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 & 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.