverage. Finally, most plans set copayments for the services and benefits that they provide. Because these plans are offered through private insurance companies, the costs associated with each plan may widely vary. However, the government does set an annual maximum out-of-pocket limit on how much you must spend for your covered services.

Medicare Advantage Plan eligibility and enrollment in Florida

To be eligible to enroll in a Medicare Advantage plan in Florida, individuals must be enrolled in both Medicare Part A and Part B, reside in the service area of the plan in which they choose to enroll, and not have have end-stage renal disease (ESRD). Beneficiaries may enroll in or switch plans during their Initial Coverage Election Period (ICEP), the Annual Election Period (AEP), or during a Special Election Period (SEP) for which they are eligible. The Initial Coverage Election Period differs for each individual and begins three months before they become eligible for Medicare, lasting for a total of seven months. If you delay Medicare Part B, your Initial Coverage Election Period starts three months before you have Medicare Part B and lasts three months. On the other hand, the Annual Election Period occurs from October 15 to December 7 of each year. Qualifying beneficiaries may also have the option of enrolling during a Special Election Period as well.

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