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Medicare in Florida

Medicare Advantage plans are more popular in Florida than they are nationwide, with 49% of the state's Medicare beneficiaries selecting private coverage

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Key takeaways

Medicare enrollment in Florida

Medicare enrollment in Florida stood at 4,672,774 as of October 2020.
That’s more than 21 percent of the state’s total population, compared with about 19 percent of the United States population enrolled in Medicare.

For most people, Medicare coverage enrollment happens when they turn 65. But Medicare eligibility is also triggered for younger people if they’re disabled and have been receiving disability benefits for 24 months, or if they have ALS or end-stage renal disease. Individuals in these situations are eligible for Medicare benefits even if they’re not yet 65 years old.

87 percent of Medicare beneficiaries in Florida are eligible due to age, while the other 13 percent are under 65 and eligible due to a disability. Nationwide, 85 percent of Medicare beneficiaries are eligible due to age, while 15 percent are eligible due to disability. But Florida has the second-highest percentage of 65+ residents in the country, so it makes sense that a greater percentage of the state’s Medicare beneficiaries are eligible due to age.

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Medicare options

Medicare beneficiaries can choose among several options to access Medicare coverage. The first choice is between Medicare Advantage plans, where coverage is provided via private health insurance companies, or Original Medicare, where benefits are provided directly by the federal government. Medicare beneficiaries also have options around Medigap policies (which cover out-of-pocket costs under Original Medicare) and Medicare Part D (coverage for prescription drugs).

Original Medicare includes Medicare Parts A and B. Medicare Part A (also called hospital insurance) helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center. Medicare Part B (also called medical insurance) helps pay for outpatient care like a visit to a doctor (or nurse practitioner or physician assistant) and preventive healthcare service, such as most vaccinations).

Medicare Advantage includes all of the basic coverage of Medicare Parts A and B, and these plans generally include additional benefits — such as integrated Part D prescription drug coverage and extras like dental and vision — for a single monthly premium.

There are pros and cons to Original Medicare and Medicare Advantage plans, and the right solution is different for each person.

Medicare enrollment periods

Medicare Advantage enrollment is available when a person is initially eligible for Medicare, but there’s also an annual enrollment window each fall (October 15 – December 7) when Medicare beneficiaries can select a different Medicare Advantage plan, or switch between Medicare Advantage and Original Medicare. There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Medicare Advantage in Florida

43 percent of Florida Medicare beneficiaries selected private Medicare Advantage plans in 2018. Nationwide, the average was 34 percent, so Medicare Advantage is more popular in Florida than it is nationwide. Most of the remaining 52 percent of the state’s Medicare beneficiaries had opted instead for coverage under Original Medicare, but there are also some Florida Medicare beneficiaries with Medicare cost plan coverage.

By late 2020, total enrollment in private Medicare plans (mostly Medicare Advantage plans, but also some Medicare cost plans) accounted for 49 percent of all residents with Medicare in Florida. This was in keeping with the general nationwide trend towards Medicare Advantage enrollment.

Medicare Advantage service areas are defined/available on a county-by-county basis, and the number of plans available in a given county can vary greatly across a single state. In Florida, residents in some counties can choose from more than 90 different Medicare Advantage plans in 2021, while residents of other counties only have fewer than twenty options.

Medigap in Florida

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

The Florida Office of Insurance Regulation (FLOIR) has a very user-friendly website people can use to compare premiums for Medigap plans available in each county in the state. FLOIR reported that as of 2016, there were 853,123 Florida residents with Medigap coverage. By 2018, AHIP reported that the number of Florida Medicare beneficiaries with Medigap coverage had grown to 901,389.

Medigap plans are standardized under federal rules, and people are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.

But Florida is among the majority of the states have adopted rules to ensure at least some access to Medigap plans for people under age 65 who are eligible for Medicare in Florida. Since 2009, Florida residents under age 65 are granted a six-month window (starting when they’re enrolled in Medicare Part B) during which coverage under a Medigap plan is guaranteed-issue. The premiums are typically higher for enrollees under age 65, although they are given another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point.

Medicare Part D in Florida

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D plan.

As of late 2020, there were nearly 1.5 million Florida Medicare beneficiaries who were enrolled in stand-alone Medicare Part D prescription drug plans. That’s about 32 percent of all the people enrolled in Medicare in Florida, as opposed to about 40 percent of all Medicare beneficiaries nationwide enrolled in stand-alone Medicare Part D plans. But in Florida, where Medicare Advantage enrollment is higher than the national average, nearly 2.2 million Medicare beneficiaries get their Part D coverage under a Medicare Advantage plan, which accounts for about 46 percent of the state’s Medicare beneficiaries.

The number of people with stand-along Part D coverage in Florida had declined by about 30,000 people from late 2019 to late 2020, while the number of people with Part D coverage as part of an Advantage plan had increased by nearly 152,000 (total enrollment in Medicare increases each month, so overall growth in Part D enrollment reflects this, despite the shifting from stand-alone Part D plans to Advantage plans that include Part D coverage).

For 2021 coverage, there are 28 stand-alone Medicare Part D plans available in Florida, with premiums ranging from about $7 to $172 per month. Medicare Part D enrollment is available during the same fall enrollment window (October 15 – December 7) that applies to Medicare Advantage plans.

Medicare spending in Florida

In 2018, Original Medicare spent an average of $11,565 per beneficiary for people with Medicare in Florida (the data were standardized to eliminate differences in payment rates from one area to another, but it was only based on Original Medicare spending, so it did not include costs for Medicare Advantage enrollees). The national average that year was $10,096 per enrollee, so Medicare spending in Florida was 15 percent higher than the national average. Florida was one of just five states (the others are Louisiana, Texas, Mississippi, and Oklahoma) where Medicare’s average per-enrollee costs exceeded $11,000 in 2018.

How does Medicaid provide financial assistance to Medicare beneficiaries in Florida?

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Florida includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

Helpful resources for Florida Medicare beneficiaries and their caregivers

These resources provide free assistance and information about Medicare beneficiaries in Florida:

  • Contact SHINE, Florida’s health insurance assistance program for seniors, with questions about Medicare eligibility in Florida or Medicare enrollment in Florida. Visit the SHINE website or call 1-800-963-5337.
  • Visit the Medicare Rights Center. This website provides helpful information geared to Medicare beneficiaries, caregivers, and professionals.
  • Contact the Florida Office of Insurance Regulation for questions or complaints about agents and brokers who sell Medicare plans, as well as Medigap plans (these are mostly regulated by the state, whereas Medicare Part D and Medicare Advantage plans are mostly regulated at the federal level).

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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