Medicare Advantage Plans in Florida

Fact Checked
Published: 3/19/2021

Medicare Advantage, known as Medicare Part C, an alternative to Original Medicare, combines coverage for preventive care, hospitalization, and prescription drugs into a single plan. A Medicare Advantage Plan is less restrictive than Original Medicare. It may even pay for services that aren't covered by Original Medicare, such as dental care, hearing aids, and vision care. Unlike Original Medicare, which is managed by the federal government, Medicare Advantage Plans are administered by private insurance companies that have been approved by Medicare.





Medicare Advantage Plans in Florida

  • In 2019, there were 254 Medicare Advantage Plans available in Florida.
  • 43% of the total Medicare population in Florida was enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $11,565 per beneficiary in Florida, which is 15% lower than the national average.
  • Available Medicare Advantage Plans range from seven to 83 across Florida’s 67 counties.

If you decide that Medicare Advantage is right for you, you’ll be able to choose one of several plans. Plan availability varies based on the type of plan you choose and your county of residence. Your selection can affect your out-of-pocket costs, such as premiums and copays, whether you need to choose a primary care provider, and whether your plan covers services, such as fitness programs and vision care.

Types of Medicare Advantage Plans

Florida’s Medicare Advantage program has several plans to suit your needs, including HMOs, PPOs, PFFS plans, and SNPs. At a minimum, each Medicare Advantage Plan must cover the same services covered by Parts A and B of Original Medicare, such as inpatient hospitalization and preventive screenings. These plans may cover additional services, including health and wellness programs.

Health Maintenance Organizations

Seniors with Medicare HMO coverage must receive services from in-network providers, except when they need emergency care or urgent out-of-area care. HMO members must choose a primary care physician who coordinates their care and provides referrals to specialists as needed. In some cases, the beneficiary must obtain prior authorization from the HMO before having a procedure. If a required authorization isn’t obtained, the beneficiary may have to pay the full cost of the service. HMO-POS plans combine many of the features of HMO plans with the ability to go to out-of-network doctors and hospitals. You’ll pay more out of pocket, but the HMO-POS plan picks up some of the cost.

Preferred Provider Organizations

Medicare PPO plans are more flexible than HMO plans. If you have a PPO plan, you don’t have to choose a primary care physician, and you typically don’t need a referral to see a specialist. Each PPO plan has a list of preferred doctors and facilities. If you receive services from one of these providers, you’ll pay less than you would if you chose a non-preferred provider. Most PPO plans cover prescription drugs.

Private-Fee-For-Service Plans

PFFS plans offer the greatest amount of flexibility but usually cost more than HMO and PPO plans. As a plan member, you can receive care from any doctor who accepts your insurance card. Some doctors promise to always treat patients in a specific PFFS plan, thus creating a type of network. It will always be less expensive to visit doctors in this network. Most PFFS plans include drug coverage, but you can always add a Medicare Part D drug plan if yours doesn’t. Similar to all plans, the insurer always covers emergency services.

Special Needs Plans

If you want to join an SNP, you must either be dual-eligible for Medicare/Medicaid or have a specific condition or disease. SNPs are designed to provide the types of services and prescription drugs needed for these special circumstances. SNPs always include drug coverage in their benefits package. Plan members typically need to choose a primary care doctor and need a referral for specialists. SNPs are limited in availability and may not be an option depending on where you live.

Enrollment and eligibility for Medicare Advantage Plans in Florida

Eligibility

To enroll in a Medicare Advantage Plan, you must live in the plan’s service area and be eligible for Original Medicare Part A and Part B. You can’t get a Medicare Advantage Plan if you have a Medigap plan.

Enrollment

In most cases, you must enroll in a Medicare Advantage Plan during one of the following enrollment periods:

  • Initial enrollment: If you’re eligible for Medicare at age 65, the initial enrollment period lasts for seven months, starting three months before your 65th birthday and ending three months after your 65th birthday.
  • Open enrollment: Once you’re enrolled in Medicare, you can’t change your plan until the next open enrollment period. Open enrollment runs from October 15 to December 7 each year. During this time, you can drop a plan, switch plans, or enroll in a plan.
  • Medicare Advantage enrollment: If you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan between January 1 and March 31 of each year. You can switch from a Medicare Advantage Plan to Original Medicare during this period, but you can only change once.

Special enrollment periods are available to seniors who have lost their insurance coverage, moved outside their plan’s service area, or have a chance to get other coverage. You may qualify for a special enrollment period if Medicare terminates your plan’s contract or sanctions your plan provider.

Prescription drug coverage

There are two ways to get coverage for prescription drugs. One is to purchase Medicare Part D to supplement your Medicare Part A and Part B coverage. The other is to purchase a Medicare Advantage Plan that includes coverage for prescription drugs. If you choose Part D, you’ll pay a separate premium for prescription coverage, and if you choose Medicare Advantage, you’ll pay just one premium for everything included in your plan. Regardless of which option you choose, your out-of-pocket costs will depend on how many medications you take and whether those medications are brand-name drugs or generics. You can’t add a Part D plan to HMO or PPO plans, so if you think you’ll need drug coverage, double-check that it’s included in your benefits package.

Medicare Advantage Resources in Florida

It will be much easier to select the right Medicare Advantage Plan for your circumstances if you understand all the options. Several Florida agencies provide information and support for seniors and their families when it’s time to enroll in Medicare. These agencies have trained professionals available to answer your questions about Medicare coverage, discuss eligibility, and find programs that can help you cover your premiums and other out-of-pocket costs.

Alliance for Aging

The Alliance for Aging is the Aging and Disability Resource Center for seniors in Monroe and Miami-Dade Counties, which include Miami, Coral Gables, and Key Biscayne. This agency has a helpline for seniors to call when they have questions or need referrals to community resources. Staff members can help you find programs to help with your Medicare premiums and copays, defray the cost of long-term care, and save money on other expenses.

Contact Information: Website | 305-670-6500

Florida SHINE

Serving Health Insurance Needs of Elders has trained volunteers available to answer questions about Medicare, Medicaid, and private insurance plans. Volunteers provide unbiased counseling that can help you understand your options for health coverage to make an informed decision based on your medical needs and financial circumstances. The SHINE website has a list of resources for seniors, including Medicare summary notices, a glossary of Medicare terms, and English and Spanish guides to Medicare coverage.

Contact Information: Website | 800-963-5337

Florida Legal Services

Florida Legal Services advocates for underserved residents of Florida, forming strategic partnerships and educating others on the inequities of the justice system. The agency provides legal services to vulnerable seniors and individuals in need of access to health care, making it a valuable resource for seniors who have difficulty paying their out-of-pocket medical costs. Florida Legal Services may be able to help you with complaints about home-health providers or long-term care facilities.

Contact Information: Website | 407-801-4350

Florida Department of Elder Affairs

The Florida Department of Elder Affairs administers a variety of programs to keep seniors safe and ensure they have access to the services they need to remain as healthy and independent as possible. In addition to operating an elder hotline, the Florida Department of Elder Affairs publishes an informational newsletter, refers seniors to community resources, and has staff members available to answer questions about health insurance, long-term care, and other topics of interest to seniors.

Contact Information: Website | 850-414-2000

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