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Florida Blue Medicare Advantage Plans for 2022

Open enrollment is coming soon, so now is a good time to learn what you can expect from Florida Blue Medicare Advantage plans for 2022. Interest in Florida Blue is gaining momentum as a way to get Part A and Part B Medicare coverage under one health insurance plan. Also, with prescription drug plans and additional coverage folded in, a Medicare Advantage plan will offer benefits you can’t get with Original Medicare.

What Medicare Advantage Plans Does Florida Blue Offer for 2022?

Blue Medicare Advantage Classic HMO

Good fit for members who:

  • Are needing broad network access in a managed care setting
  • Uses the plan infrequently to moderately each month
  • Require periodic coordination of care for conditions
  • Need basic drug coverage with protection in the donut hole
  • Occasionally leave the state and would require only emergency care if needed
  • Need basic dental and vision care
  • Broad network
  • Urgent/Emergent Care when traveling
  • Basic drug list
  • Covers cost generic drugs through the gap

Blue Medicare Advantage Value HMO Plan

Good fit for members who:

  • Are needing high-touch provider coordination or moderate to chronic medical condition’s
  • Use the plan infrequently and needs age-appropriate expert care
  • Want the lowest out of pocket per visit and out-of-pocket maximum
  • Need broad coverage of prescription drugs and protection drugs in the donut hole
  • Occasionally leave the state and would require only emergency care if needed
  • Need the elevated level of dental care for advanced conditions
  • Limited PCP’s but Experts
  • Improved specialists copay year after year
  • Lowest out-of-pocket costs
  • Basic drug list
  • Comprehensive dental coverage

Blue Medicare Advantage Saver HMO Plan

Good fit for members who:

  • Are wanting a portion of their Part B premium refunded to them each month
  • Recognize the trade-off for the partial refund results in a less rich product, a more narrow PCP network, and higher out-of-pocket
  • Occasionally leave the state and would require only emergency care if needed
  • Need basic hearing and vision care
  • Partial Part b refund in return for less-rich benefits
  • Coordinate care
  • condition monitoring
  • Competitive drug coverage

Blue Medicare Advantage Complete HMO Plan

Good fit for members who:

  • Medicare and Medicaid qualified beneficiaries needing high-touch care coordination for moderate to chronic medical conditions with no out-of-pocket costs
  • Need all available benefits afforded by the federal and state governments including transportation, over the counter items, and post-discharge meals
  • Need broad coverage of prescription drugs and protections in the donut hole
  • Need elevated level of dental care for advanced conditions
  • Need basic vision care but choices in frames/lenses
  • $0 medical costs
  • State and Federal coordination
  • Broad drug list
  • Assigned plan coordinator
  • Social worker assistance
  • Richest Extra package

Blue Medicare Advantage Value PPO Plan

Good fit for members who:

  • Freedom to use the plan how and where beneficiary wants
  • Zero premium PPO plans can offer competitive benefits and an attractive extra package
  • Realize using preferred providers can save them money on office copays in some counties
  • Wants to be able to travel outside  of the state for an emergency, planned, and consultative care and still have in-network cost-share if care is needed
  • Are new to Medicare
  • Zero premium PPO with competitive benefits, robust extra package, and access to care in-network and out-of-network
  • Limited drug list

Blue Medicare Advantage Choice Regional PPO Plan

Good fit for members who:

  • Monthly premium covers freedom to choose how and where plan is used
  • Ability to seek specialist care with or without primary care physician coordination
  • Need access to basic prescription coverage
  • Able to travel outside of the state for emergency planned and consultative care and still have in-network cost-share, if care is needed.
  • Freedom of choice on how to use the plan
  • Premium = broad network + competitive benefits
  • travel options
  • combine competitive out-of-pocket costs and rich drug formulary with large networks provider and pharmacy

Blue Medicare Advantage Select PPO Plan

Good fit for members who:

