If you live in Florida and are an Original Medicare (Part A and Part B) enrollee, then you can sign up to a Medicare Advantage plan. A Medicare Advantage plan has the same level of benefits as Original Medicare plus it may have extra benefits depending on the plan. Extra benefits for a Medicare Advantage plan include, but not limited to:
- Dental
- Vision
- Prescription drug coverage
Private insurance companies offer these plans instead of the government-run Original Medicare. Depending on where you live in Florida determines on what plans are available to you. Plans can vary in benefits and costs.
The basics of Medicare Advantage plans in Florida
By law, Medicare Advantage plans must offer the same level of coverage as Original Medicare. You can also get a plan with extra coverage beyond Original Medicare. In Florida, you have four primary types of Medicare Advantage plans:
- HMO (Health Maintenance Organization) plans: These plans cover a network of providers. If you don’t use these providers, you may have to pay in full (unless it is a medical emergency). You also have a primary care physician to handle most of your health needs. If you need specialist care, you need a referral from your primary care physician.
- PPO (Preferred Provider Organization) plans: Like HMOs, these plans also have a network of providers. The difference is that you are still covered if you don’t use the network of providers. Although, cost sharing may be more if you use out-of-network providers.
- Private Fee-for-Service (PFFS) plans: Unlike HMOs and PPOs, these plans do not have a network of providers. These plans will determine how much you pay for each health care service you get. Providers must agree to the plan’s terms and conditions before they can treat you.
- Special Needs Plans (SNPs): These plans cater toward people who qualify. You must have specific conditions or characteristics to be eligible.
Medicare Advantage plan expenses in Florida
You will have certain out-of-pocket expenses if you choose to enroll in a Medicare Advantage plan in Florida. These expenses include deductibles, copayments, coinsurance, and monthly premiums. You also have to pay your Part B monthly premium as a Medicare Advantage enrollee. Some Medicare Advantage plans may have free premiums but that does not mean other out-of-pocket costs are cheaper. You may also have to pay an annual deductible before the plan can cover your services. Lastly, you will most likely have a copayment for each covered service that you get. Since private insurance companies offer these plans, the costs and benefits can vary greatly from one plan to another. However, every Medicare Advantage plan has a yearly out-of-pocket limit. You have a maximum amount of out-of-pocket spend, then the plan covers the rest after you reach that limit.
When to enroll in a Medicare Advantage plan in Florida
You must enroll in Original Medicare (Part A and Part B) to qualify for a Medicare Advantage plan in Florida. Not all Medicare Advantage plans are available in your area of Florida. In most cases, you cannot have end-stage renal disease (ESRD) if you want to enroll in a Medicare Advantage plan. You can enroll in a Medicare Advantage plan in Florida during these time periods:
- ICEP (Initial Coverage Election Period)
- AEP (Annual Election Period)
- SEP (Special Election Period)
The Initial Coverage Election Period starts 3 months before you become eligible for Medicare. This period lasts for a total of 7 months. If you postpone your enrollment into Medicare Part B, then your ICEP will begin 3 months prior to having Medicare Part B and lasts for 3 months. You can also enroll during the Annual Election Period which starts on October 15 and ends on December 7 every year. You can also sign up during a Special Election period if you are eligible.