PolicyScout’s Guide to Medicare Advantage Plans in FloridaFind out which Medicare Advantage plans are available in Florida and how to apply.
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Medicare Advantage plans in Florida are known for the additional health benefits and coverage options they offer Medicare beneficiaries. But with all the different plans available, it can be hard to find the right plan for you.
This article will tell you everything you need to know about private Medicare health plans and how you can find great coverage in Florida.
What Is Medicare?
Medicare is a federal government health scheme that provides people over 65, individuals with disabilities, and those that suffer from ESRD (End-Stage Renal Disease) and ALS (Lou Gehrig’s disease) with medical insurance.
The Medicare Parts Explained
Medicare is divided into different “Parts” that separate expenses and coverage for medical services, tests and items.
Part A insurance covers hospital-related expenses and treatment in a skilled nursing facility.
Part B insurance pays for outpatient or general medical expenses as well as preventative services.
Part C, also known as Medicare Advantage, are private health insurance plans that offer the same coverage as Original Medicare (Part A and B cover).
They often include prescription drug plans and offer additional benefits, such as dental, hearing, and vision expenses.
Part D insurance covers the costs of self-administered prescription drugs. For example, medication for blood pressure, back pain, or chronic conditions.
Your Medicare Coverage Options in Florida
There are a few health insurance options for seniors in Florida, and most beneficiaries either have Original Medicare, Medicare Advantage, a Part D plan, or Medicare Supplement Insurance.
Let’s go through the different Medicare coverage options:
Original Medicare is a government-run Medicare plan that assists with Part A and Part B medical costs. When you enroll in Medicare, you’ll automatically join Original Medicare.
Medicare Supplement Plans offer their members additional coverage and help to pay out-of-pocket costs that Original Medicare doesn’t cover.
Part D Plans, also known as Prescription Drug Plans (PDPs), are stand-alone drug plans that help people pay for prescription drug costs.
Terms you should know:
Monthly Premium is the fee you pay to be a member of Part D drug plans, Medicare Advantage, or Medicare Supplement Plans.
Deductibles are amounts that beneficiaries have to pay before their Medicare insurance starts.
Coinsurance is the portion of medical costs that beneficiaries have to pay for medical treatment, services, and tests.
Copayments are set amounts that people have to pay for services, tests, and items.
Out-of-pocket costs are any expenses that aren’t covered by Medicare or a private health insurance company.
Medicare Advantage is private health insurance that you can purchase as a Medicare beneficiary. These plans have the same benefits as Original Medicare and often cover other medical expenses that aren’t covered by Original Medicare, such as vision and dental care.
There are two main types of Medicare Advantage plans available in Florida:
MA Plans (without prescription drug cover) - These private health plans do not offer prescription drug coverage (Part D) and only cover Part A and Part B expenses.
MA-PD Plans (with prescription drug cover) - These are private health plans that cover Part A and B medical expenses and also offer prescription medication coverage for (Part D) expenses.
Understanding the different MA and MA-PD plan structures
MA and MA-PD plans also have unique structures which can influence costs, benefits, and covered services. Here are some of the different Medicare Advantage plan structures:
Health Maintenance Organization (HMO plan) offers health insurance through a specific healthcare provider network. People on HMOs are only covered for service in-network.
HMO point-of-service (HMO-POS plan) covers some health care costs outside your network, but monthly premiums and copayments are usually higher than HMO plans.
Preferred Provider Organization (PPO plan) allows you to see any provider that accepts insurance. You don’t need a referral from your primary care physician to get specialist help.
Private Fee-for-Service (PFFS plan) allows members to see any health care provider enrolled in Medicare who accepts your plan.
Special Needs Plans (SNPs) are for people with specific needs or diseases. For example, these can be people who live with chronic conditions or live in assisted living facilities.
Private Medicare Cover in Florida
Both Medicare Advantage plans are popular in Florida, and more than half of all Medicare beneficiaries have private health cover.
This can be seen in the state penetration rate, which looks at the number of Medicare-eligible people who have joined an MA or MA-PD plan.
For example, if ten people are eligible for Medicare and two have a Medicare Advantage plan, the penetration rate is 20% (2 out of 10 people).
In Florida, MA and MA-PD plans had a 50.8% penetration rate in 2021, which means that for every 100 Medicare-eligible people, around 50 - 51 of them had a Medicare advantage plan.
This graph shows how quickly private health plan membership is growing in Florida.Total Number of Medicare Advantage Beneficiaries, 2014 - 2020
According to the Kaiser Family Foundation, the number of MA and MA-PD members in Florida has increased from just under 1.5 million to 2.2 million in the last six years.
Similarly, the number of MA and MA-PD plans offered by health care companies has increased:
In 2021, there were 526 Medicare Advantage plans available in Florida
In 2022, there will be 583 MA and MA-PD plans offered in the state.
To learn more about Medicare plans offered in your county, simply enter your ZIP code below. You can also reach out to one of PolicyScout’s knowledgeable consultants at 1-888-912-2132 for additional information on MA and MA-PD plans in Florida.
