Medicare is a federal health insurance program that provides coverage for people 65 and older, as well as coverage for people with certain health conditions.
Because the program is federal, it operates in Florida the same way it operates in other states. The same eligibility requirements and the same enrollment deadlines apply in Florida.
We’ll discuss Medicare in Florida, how it works, who’s covered, and how much it may cost.
In the state of Florida, 4,515,510 people are enrolled in Medicare; around 21 percent of the population. That rate of enrollment is slightly higher than the national average. Most of those enrolled in Florida have what is known as original or classic Medicare. Classic Medicare includes Medicare Part A (hospital insurance) and Medicare Part B (medical insurance).
To enroll in Medicare you must be one of the following:
- at least 65 years old
- have end stage renal failure (ESRD)
In Florida, 87 percent of the people enrolled in Medicare are eligible because of their age, and the remaining 13 percent are enrolled because of a disability. To find out if you’re eligible for Medicare, you can use this Medicare Premium & Eligibility Calculator.
The official website of the Medicare program offers a plan-finding tool you can use to search for information about Medicare Advantage plans, Medicare Part D prescription plans, and Medigap plans in your area.
Because Medicare is a federal program, the same types of Medicare available nationally are available in Florida. These include:
This program covers inpatient hospital, skilled nursing facility, home health care, and hospice care. Most people don’t pay any premium for Medicare Part A.
For those who do pay, the monthly premium in 2020 is $458.00. If you have to pay a premium for Part A coverage, it might be less, depending on your taxes.
This program covers medical services, including doctors’ services, lab and x-ray services, ambulance services, durable medical equipment like wheelchairs and hospital beds, outpatient hospital care, home health care, and medical supplies.
For 2020, the Part B premium is $144.60. After you meet the deductible of $198.00, you will pay 20 percent of the approved cost of your covered services and equipment.
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans cover everything included in Medicare parts A and B, and many Medicare Advantage plans also provide prescription drug coverage and additional benefits like vision and dental benefits.
More information about Medicare Advantage in Florida
Depending on where you live in Florida, you may have between 8 and 68 different Medicare Advantage options in your area.
These plans are offered by different private insurance companies, so the costs vary widely. With many Medicare Advantage plans, you won’t have to pay any premium at all. Deductibles range from $0 to around $450.00, depending on the provider and the plan.
The maximum amount you may have to pay for out-of-pocket expenses also varies between plans. Some plans cap your out of pocket spending at $1,500, and others have a cap as high as $10,000, so it’s a good idea to talk to an independent consultant to help you decide which plan meets your needs.
Examples of 2020 costs of Medicare Advantage plans in various cities in Florida
|Monthly premium range||Annual deductible range||Annual out-of-pocket|
This program is Medicare prescription drug coverage, but it is offered by private insurance companies. Costs for Part D plans vary between providers and plans.
Monthly premiums for Medicare Part D plans range from $13.20 to $167.30, and annual drug deductibles range from $0 to $435. Your costs will also depend on the prescription medications you take.
You can compare prices for medications you take by checking each company’s list of covered medications. This list is known as a formulary.
These are private insurance policies that can help you pay out-of-pocket costs like deductibles, copayments, and coinsurance associated with classic Medicare coverage. Theses costs also vary depending on your location and the policy you choose.
Medigap costs vary widely depending on whether you choose a Medicare Part D plan along with a Medigap plan or if you choose Medigap alone. Monthly premiums range from $78 to $505 depending on your choices. Other costs you will pay include your Medicare Part A premium (if you have one) and Medicare Part B premium. You may also have to pay a percentage of your Medicare Part B coinsurance costs.
The federal government requires all Medigap plans, including those in Florida, to provide the same basic benefits to their beneficiaries. There are 10 Medigap plans, and all have letter names. Medigap “plans” include A, B, C, D, F, G, K, L, M, and N.
All Medigap policies are also required to offer you certain consumer protections. Insurance companies that sell Medigap policies can offer you additional benefits that go beyond the ones that are required, though, so it’s a good idea to carefully compare policies before you enroll.
