Your Guide to Medicare in Florida

Medicare is a federal government-sponsored health insurance program. The purpose of the Medicare program is to offer options and lower the cost of healthcare services for eligible individuals residing in the United States.

The Centers for Medicare and Medicaid, a federal agency, governs Medicare for those who apply in Florida. Almost 4.7 million Floridians enrolled in Medicare in 2021.

Applying for Medicare in Florida

Before applying for Medicare in Florida, you must first see if you are eligible.

Eligibility for Medicare in Florida

There are three qualifiers that make you eligible for Medicare in Florida. If you are either:

• At least 65 years old.
• Younger than 65 years old but have eligible disabilities according to the Social Security Administration.
• Diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis.

Provided you meet one of the factors above, you may apply for Medicare in Florida.

When Do You Apply for Medicare in Florida?

When initially applying for Medicare, there are three important enrollment periods. These include:

• Initial Enrollment Period
• General Enrollment Period
• Medigap Open Enrollment Period

If you fail to enroll in one of these periods you might be able to enroll during a Special Enrollment Period, provided that you meet the qualifications.

Medicare Initial Enrollment Period in Florida

The initial enrollment period becomes available for eligible Floridians three months before turning 65 years old and continues for three months after. The total duration of the initial enrollment period is seven months.

If you miss this period, penalties for late enrollment will be assessed.

Medicare General Enrollment Period in Florida

if you fail to enroll during the initial period, your next opportunity would be during the general enrollment period. The General Enrollment Period runs every year from January 1 through March 31. Floridians who enroll during this period will have Medicare coverage on July 1.

Be advised that when enrolling in Medicare for the first time, during the general enrollment period, may subject you to penalties.

Medigap Open Enrollment Period in Florida

The Medigap Open Enrollment Period is the ideal time to enroll in a Medicare Supplement plan as a result of better pricing and more plan options. In addition, during this period, you can enroll in a Medigap plan irrespective of any pre-existing medical conditions.

If you’re thinking of enrolling in a Medicare Supplement plan, be sure to mark your calendar for the first month when you’re enrolled in Medicare Part B and are 65 years of age. This enrollment period only lasts for six months, only occurs one time, and may not be extended or changed. Furthermore, if you attempt to enroll in a Medicare Supplement plan beyond this enrollment period, underwriting may be required and coverage may be denied.

When Can You Change Your Medicare Plan in Florida?

According to most insurance agents, you should have your Medicare plan reviewed annually. This can be done during either of the following:

• Annual Enrollment Period;
• Medicare Advantage Open Enrollment Period; or
• Special Enrollment Period.

Making Medicare plan changes during these enrollment periods may save money and/or offer better benefits.

Annual Open Enrollment Period in Florida

The Medicare Open Enrollment Period is for Floridians who are already enrolled in Medicare. This enrollment period occurs each year between October 15 and December 7.

If you are already enrolled in Medicare, the Open Enrollment Period is the ideal time to review your Medicare plan with your licensed insurance agent. An annual review of your Medicare coverage can help ensure that you are enrolled in the best plan for your health insurance requirements and finances.

Lots of things can happen in the course of a year, such as losing your doctors or specialists, or a significant change to the prescription drug coverage you depend on. Medicare health plans replace their contracts with Medicare annually, and you should make sure that your plan won’t be negatively impacted for next year.

Every year private health insurance companies announce new plans, competing for your business. As a result, Floridians who have a Medicare Part C, D, or Medigap plan, may be offered a better plan with more benefits at a lower price.

What Medicare Plan Changes Can You Make During the Annual Enrollment Period in Florida?

Once you review your plan with a Florida licensed insurance agent, some of the changes you can make include:

• Changing to Original Medicare from a Medicare Part C plan.
• Change from Original Medicare to a Medicare Advantage plan.
• Switching from one Medicare Part C plan to another with or without prescription medication coverage.
• Getting a separate Medicare Part D prescription drug plan.
• Switching from one separate Medicare Part D prescription drug plan to another.
• Cancel your separate Medicare Part D prescription drug plan coverage. However, before making this decision, find another reputable prescription drug coverage source.