  • Fixed costs for medical and prescription care with the freedom to use the plan how and when they desire
  • Able to travel outside of the state for emergency planned and consultative care and still have in-network cost-share, if care is needed
  • Don’t mind paying more for the blue brand
  • Has more prescription needs and requires a broad drug list
  • Freedom and choice
  • Broad drug list
  • Combine competitive out-of-pocket costs and rich drug formulary with large networks (provider and pharmacy)

Blue Medicare Advantage Patriot PPO Plan

Good fit for members who:

  • Health only PPO plan, but does not offer Rx coverage
  • has alternative Rx coverage through VA, TriCare, Employer, ETC
  • Part B Give Back
  • Can go in- or out-of-network,  in and out-of-state
  • Freedom of choice
  • Partial Part B refund and competitive benefits
  • Access to care in and out-of-network
  • Flexibility to use alternative Rx coverage

Which Is Better, PPO or HMO?

Medicare Advantage is also known as MA or Medicare Part C. The primary types of Florida Blue MA plans are Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO).

Identifying the best Florida Medicare Advantage plan is a matter of personal perspective and priorities. For some people, latitude with network and referral requirements is critical. Others focus on minimizing cost.

  • PPO plans: greater flexibility
  • HMO plans: minimal cost

How Much Is a Medicare Advantage Plan in Florida for 2022?

Although zero-premium HMO and PPO plans are available in some areas, more and more PPO plans are charging a premium. You will find that availability and cost vary from one county to the next.

For 2021, there are 178 Medicare Advantage Prescription Drug (MAPD) plans across Florida with an average monthly premium of $13.17.

Which Is the Best Medicare Advantage Plan in Florida?

Best network freedom: Medicare Advantage PPO

  • Wide-reaching network
  • No need to get referrals from your primary care physician to see specialists
  • Monthly premiums range from zero to $100

Best for lowest out-of-pocket: Medicare Advantage HMO Plan

  • Zero premium is common
  • Bound to network of healthcare providers
  • Referral network enables plan to keep your out-pocket-costs down

Best for low income or health conditions: Medicare Advantage D-SNP

Special Needs Plans (SNPs) are insurance plans that accommodate people who have either specific health care needs or limited financial resources.

There are three populations that qualify for an SNP:

  • Chronic Condition (C-SNP): for people with certain conditions like end-stage renal disease or chronic heart failure
  • Institutional (I-SNP): for nursing home residents and recipients of nursing care at home
  • Dual Eligible (D-SNP): for dual-eligible Medicare beneficiaries

Dual eligible is the term used to describe eligibility for both Medicare and Medicaid. D-SNP plans are contracted to coordinate benefits between the programs to help you pay coinsurance, copayments, deductibles, and premiums.

When Can I Join, Switch or Drop a Medicare Advantage Plan in 2022?

Initial Enrollment Period

The Initial Enrollment Period is your earliest opportunity to sign up for Original Medicare. Once you have Medicare Part A and Medicare Part B, you can sign up for a Florida Blue Medicare Advantage plan.

The Initial Enrollment Period encompasses the:

  • The month you turn 65
  • Three-month period before the month of your 65th birthday
  • Three month period after the month of your 65th birthday

Open Enrollment Period aka Annual Election Period

Between October 15 – December 7, you can:

  • Enroll in a Medicare Advantage plan in Florida, such as Florida Blue.
  • Switch to another Medicare Advantage plan in Florida.
  • Drop your Medicare Advantage plan and return to Original Medicare.
  • Join, change or leave a Medicare drug plan.

Medicare Advantage Open Enrollment Period

If you are enrolled in a Florida Blue MA plan, here is what you can do during the annual Medicare Advantage Open Enrollment Period, which is between January 1 and March 31:

  • Change to another Medicare Advantage plan
  • Leave your Florida Blue Medicare Advantage plan and return to Original Medicare
  • Apply for Medicare Part D if you are leaving a Florida Blue Medicare Advantage plan that included prescription drug coverage

Special Enrollment Periods – Special Circumstances

There are specific scenarios that qualify you to enroll in a Florida Blue Medicare Advantage plan outside the annual enrollment periods. Your particular situation will drive the timing of your Special Enrollment Period and the type of changes allowed.

