How To Make Your Medicare Choices If You Live In Florida

Updated for November, 2021

Key Takeaways:
  • The most popular Medicare choices for Florida residents are Original Medicare and Medicare Advantage
  • Cost profiles of Original Medicare are standardized, while those of Medicare Advantage vary based on a number of factors like your zip code and the type of healthcare coverage you want.
  • You can supplement your Original Medicare coverage with Medicare Supplement and prescription drug plans

In Florida and the U.S., the two main Medicare options available are Original Medicare and Medicare Advantage (MA).

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Original Medicare is the most popular choice among Florida residents, with almost 56% of enrollees, according to date from the Centers for Medicare and Medicaid Services. Forty-four percent of enrollees opt for Medicare Advantage plans and other coverage.

While Original Medicare is standardized and federally managed, Medicare Advantage is provided by private companies that contract with Medicare. Either option provides basic Part A and Part B benefits.

Part A covers:

  • Hospital costs for inpatient care
  • Skilled nursing facility care
  • Inpatient care in a nursing home or a skilled nursing facility (excludes long-term)
  • Hospice care
  • Home health care

Part B covers:

  • Medical insurance for doctor visits
  • Mental health care
  • Some outpatient prescription drugs
  • Participation in clinical research
  • Ambulance services
  • Durable medical equipment

Although these basic Medicare benefits are covered, you will still have some out-of-pocket costs. These costs cover deductibles, coinsurance, and copayments. Additionally, Part A and Part B do not cover:

  • Long-term (custodial) care
  • Dental care
  • Vision care
  • Hearing care
  • Cosmetic surgical procedures
  • Acupuncture
  • Routine foot care

Medicare Advantage plan benefits include vision and dental coverage, as well as wellness programs such as gym memberships.

Original Medicare Costs in 2020

The cost of Original Medicare is standardized across the U.S. However, some cost variation is influenced by:

  • Eligibility for premium-free Part A: If you are 65 or older and you or your spouse paid Medicare payroll taxes for at least 40 quarters (10 years), you do not have to pay Part A premium. Otherwise, you would pay up to $458 for Part A premium in 2020.
  • Length of hospital stay (Part A): Your deductible for inpatient care is capped at $1,408 per benefit period. A benefit period starts when you are admitted for inpatient care. This period ends 60 days after your inpatient stay. Beyond the deductible, there are coinsurance charges that start accruing daily after 60 days of an inpatient stay in one benefit period.
  • Income: Your income affects your Part B premium. Overall, the standard Part B premium in 2020 is $144.60 if income from your individual tax return in 2018 was $87,000 or less. You would pay the same amount if you filed your 2018 tax return jointly and had a combined income of $174,000. In case your income and resources are limited, you may get help through the Medicare Savings Program to cover your Part A and Part B premium.
  • Supplementing your Original Medicare Insurance: While Original Medicare covers a lot of your healthcare, it still leaves 20% of costs uncovered. You can make your costs more affordable by adding:
    • Medicare Supplement plans: Medicare Supplement plans (also known as Medigap) can help to cover your premiums, deductibles, and coinsurance. Medigap plans costs vary by zip codes and insurance company providers. There are 10 specific plans that have standardized benefits.
    • Medicare Part D: Since prescription drugs are not covered by your Original Medicare plan, you can also add a Medicare Part D plan to help cover these costs. Plan costs vary based on the type of prescription drugs, who your in-network provider is, and your income. Depending on your situation, you can get Extra Help to cover your prescription drug costs.

Medicare Advantage Plans in Florida

If you choose a Medicare Advantage plan instead of Original Medicare, you have the option of benefits including:

  • Basic Medicare coverage (Part A and Part B)
  • Prescription drug coverage (Part D)
  • Vision
  • Dental
  • Wellness programs (such as gym memberships)
  • Transport to doctor visits
  • Adult daycare

Cost of Medicare Advantage Plans in Florida in 2020

The cost of private Medicare Advantage plans vary according to:

  • Your zip code
  • Plan premiums – Some MA plans do not charge premiums
  • Deductibles
  • Copayments
  • Coinsurance
  • Type of healthcare you need
  • Whether you are visiting an in-network provider or not
  • Your plan’s annual cap limit for all healthcare costs

You can reduce out-of-pocket expenses by adding a Medicare Supplement plan (also known as Medigap), and a Part D prescription drug plan to your Original Medicare plan.

How Can You Supplement Your Medicare Coverage?

You can reduce out-of-pocket expenses by adding a Medicare Supplement plan (also known as Medigap), and a Part D prescription drug plan to your Original Medicare. These options cover complementary portions of your costs as described below:

Medicare Supplement: A selection of 10 standard plans with specific coverage levels. Within each plan, you get a varying range of coverage, including:

  • Copayments
  • Deductibles
  • Blood transfusions (the first 3 pints)
  • Emergency healthcare when traveling outside the U.S.

Medicare Part D: This is prescription drug coverage that takes care of the cost of drugs not covered by your Original Medicare. Medicare requires a basic level of coverage from each Part D plan, that equal of Part A and B. Part D plans have a list of covered prescription drugs (known as a formulary). Drugs are usually categorized into tiers that vary per plan. Tiers can be separated by copayment amounts and whether or not the drugs covered are generic, preferred, brand-name, or high-cost prescription drugs.

Next Steps To Enroll In Coverage

Looking for more information or need additional questions answered as you begin to enroll in a Medicare Florida plan? Contact a licensed health insurance professional who can guide you through the sign-up process and help you make the best choices for your health and wallet.