Medicare Advantage Open Enrollment Period in Florida

Floridians who are already enrolled in a Medicare Part C plan can make a change during the Medicare Advantage Open Enrollment Period. This enrollment period starts every year on January 1 and runs through March 31.

If you fail to change your plan during the Medicare Advantage Open Enrollment Period or miss it, you will need to wait for the Annual Enrollment Period. In addition, Floridians who qualify, are also able to make changes during a Special Enrollment Period.

Changes You Can You Make During the Medicare Advantage Open Enrollment Period

During the Medicare Advantage Open Enrollment Period you can make the following changes:

• Substitute your Medicare Advantage plan plus prescription drug coverage or without.
• Revert back to Original Medicare Part A and B.
• Enroll in a separate Medicare Prescription Drug Plan (Medicare Part D) if you return to your Original Medicare.

Special Enrollment Period in Florida

Certain situations permit changing Medicare plans outside of the five previously mentioned enrollment periods. This generally occurs during a Special Enrollment Period which is contingent on life events or the availability of a new plan.

Qualifying Life Event for the Special Enrollment Period in Florida

Life events that may qualify you during a Special Enrollment Period include:

• Moving or changing your primary residence.
• Losing your health insurance.
• Getting an opportunity to get other health insurance.

If you have experienced any of the following changes, you should speak with a Florida-licensed insurance agent to discuss the possibility of changing your plan outside one of the general enrollment periods. A Florida insurance agent can help verify if the life event you have experienced qualifies you for the Special Enrollment Period.

5-Star Medicare Plans Special Enrollment Period in Florida

The Centers for Medicare and Medicaid Services assess Medicare plans and use a star rating system from one to five (5 stars being the best).

Floridians whose county of residence offers the 5-star Medicare plan can enroll during the 5-Star Special Enrollment Period. If you register during this period, you can switch from your current plan to a 5-Star Medicare Advantage plan, Medicare Advantage Prescription Drug plan, or a separate Medicare Part D prescription drug plan.

The 5-Star Special Enrollment Period may be used one time during the enrollment period which runs between December 8 and November 30 of the following year. To see if a 5-Star plan is offered in your county, call your Florida licensed insurance agent.

If You Plan to Work After Age 65

Are you or your spouse planning on working after the age of 65, and delaying Medicare as a result?

If the health care coverage benefits at your job are equivalent to what Medicare provides, this is called creditable coverage.

Each year that you and/or your spouse work after age 65, you should verify with your employer that you have creditable coverage for Medicare Part B and Medicare Part D for prescription drugs. If you do not have creditable coverage from your employer’s health plan, you may get hit with lifetime penalties for late enrollment in Medicare Part B and prescription drug coverage. You need to confirm that you have creditable coverage from an insurer before you delay enrolling in Medicare.

During a Special Enrollment Period, you are given eight months to sign-up for Medicare Part and Part B if your employer’s health coverage ends. Floridians wishing to sign-up for a Medicare Advantage Plan such as Medicare Part C or Part D, only have 63 days to do so. Failing to enroll can expose you to penalties for late enrollment. An important thing to remember is that COBRA insurance is not considered creditable coverage.

How Many Floridians in Medicare Plans?

Today there are more than 5 million Floridians enrolled in Medicare. More than half of Floridians (approximately 2.6 million) are signed up with Original Medicare Part A and Part B. According to AHIP, approximately 40 percent of those who are enrolled in Original Medicare are also enrolled in a Medicare Supplement plan. According to Kaiser Family Foundation (KFF), the other 2.4 million Floridian Medicare beneficiaries are enrolled in a Medicare Part C, Medicare Advantage plan.

In addition, KFF has stated that the number of Floridians who have enrolled in a Medicare Advantage plan has increased by more than 130 percent since 2010.

