Medicare in Florida

In this article...
  • Medicare in Florida can be a hard topic to wrap your head around. Get started on research with a guide to Medicare plans, enrollment deadlines and whether or not you have to apply.

What Florida Medicare Plans Are Available?

With a large senior population in the state, Medicare in Florida is a commonly used program to secure health care services. The program, while beneficial, can also be complex. Therefore, it's helpful to know the various components of it are and the ins and outs of enrollment and eligibility. 

Medicare consists of several different parts, each of which speaks to a different aspect of healthcare. 

Part A: Medicare Part A is the element that covers hospitalization as well as inpatient care in a skilled nursing facility. It may also cover care in a stand-alone surgical center or hospice. It is free to those who qualify for Medicare coverage due to paying into the Social Security system and available for purchase for those that do not who are of retirement age.

Part B: This portion of the program functions a lot like traditional medical insurance in that there is a monthly premium (determined by income ratios). It covers in-office physician visits and other elements of preventative care. Those ineligible for automatic free Medicare Part A benefit may purchase Part B, but they must also purchase Part A. 

Part C: Medicare Part C is commonly referenced as the Medicare Advantage plan. This plan is administered by privatized entities that work with Medicare to provide the benefits of both Parts A and B and may sometimes even include prescription drug benefits and other coverage. 

Part D: Part D is the stand-alone prescription drug benefit. It also requires a monthly premium for those eligible (also based on income). 

Medigap: The Medigap program does exactly as it suggests: fills in the gaps of insurance coverage. It is administered by private entities as well. It covers the costs of many elements that Medicare does not pay for, including copays, coinsurance, deductibles and even certain medical services. 

Medicare is extremely popular in Florida, with more than 4.6 million residents enrolled in the program. Of this, half of those beneficiaries have Advantage plans with 83 options from which to choose. Medicare Advantage programs are actually more commonly used in Florida than elsewhere in the country.

Florida law dictates that Medigap coverage must be available to those under the age of 65 (who already qualify for general Medicare coverage), but does not prevent these demographics from paying higher premiums. 

Who Is Eligible for Florida Medicare?

Individuals age 65 and older who have paid into the Medicare system through taxed income are automatically eligible for the program. Those younger must have a qualifying health issue or disability, which is determined by the Social Security Administration. 

Those automatically eligible will be enrolled around 4 months before their 65th birthday. 

How Do I Enroll in Medicare in Florida?

Those who are not automatically enrolled must sign up during a period that starts 3 months prior to turning 65 and extends 3 months after that month. While beneficiaries can enroll late, there may be a penalty for doing so. Exceptions to late enrollment penalties include those who had other insurance and suddenly lost it. 

Beneficiaries may also enroll during enrollment periods. The first is between January 1 and March 31, with benefits kicking in on July 1. This period is for changing your Medicare Advantage plan elections. The second is between October 15 and December 7, with benefits kicking in on January 1. 

Those individuals waiting for a five-star Advantage or Part D plan may sign up without incurring a penalty any time between December 8 and November 30. However, this benefit may only be utilized one time during this period. 

Qualified beneficiaries can enroll in one of several ways: 

  • Visit the Social Security Administration website at SocialSecurity.govto sign up.
  • Call the Social Security Administration at (800) 772-1213 Monday through Friday from 7 a.m.-7 p.m.
  • Make an appointment at a local Social Security office to receive in-person assistance. 

Contact Information for Florida Medicare, Medicaid and Insurance Help

To get more information about Florida Medicare, Medicaid and additional insurance help, take advantage of one of the local resources available for further assistance. 

HelpAdvisor: The Florida Medicare/Medicaid HelpAdvisor page provides information on qualifying for Medicaid, enrollment information and more. Those unsure of where to start when it comes to the wealth of information available will find this to be a great place to start if they're interested in Medicaid. 

Florida SHINE: To learn more about Medicare in Florida as well as Medicaid and general insurance information, reach out to the Serving Health Insurance Needs of Elders (SHINE) program at (800) 963-5337 or via the website at http://www.floridashine.org.

Florida State Health Insurance Assistance Program: The Florida State Health Insurance Assistance Program (SHIP) can help with Medicare enrollment, one-on-one counseling and general information about the options available to beneficiaries. Check out the SHIP website or call (800) 963-5337 to learn more. 

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