Any company selling Medigap insurance, including those in Florida, must offer Medigap Plan A. They must also offer plans C and F.
Medigap changes starting January 1, 2020
Starting January 1, 2020, Medigap policies can’t cover your deductibles for Medicare Part B if you’re enrolling in Medicare for the first time this year. Because of the way plans are written, that means that if you’re enrolling in Medicare after January 1, 2020, you won’t be able to purchase Medigap Plans C or F, because both of those plans cover deductibles for Medicare Part B.
Every state has an organization that provides seniors with information about the health insurance programs available to them. The Florida Department of Elder Affairs has a program called SHINE (Serving Health Insurance Needs of Elders) that will pair you with a volunteer counselor to guide you through the Medicare enrollment process.
For help applying for Medicare in Florida or to discuss your options with a counselor, contact the Florida Department of Elder Affairs’ SHINE Program by calling the Elder Helpline at 1-800-963-5337, or visiting www.floridashine.org.
SHINE counselors can also help you explore which plans are available in your area, and they can explain the differences in deductibles and out-of-pocket limits between policies. During the Medicare enrollment period, SHINE may even offer enrollment events near you.
Services offered through SHINE are free, and the organization is not affiliated with any insurance company, so the information volunteers provide is not geared toward selling specific products or services.
Medicare enrollment dates are the same in every state.
You can apply for Medicare in two different ways. Your initial enrollment period (IEP) is a 7-month window close to your 65th birthday. You can apply for any part of Medicare coverage up to 3 months before you turn 65, or for 3 months after you turn 65.
If you want your Medicare coverage to begin as soon as you turn 65, it’s a good idea to apply 3 months before your birthday. If you wait until the month of your birthday, your coverage might not start until 1-3 months after you turn 65.
If you didn’t sign up for Medicare Part A and B during your IEP, you can still sign up for Medicare between January 1 and March 31, during the general enrollment period. If you didn’t sign up for Medicare when you first became eligible, you may have to pay a penalty and your premiums might be higher.
If you’ve already enrolled in Medicare in Florida but you’d like to switch to a different plan or change your coverage, you may do that during the Medicare open enrollment period (OEP), from October 15 through December 7, 2020.
In some circumstances, you might be able to add or change your Medicare coverage during a special enrollment period. If you:
- move somewhere your old policy does not have coverage or somewhere with new options
- are just released from jail
- lose the coverage you currently have
- have an opportunity to get insurance through your employer, union, or PACE plan
- Medicare sanctions or ends your plan
- you become eligible for Medicaid, a state pharmaceutical assistance plan, or a Medicare chronic special needs plan
- you chose a plan based on bad information given to you by a federal employee
The deadline to apply for Medicare Part D is the same in Florida as it is in the rest of the nation. When you turn 65, you are eligible to apply for Medicare Part D, which is an optional prescription coverage program. If you do not apply when you’re first eligible and you decide later that you do want to apply, you will probably have to pay a late enrollment penalty every month for as long as you have Medicare Part D coverage.
About 70 percent of those who have Medicare also have prescription drug coverage through Medicare Part D — roughly twice the number enrolled in Part D in 2006. UnitedHealth, CVS Health, and Humana provide most of that coverage nationwide. People paid an average of $29 monthly for their Part D premiums in 2019.
The cost for Medicare Part D coverage varies according to your plan and your income. To find out more about the costs involved, you can consult the chart provided by the Social Security Administration.
It’s important to know that if you have a Medicare Advantage Plan and you apply for Medicare Part D, you could lose your Medicare Advantage Plan, since many Medicare Advantage plans also have drug coverage.
Medicare is a federal health insurance program that provides coverage for people 65 or older, or who have certain illnesses or disabilities. Because Medicare is a federal program, the eligibility requirements and enrollment deadlines are the same in Florida as they are everywhere else in the nation.
It’s important to understand when to apply for Medicare because if you miss your initial enrollment period, you could end up paying higher premiums or penalties long term.
The State of Florida operates the SHINE program to help you work out which Medicare plans might be best for you. SHINE counselors are not affiliated with any particular insurance company, so they can also help you with the Medicare application process.