Medicare Plan Options in Florida

In evaluating Medicare plan options, one of two alternatives is available:

• Enrolling in Original Medicare (Part A and B), Medicare Part D prescription drug coverage, and, possibly, a Medicare Supplement plan (Medigap).
• Enrolling in a Medicare Advantage Plan (Medicare Part C) or a Medicare Advantage Prescription Drug Plan.

Every Floridian looking into getting Medicare should enroll in Original Medicare Parts A & B. Once enrolled, review options on how to protect yourself against out-of-pocket costs with your insurance agent. Almost 75 percent of Floridians who have Medicare have either a Medicare Advantage or Medicare Supplement plan which can provide protection against significant out-of-pocket costs.

What is Medicare Part A in Florida?

Medicare Part A, hospital insurance a component of Original Medicare, provides coverage for inpatient hospital care, nursing facilities, laboratory testing, hospice, home health care, as well as surgery. This option is provided to the public by the federal government and is generally free of any premiums.

Medicare Advantage plans, which are private plans, generally contract with the Centers for Medicare & Medicaid. Although Medicare Advantage plans may have different policies, each plan has to provide at a minimum the same coverage as Original Medicare Part A.

Medicare Part A Eligibility in Florida

In Florida, you are eligible for Original Medicare Part A if you meet one of the following three conditions:

• You are at least 65 years of age.
• You are younger than 65 but may qualify as a result of eligible disabilities.
• You have been diagnosed with End-Stage Renal Disease or Amyotrophic Lateral Sclerosis.

What Coverage Does Medicare Part A Provide?

Medicare Part A includes coverage for medically-necessary services made available by a Medicare-assigned provider from a Medicare-approved facility.

Medicare Part A provides services that include:

• Coverage for inpatient hospital care: Treatment received when admitted to a hospital for an overnight stay. This care can be provided at an acute care hospital, a long-term care hospital, a critical access hospital, psychiatric facilities, rehab facilities, or being involved in a clinical research study.
• Skilled nursing care coverage: Care received from nursing professionals and/or technical personnel in treating, managing, observing, or evaluating your particular condition.
• Home health care: Includes health care services provided in your home for the treatment of an illness or injury.
• Hospice care: The care necessary to relieve pain and make you as comfortable as possible in the event you are diagnosed with a certified terminal illness by your doctor and have six months or less to live.

Please note that Medicare Part A coverage has limitations. Review the coverage exclusions to help you prevent extraordinary out-of-pocket and unexpected costs. More about Medicare Part A below.

Medicare Part A Premiums in Florida for 2022

Medicare Part A coverage in Florida can be without a premium, provided that you meet certain conditions. You must be at least 65 years of age or older and in addition:

• Collect Social Security Administration or Railroad Retirement Board retirement benefits.
• Presently eligible to receive Social Security Administration or Railroad Retirement benefits but have not filed to receive them yet.
• You and/or your spouse have status as government Medicare-approved employees.
• Have paid Medicare taxes for at least 40 quarters.

Under 65 years of age? You may be eligible to receive premium-free Part A if:

• You accept Social Security Administration or Railroad Retirement Board disability benefits for 24 months.
• You have been diagnosed with End-Stage Renal Disease and also meet certain additional requirements.

If none of these conditions are applicable to you or your spouse, you will not qualify for premium-free Part A. Nonetheless, you may purchase Part A. In 2022, a Medicare Part A plan may cost up to $499 per month.

Your premium amount is based on the number of quarters that Medicare taxes were paid. According to medicare.gov, Medicare taxes paid for less than 30 quarters, will result in a Part A premium cost of $499. However, if Medicare taxes were paid for 30 quarters, the Part A premium would cost $274 per month.

If Medicare Part A coverage was purchased, Medicare Part B must also be purchased. This would result, in paying both Medicare Part A & B monthly premiums. Moreover, if you decided not to purchase Part A, you may still purchase Medicare Part B.