Key Facts about Medicare Advantage in Florida
Learning about Medicare in your state can help you understand what you can expect when joining a private health plan.
Here are some key takeaways you should consider about Medicare in Florida:
Monthly premiums for private health cover are affordable. In 2021, the average monthly premium cost for Medicare Advantage plans in Florida was $8.36. In 2022, the average monthly premium will be $8.54.
According to the CMS, as of November 2021, 4,794,315 Florida residents are enrolled in Medicare. Approximately 2,477,277 are members of an MA or MA-PD plan.
Florida residents can enroll in Medicare Advantage and purchase a $0 monthly premium MA or MA-PD plan (this means that these plans do not charge members a monthly fee to join).
- Just remember, when you enroll in a plan with $0 monthly premium costs you will still have to pay your Medicare Part A and Part B monthly premiums.
The majority of medical professionals in Florida accept Medicare. Of the 54,102 registered physicians in the state, only 471 opted out of Medicare (That's under 0.05% of physicians).
- This means that if you live in Florida, you should be able to find a doctor that will treat you at Medicare rates.
Which Health Insurance Companies Offer Medicare Advantage in Florida?
Florida has 583 MA and MA-PD plans in 2022. Medicare beneficiaries can purchase policies from several providers, including:
BayCare Health Plans
Capital Health Plan
CarePlus Health Plans
Doctors HealthCare Plans
Florida Blue HMO
Health First Health Plans
HealthSun Health Plans
MMM of Florida
Prominence Health Plan
Simply Healthcare Plans
Solis Health Plans
Ultimate Health Plans
How to Choose Medicare Advantage Plans in Florida
If you want to get a Medicare Advantage plan in Florida, use these tips when choosing a plan:
1. Decide if you want to get a prescription drug cover (MA-PD) plan or one that only covers Part A and B expenses (MA-only).
2. Check if your provider offers plans in your area. Many people don’t realize that Medicare Advantage providers have different plans for different counties.
For example, in 2021, Broward County, Florida, had 53 MA and MA-PD plans to choose from. However, Monroe County, Florida, only had 8 Medicare Advantage plans.
3. Look at the costs associated with the plan you would like to sign up for and check if you can afford your plan if the price goes up because of inflation.
4. Ensure that you can cover the monthly premium and out-of-pocket costs (costs your plan won’t cover), such as deductibles, coinsurance, and copayments.
5. You should also research the plan's and health insurance company's Star Rating. For good measure, make sure you find out what third parties, such as ConsumerAffairs and JD Power, say about the plan that you would like to buy.
6. Ask around and check with friends or family about their experiences using a particular insurance company or Medicare plan.
7. Speak to a licensed Medicare insurance agent about the plan’s benefits, perks, and coverage. You’ll be able to see if the plan is the right one for you.
8. Compare your options before making a final purchase. Check to see if there are other providers in your area that offer similar plans.
What are Medicare Star Ratings?
The Centers for Medicare & Medicaid Services releases an annual report on the quality and performance of private Medicare plans and providers. They do this through a scoring system called the Medicare Star Ratings.
Each plan and provider will receive a score of out five, which tells beneficiaries how well the plan performed in the year.
Here’s what the different star ratings mean:
⭐⭐: Below average
If you want to learn more, read our guide to Medicare Star Ratings. You can check out your plan’s current star rating by visiting the Medicare.gov website. Simply search your county’s ZIP code, find your plan, and check the number of stars it received.
Important Enrollment Dates for Medicare in Florida
With Medicare Advantage, there are specific times in the year when you can enroll or swap your health coverage policy. Once you’ve found the right plan, it’s essential to know when you can and should apply.
Here are the enrollment dates to remember if you want to join an MA or MA-PD plan in Florida:
Initial Enrollment Period
This is your first chance to sign up for Medicare once you are eligible and begins three months before your 65th birthday. During the IEP, you can sign up for Medicare Parts A and B or join a Medicare Advantage plan or Prescription Drug Plan.
General Enrollment Period
From January 1st to March 31st, you can sign up for Parts A and B, and change your Medicare Advantage Plan if you missed your Initial Enrollment Period.
Open Enrollment Period
Between October 15th to December 7th, you’ll be able to join a Medicare Advantage plan or switch Medicare Advantage plans. Any changes you make to your Medicare coverage will take effect from January 1st.
Special Enrollment Period
This period refers to specific situations where you can enroll outside the regular enrollment periods (for example, if you move states or if your healthcare coverage under an employer ends). The dates for the Special Enrollment Period are different for each person.
For more information, read our guide to Medicare Open Enrollment Period 2022.
How Can I Find Out More about My Health Care Options?
If you’re interested in learning about Medicare, Medicare Supplement plans, or your health care options, our Medicare Hub is a great place to start. You’ll be able to read about costs, enrollment, coverage, and benefits all in one place.
Our experienced consultants are ready to answer any questions you may have. If you want one-on-one help with finding a Medicare plan in Florida, we can offer expert advice and assistance.
If you'd like to speak with one of PolicyScout's experienced advisors, feel free to call 1-888-912-2132 or send an email to Help@PolicyScout.com.