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Best Medicare Advantage Plans in Florida

Florida is among the highest enrollment rates in Medicare Advantage plans in the U.S. The state boasts many different Medicare Advantage plans. There are more then 207 local HMO plans, 40 local PPO plans, and six regional PPO plans, attesting to the popularity of a Florida Medicare Advantage plan.

Best network freedom: Medicare Advantage PPO

A Medicare Advantage PPO plan will offer a larger network of preferred providers and will not require referrals. People also will not have to choose a primary care physician and can get care from out-of-network providers at a higher cost. The premiums for a PPO plan can range from $0 to $100 per month. While there are a few PPO plans offering $0 premiums, an increasing number are charging monthly premiums. These premiums must be paid in addition to the monthly premium you pay for Part B.

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

HMO plans can offer significant cost savings to members. Most HMO plans do not charge monthly premiums. Members can also benefit from lower out-of-pocket costs in copays and deductibles because HMO plans use the HMO referral network.

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

Medicare Advantage dual-eligible special needs plans (D-SNP) are the best plans to choose for people who suffer from chronic health conditions or limited incomes. The plans are offered to qualifying individuals through the Centers for Medicare and Medicaid Services. People who can benefit from SNP plans are those who are dual-eligible for both Medicare and Medicaid. This helps them to lower their out-of-pocket costs for copayments, premiums, and deductibles.

How much is a Medicare Advantage plan in Florida for 2022?

Many HMO plans in Florida offer $0 monthly premiums. While some states still offer PPOs with $0 monthly premiums, an increasing number of PPO plans are charging premiums ranging from $0 up to $100 per month. On average, however, Medicare Advantage-Prescription Drug plans (MA-PD) cost $13.17 per month in Florida. However, plan availability and premiums will vary from county to county.

When can I join, switch, or drop a Medicare Advantage Plan?

Initial Enrollment Period

Before you will be eligible for a Medicare Part C plan, you will first need to enroll in Original Medicare, including Medicare Part A and Medicare Part B. The initial enrollment period for Medicare Part A and Medicare Part B opens three months before you turn 65 and ends three months after the month of your 65th birthday for a total of seven months.

If you are already receiving Social Security benefits, you will receive a package in the mail a couple of months before you turn 65. If not, you can apply for Original Medicare at your local Social Security office in person, online, or by calling the Social Security Administration. Once you enroll in Original Medicare, you can then enroll in a Medicare Advantage plan or a Medigap Supplement for additional coverage.

Some people with serious medical conditions or disabilities are eligible for Medicare Parts A and B earlier than age 65. For them, the initial enrollment period for Medicare Advantage or Medigap plans will be different.

Open Enrollment Period – AKA Annual Election Period

The Medicare annual election period runs from Oct. 15 to Dec. 7 each year. During this period, you are allowed to make changes to your current Medicare coverage. Medicare beneficiaries can change from Original Medicare to a Medicare Advantage plan, change from one Medicare Advantage plan to another, or change back to Original Medicare with Part D prescription drug coverage. Any new coverage elected will start on Jan. 1 of the following year.

Medicare Advantage Open Enrollment Period

The Medicare Advantage open enrollment period runs from Jan. 1 to March 31 annually. If you are enrolled in a Medicare Advantage plan in Florida and are unhappy with it, you can choose a new plan or return to Original Medicare and add a Medicare Part D prescription drug plan.

Special Enrollment Periods – Special Circumstances

Certain circumstances in your life can trigger a special enrollment period (SEP). These are periods outside of the normal open enrollment period during which you can make changes to your health plan. Some examples of triggering circumstances include the following:

  • Loss of creditable health insurance coverage for prescription drugs
  • Enrollment in an SNP when you no longer have a qualifying condition
  • Current plan changes its contract with Medicare
  • Opportunity to enroll in other coverage such as an employer-sponsored private health insurance plan
  • Loss of current coverage
  • Moved to an address outside of your service area
  • Diagnosis of a serious or disabling health condition such as end-stage renal disease

5-star Special Enrollment Period

Medicare conducts surveys of members and health care providers and compares plans each year to give star ratings for the plans’ performance. The star ratings range from one to five, with a five-star rating designating excellence. The ratings are meant to help Medicare beneficiaries to compare the performance and quality of different plans. The ratings are updated annually in the fall for the upcoming year and can change each year.