You can change your MA or Part D plan if:

  • You relocated to an area outside your plan’s service area.
  • Your new address is in an area that your plan services, but new plan options are available.

You can join an MA or Part D plan if:

  • You return to the United States after residency outside the country.
  • You were covered under a group health plan through your employer or a union and no longer have that coverage.

You can join, switch or drop an MA or Part D plan if:

  • You have both Medicare and Medicaid.
  • You did have Medicaid but no longer qualify.

5-star Special Enrollment Period

After assessing the performance and quality of Florida Blue and other Medicare Advantage plans, Medicare awards the best plans with a five-star rating. The 5-star Special Enrollment Period is when you can switch to a 5-star plan if one is available in your area. This is allowed one time between December 8 and November 30.

Special Enrollment Periods if you get “Extra Help”

If you are eligible for the “Extra Help” program for prescription drug coverage, you may be allowed to change your drug coverage one time during each of the first three quarters of the year:

  • January through March
  • April through June
  • July through September

During the fourth quarter, you can use the Open Enrollment Period to make changes.

What is the highest-rated Florida Blue plan for 2022?

Medicare uses a five-star rating system for Medicare Advantage, Medicare drug plans, and Medicare Cost plans. These ratings can help you compare plans on the basis of quality and performance. Medicare appoints star ratings annually. If a five-star-rated plan becomes available in your area, you can switch from your current plan during the 5-star Special Enrollment Period.

Note that companies can be upgraded or downgraded based on the performance and quality they demonstrated the previous year, so it’s important to have the most updated information. Our insurance agents stay abreast of these changes and can help you find five-star plans in your county.

FAQs

What is the difference between Original Medicare and Advantage plans?

The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, allows you to get Part A and Part B benefits from Medicare Advantage. During designated enrollment periods, you can switch back to Original Medicare.

Following are the main differences between these coverage options:

  • Medicare Advantage has an annual out-of-pocket maximum whereas Original Medicare does not cap your out-of-pocket costs.
  • When you are a Medicare Advantage member, your Medicare Part A, and Medicare Part B benefits will come from your MA plan, administered by a private insurance company.
  • Having Original Medicare means your benefits are administered directly by Medicare.
  • Most Medicare Advantage plans include extra benefits like vision, hearing, dental, and wellness programs.
  • Medicare Advantage plans generally incorporate the Part D plan into your coverage.
  • Medicare Advantage may have lower deductibles, copays, and coinsurance than Original Medicare.

Do you still pay Part B with Medicare Advantage?

You are responsible for the Part B premium whether you have Original Medicare, Medicare Advantage, or Medigap.

What are the pros and cons of Medicare Advantage Plans?

Pros:

  1. All parts of Medicare bundled under one plan, often including Part D
  2. Limited financial exposure because of out-of-pocket maximum
  3. Usually includes extra benefits that Original Medicare does not cover

Cons:

  1. Requires use of network providers to get the maximum benefits
  2. Restrictive networks and required referrals for HMO plans
  3. Premium savings, compared to a Florida Medicare Supplement Plan, potentially offset by cumulative out-of-pocket costs for doctor visits and other services
  4. Puts onus on members to take responsibility for reconciling medical bills, paying copays, and researching options when plan makes annual changes
  5. Expects you to perform a reevaluation of plan every year when changes are announced, unlike Florida Blue Medigap Plans, which is standardized and not subject to change

Do Medicare Advantage plans use the SilverSneakers program?

SilverSneakers is a program that provides access to fitness activities to stay in shape. If this benefit interests you, verify that your Medicare Advantage plan offers it. An insurance company may include this benefit in some of their Medicare Advantage plans but not across the board. If not included, inquire about comparable programs.

Does Medicare Advantage cover prescription drugs?

Most Medicare Advantage plans do include prescription drug plans. Our insurance agents can help you find a Medicare Advantage Prescription Drug (MAPD) plan in your area.