Florida Medicare Guide

Schedule an appointment with one of our licensed Florida Medicare Advisors or give us a call at (888) 604-0055 to learn about your options and get help with enrollment.

If you prefer to explore on your own first, the information below will help you understand Medicare options and choose the best Medicare coverage for your needs.

Use this table of contents to jump to specific sections:

A Snapshot of Medicare in Florida

There are 4.8 million Medicare beneficiaries in Florida, making up 22% of Florida’s total population. 19% of Florida’s Medicare beneficiaries are also on Medicaid.

Medicare Advantage vs. Original Medicare in Florida

Medicare beneficiaries have options. One important decision is between Medicare Advantage and Original Medicare (with or without supplemental coverage). 51% of Florida Medicare beneficiaries are on a Medicare Advantage plan and the other 49% are on Original Medicare (source).

Florida Medicare Advantage Plans

Medicare Advantage (Part C) is one of your supplemental coverage options. Medicare Advantage replaces Original Medicare (Part A and B), providing at least the same coverage, and often additional benefits like dental, vision, and hearing. Medicare Advantage plans also have their drawbacks, including limited provider networks, preauthorization approval requirements, and higher out-of-pocket costs when compared to Medigap plans. You can enroll in or switch your Medicare Advantage plan once a year during Medicare’s Open Enrollment Period.

51% of Florida Medicare beneficiaries choose to enroll in one of the 369 Medicare Advantage plans available statewide. Plan availability varies by zip code, and the details of every plan, including premiums, deductibles, networks, and ratings vary. To hear about available Medicare plans in Florida, give us a call at (888) 604-0055, or schedule a free appointment at your convenience.

Florida Medicare Supplement Plans

Medicare Supplement (Medigap) plans sit on top of Original Medicare and fill the gaps in coverage. Medicare Supplement plans generally have higher premiums, but reduce your out-of-pocket costs. Supplement plans don’t provide additional benefits like Medicare Advantage plans, but they allow you to see any doctor that accepts Medicare (about 90% of doctors nationwide) and don’t require prior authorization for covered services.

When you enroll in a Medicare Supplement plan matters! If you enroll during the Medigap Open Enrollment period, which occurs when you first enroll in Medicare, then you cannot be denied coverage, regardless of your age or medical condition. Outside of this time, you may need to answer questions about your health and could be denied coverage from the carrier.

Nationwide, Medicare beneficiaries have 10 Medigap plan options, and each plan type (e.g., all Plan Gs) is identical across any insurance carrier. The most comprehensive Medicare Supplement plan is Plan G. Find a complete comparison of Medigap plan coverage here.

Florida Part D (Prescription Drug Coverage) Plans

Florida Medicare beneficiaries can get prescription drug coverage through a Medicare Advantage plan that includes Part D coverage or through one of 23 stand-alone Part D plans available in Florida (exact number varies by zip code). The average monthly premium for a Medicare Part D stand-alone drug plan is $44.16, which is the 5th highest average in the country.

Even if you aren’t currently taking any prescription medications, you should consider getting one of the cheapest prescription drug plans to avoid the Part D late enrollment penalty.

Getting help paying for prescription drug coverage

Medicare Extra Help Program

Medicare’s Extra Help program helps those with limited incomes and resources pay for Medicare Part D premiums and out-of-pocket costs. You qualify for Extra Help automatically if you get:

Full Medicaid coverage from Florida
Help from Florida to pay your Part B premium
Supplemental Security Income (SSI) benefits

If you automatically qualify, you’ll receive a letter telling you things like how much you’ll pay for your Medicare drug plan.

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed Florida Medicare Advisors who can help you determine if you should apply and assist with the application process.

Other ways to save on Medicare prescription coverage in Florida

Price check your pharmacy - different pharmacies charge different prices for prescriptions, and your costs may be lower at your drug plan’s preferred pharmacies.
Opt for generic or comparable prescriptions - In some cases, switching the form of your drug (e.g., capsule vs. tablet vs. softgels) can result in significant savings.
Re-evaluate your drug plan each year - Medicare plans change every year, and your needs may change too. Work with a licensed Medicare advisor to compare your options every year and ensure you’re on the best Medicare plan.

Get help paying for Medicare in Florida

The Medicare Extra Help Program only helps Medicare beneficiaries with prescription costs. There are two additional programs (Medicaid and SSI Benefits) that can help you cover the cost of your Medicare and other healthcare related expenses.

Medicaid

Medicaid is a joint federal and state program that helps low-income individuals pay for medical costs. In Florida, Medicaid for individuals who are aged (65 or older) or disabled is called SSI-Related Medicaid. Learn more about eligibility and benefits here.

Florida residents who receive Supplemental Security Income (SSI) are automatically eligible for Medicaid and do not need to file an application. You may, however, need to submit an application to receive benefits from Florida’s Medicare Savings Program (more info below).

If you are not receiving SSI benefits and believe you may qualify for Medicaid due to low income and resources, you can apply online at ACCESS Florida or in-person at a local office.

Medicare Savings Programs

Florida Medicare Savings Programs (also known as Medicare Buy-In) are part of Medicaid. They help beneficiaries with limited finances pay Medicare premiums. In some cases, they also help with deductibles and copayments. When you apply for Medicare Savings Programs, Florida will determine if you qualify for one of four levels of Medicare Savings Programs.

To apply, fill out this application and mail or fax it to one of the Florida customer service centers.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

Florida Medicare Eligibility and Enrollment Steps

Florida residents have the same Medicare eligibility requirements as the rest of the United States. You’re eligible for Medicare if you’re a US citizen who meets one of the following criteria:

You’re 65 or older
You have certain disabilities, like End-Stage Renal Disease or ALS

Three key steps for Florida Medicare enrollment:

Enroll in Original Medicare (Part A & Part B)
Choose your supplemental coverage

Medicare Supplement (Medigap)
Medicare Advantage (Part C)
Part D (drug coverage)

Find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage.

If you’re eligible for Medicare and not sure where to start, give us a call at (888) 604-0055 or schedule a free consultation at your convenience. We’ll help you understand your options, enroll, and get the most value from your Florida Medicare coverage.

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