If there is a Medicare drug plan, Medicare Advantage plan, or Medicare cost plan in your area that receives a five-star rating, you can switch from your current Medicare plan to a five-star plan during the 5-star special enrollment period. You can use this period once from Dec. 8 and Nov. 30.

Special Enrollment Periods if you get “Extra Help”

Most Medicare beneficiaries are only allowed to change their drug coverage at specific times during the year. If you receive Medicaid or Extra Help, you might be able to change your drug coverage once during each of the following periods:

  • Jan. 1 – March 31
  • April 1 – June 30
  • July 1 – Sept. 30

If you change your prescription drug coverage during one of these periods, the change will be effective beginning the first day of the next month. If you need to make another change, your eligibility to do so will begin the first day of the next period. The special enrollment period for people who have Extra Help is not available from October through December. However, all Medicare beneficiaries are allowed to make changes to their coverage from Oct. 15 to Dec. 7 with changes becoming effective on Jan. 1.

What is the highest-rated Medicare Advantage plan?

Plans in Florida are rated annually from one to five with five meaning the best in terms of performance and quality. You can check in your county for a Florida Medicare Advantage plan from an insurance company that has a 5-star rating. The plans’ ratings can be downgraded from five stars in the fall based on the prior year’s performance. The best approach is to work with one of our insurance agents to determine which five-star plans are available where you live and compare their coverage options and extra benefits.

What is the difference between Original Medicare and Advantage plans?

Original Medicare consists of Medicare Part A hospital insurance and Medicare Part B medical insurance for outpatient services. If you have Original Medicare, you will have to pay an annual deductible before Medicare will pay its share. You will also be responsible for your Medicare Part B premium, coinsurance, and deductibles. If you exceed the maximum lifetime days for a hospital inpatient stay, you will be responsible for 100% of the costs.

With Original Medicare, there is no out-of-pocket maximum protection. However, Medicare Advantage plans do provide out-of-pocket maximum protection to members.

Medicare directly administers the benefits offered by Original Medicare. By contrast, when you choose a Medicare Advantage plan, your plan will replace your Original Medicare benefits and will be administered by the insurance company you selected for your Advantage plan. Finally, many Advantage plans have prescription drug coverage built into one plan. If you have Original Medicare, you will have to purchase Part D coverage in addition to Medicare Parts A and B to receive prescription drug benefits.

Do you still pay Part B with Medicare Advantage?

Even if you choose a Medicare Advantage plan, you will still be required to continue paying your Medicare Part B premium. The same is true if you instead choose a Medigap plan.

What are the Pros and Cons of Medicare Advantage Plans?

The advantages of choosing a Medicare Advantage plan include bundling your prescription drug benefits together with your other benefits, having an out-of-pocket maximum to reduce your financial exposure for medical costs, and having all of your health and wellness benefits bundled into a single plan.

The disadvantages of a Medicare Advantage plan include being restricted to a network in a specific service area for an HMO plan, having less financial predictability than a Medicare Supplement plan, having to confirm that you are remaining in the network, having to make changes to your plan each year, and experiencing annual changes to the plans, networks, premiums, and covered drugs. By contrast, Medicare Supplement benefits are standardized and will not change.

Do Medicare Advantage plans use the Silver Sneakers program?

The SilverSneakers fitness program is a very popular benefit that many plans include. When you are choosing a Medicare Advantage plan, you will want to check with your insurance agent to ensure that the plan you are considering includes SilverSneakers if it is important to you. The availability of this benefit varies from plan to plan even when the same company offers them. However, it’s still worthwhile to ask about what’s available because some plans offer similar fitness and wellness benefits to what is offered through SilverSneakers.

Does Medicare Advantage cover prescription drugs?

Most plans in Florida are Medicare Advantage Prescription Drug plans (MAPD). These plans are combination plans with prescription drug benefits built-in. However, some Advantage plans do not include prescription drug coverage, so it is important to check to make sure you choose an MAPD plan.