2022 Medicare Part A Out-of-Pocket Costs: Coinsurance, Copays, and Deductibles

Medicare Part A costs don’t end with the premium. Regardless of whether you pay a premium, Medicare Part A also includes coinsurance, copays, and deductibles. Remember to include these costs as part of your healthcare budget.

According to medicare.gov, the deductible for Medicare Part A is $1,556 for 2022.

If you have inpatient care coverage, the coinsurance amount owed will depend on the duration of your hospital stay. Coinsurance costs are calculated on a daily basis, so the longer your hospital stay, coinsurance costs become more expensive.

The rates for Medicare Part A coinsurance in 2022 are:

• Hospital stay for 1 to 60 days = $0 per day
• Hospital stay for 61-90 days = $389 per day
• Hospital stays greater than 91 days = $778 per day. Day 91 is also referred to as your “lifetime reserve day,” your rate will remain the same for up to 60 days over your lifetime.

If you have an inpatient hospital stay longer than what coinsurance covers, or require a service that is not approved by Medicare-approved, this would be your out-of-pocket costs. Therefore, it is crucial to fully understand what coverage you have, in order to avoid significant out-of-pocket and/or surprise costs.

Enrolling in Medicare Part A in Florida

The ideal time to enroll in Medicare Part A is during your Initial Enrollment Period. If you happen to miss the Initial Enrollment Period, you may enroll during the General Enrollment Period or during a Special Enrollment Period as long as you meet the qualifications.

Enrolling in Medicare Part B in Florida

Medicare Part B is medical insurance provided by the federal government and is the additional part of Original Medicare.

Medicare Part B Eligibility in Florida

In Florida, Medicare Part A eligibility enables eligibility for Original Medicare Part B. Additional eligibility requirements include:

• Being at least 65 of age.
• You have eligible disabilities if younger than 65.
• You have been diagnosed and currently have End-Stage Renal Disease or Amyotrophic Lateral Sclerosis.

What Is Covered Under Medicare Part B?

Medicare Part B medical insurance coverage includes necessary and preventative medical services.

• Necessary Medical Services: includes the treatment or supplies needed to diagnose and/or treat a medical condition.
• Preventative Services: includes medical services for the prevention or early detection of an illness.

What Is Covered Under Original Medicare Part B?

Original Medicare Part B coverage includes but is not limited to:

• Clinical research.
• Doctor visits and lab tests.
• Visiting a specialist such as a Cardiologist, Orthopedist, or Radiologist.
• Second opinions regarding medical issues.
• Preventative vaccinations, such as flu vaccines.
• Ambulatory services.
• Durable Medicare Equipment.
• Limited outpatient prescription medications.
• Inpatient, outpatient, as well as limited hospitalizations for mental health.

2022 Medicare Part B Premiums

According to medicare.gov Medicare Part B’s standard premium is $170.10 for 2022. Although this amount is what most pay, the premium is based on the individual’s income.

Income-Related Monthly Adjustment Amount for Medicare Part B

Your Medicare Part B premium is based on your individual or joint modified adjusted gross income. If your income is greater than the income threshold for the standard premium, you will pay more. As a result, besides paying the standard $170.10 premium, you will also have to pay the Income Related Monthly Adjustment Amount.

The Centers for Medicare and Medicaid Services calculates premium costs based on the IRS-reported modified adjusted gross income for the two years. As a result, in 2022, your Medicare Part B premium would be based on your 2020 federal tax return.

2022 Medicare Part B Out-of-Pocket Costs: Coinsurance, Copays, and Deductibles

According to medicare.gov, in 2022, the standard Medicare Part B deductible in Florida is $223.

Once the $223 deductible is paid, you will normally pay 20 percent coinsurance of Medicare-approved costs for most physician-provided services, including an inpatient hospital stay. Moreover, this plan includes a 20 percent coinsurance for any outpatient therapy as well as Durable Medical Equipment.

An important thing to remember is that Original Medicare Part A and/or B do not have a max out-of-pocket cost. Typically, 20 percent or more is paid for Medicare-approved services, unless you have a plan that increases your Original Medicare coverage. Therefore, a Medicare Advantage or Medicare Supplement plan can provide limited or reduced out-of-pocket costs.

Moreover, healthcare providers that accept Medicare, do not charge for all preventative services under Medicare Part B.

When Can I Enroll in Medicare Part B in Florida?

You should enroll in Medicare Part B during your Initial Enrollment Period. If you should miss enrolling during your Initial Enrollment Period, the next available opportunity to enroll is during the General Enrollment Period or during a Special Enrollment Period provided that you meet the qualifications.

Timing is critical for enrollment, should you miss the Initial Enrollment Period, you may incur lifetime late enrollment penalties. Usually, a penalty will be incurred if you enroll in Medicare Part B during the General Enrollment Period.

What is Medicare Part B Creditable Coverage in Florida?

When you have similar coverage to Medicare Part B from another provider, and as a result delay enrollment in Medicare Part B. This other coverage is referred to as creditable coverage.

A Notice of Creditable Coverage will be sent to you if you have your health insurance through one of the following:

• Group Health Plan Coverage
• Department of Veterans Affairs
• Union Coverage
• Federal, State, or Local Government Coverage
• TRICARE for Life

Retaining creditable coverage pending your enrollment in Medicare Part B will allow you to avoid incurring lifetime late enrollment penalties.

Medicare Advantage/Medicare Part C Plans in Florida?

Medicare Advantage/ Medicare Part C plans in Florida, provide an opportunity to receive your Original Medicare coverage with added benefits. These plans can be purchased by private insurance companies, and are regulated and contracted by the Centers for Medicare and Medicaid Services.

Distinct from Original Medicare, Medicare Advantage plans limit out-of-pocket costs. A Medicare Advantage Prescription Drug Plan is a Medicare Advantage plan that provides creditable prescription drug coverage.

Eligibility Requirements for a Medicare Advantage Plan in Florida?

In order to qualify for a Medicare Advantage plan in Florida, you need to enroll in Medicare Part A and B. In addition, you must reside in the service area of the plan you plan to enroll in. Medicare Advantage plans are offered at the county level and offer many available options.

Medicare Advantage Plans Popularity in Florida

In Florida, there are 583 Medicare Advantage plans available in 2022. That is an increase in 109 additional plans since 2020. Moreover, in 2022, there are 11 percent more Medicare Advantage plans available in Florida than in 2021.

The increase in the number of plans provides better options and values for Floridians. As a result, you can compare plans, and have a better opportunity of finding a plan ideally suited to your coverage and budget needs.

Although Medicare Advantage plans are increasing in popularity in Florida, there are only a limited number of counties where there were high enrollments for Medicare Advantage plans.

The top 10 Florida counties with the largest Medicare Advantage plan enrollment for 2022 are:

• Miami-Dade County
• Osceola County
• Gadsden County
• Pasco County
• Polk County
• Hernando County
• Broward County
• Liberty County
• Wakulla County
• Jefferson County

Medicare Advantage Plan Benefits

Medicare Advantage plans can provide low or no-cost premiums as well as cap out-of-pocket costs, along with extra benefits that Original Medicare doesn’t offer. In addition, Medicare Advantage plans offer the same coverage as Original Medicare Part A and B, but frequently at a lower cost. According to the Center for Medicare and Medicaid Services, in 2022, 53 percent of Floridians are enrolled in a Medicare Advantage plan.

Low or Zero Cost Premiums With Medicare Advantage

Floridians enrolled in Medicare, gain access to a free monthly premium Medicare Advantage plan. If you don’t enroll in the free monthly premium plan, the average monthly cost for a Medicare Advantage plan is $8.54.

Floridians, who enroll in a Medicare Advantage plan, will have to pay any applicable Medicare Part A and B premiums, in addition to their Medicare Advantage plan premium. Another advantage of these plans is that the majority of prescription drugs are covered. In addition, when compared with Original Medicare, out-of-pocket expenses are capped