Medicare Advantage Plans in Florida

Written by: 
Matt Kiggins
Last updated: 
Jun 20, 2023

Medicare Advantage (Part C) plans in Florida are managed by private insurance companies and provide a few unique benefits that set them apart from Parts A and B of the Original Medicare system. Part A offers coverage for hospital stays and Part B covers services such as doctor visits, preventative screenings, and durable medical equipment. Medicare Advantage plans offer both Part A and  Part B coverage and usually include the following additional benefits: dental care, routine vision exams, and often discounts on gym memberships.

Medicare Advantage plans have out-of-pocket limits, meaning if you incur $500,000 in medical bills, you would be responsible for 20% of that bill (which is $50,000) if you are insured with Original Medicare only. However, when you are insured with a Medicare Advantage plan (depending on the plan type) you would only be responsible for paying $5,500 per calendar year in that same scenario. This benefit alone makes a Part C plan worth it.

Before you decide on a plan, be sure to research all the plans available in your county because not all companies offer supplemental benefits like dental or vision coverage. Additionally, ensure that your company of choice includes the healthcare facilities that you normally use in their network.

Key Takeaways:

  • 72 PPO plans and 464 HMO plans are offered in Florida for 2023.
  • $0 monthly premium plan options are available in Florida on a county-by-county basis.
  • Florida has 23 plans with a 5-star rating from Medicare's quality score metric.
  • Premiums for a Medicare Advantage plan range from $0.00 - $111.00 per month.
  • The lowest out-of-pocket maximum is $500.00, and the highest is $8,300.00 per calendar year.
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Medicare Advantage Companies in Florida

Compare star ratings and market share of some of the most popular Medicare Advantage providers in Florida:

Company

Humana Inc.

UnitedHealth Group, Inc.

Aetna - CVS Health Corporation

Florida Blue - Guidewell Mutual Holding Corporation

Wellcare - Centene Corporation

CIGNA

Market Share

30.30%

27.37%

9.84%

7.71%

6.14%

1.65%

Average Star Rating

3.2

3

3.5

3.25

2.75

3

AM Best Rating

A-

A+

A

A+

-

A

Editor’s Rating

3

4.5

4

4.6

2.5

3.5

Market Share and AM Best Rating - CSG Actuarial

Average Star Rating - reportcards.ncqa.org

What Do Medicare Advantage Plans Cover?

Medicare Advantage plans cover all the benefits of Original Medicare Part A (hospital insurance) and Part B (medical insurance), and Part D (prescription drug coverage). They often also have extra benefits that aren't included in Original Medicare.

Advantage plans cover:

Medically necessary outpatient services, such as:

  • Doctor's visits
  • Ambulance services
  • Emergency and urgent care
  • Durable medical equipment (DME)
  • Mental health care      
  • Laboratory tests

Preventive services, such as:

  • Vaccinations
  • Cancer screenings
  • Diabetes screenings
  • Depression screenings

Depending on the plan you choose, other benefits may include the following:

  • Prescription drug coverage
  • Regular eye exams with glasses coverage
  • Routine dental check-ups
  • OTC medication
  • Yearly hearing tests with hearing aid discounts
  • Fitness and wellness programs/discounts
  • Transportation to the required medical care facility

Types of Medicare Advantage Plans in Florida

Four Florida plans are available through the Medicare Advantage program: HMO, PPO, PFFS, and SNP.

Health Maintenance Organization (HMO) - You will need to receive all services from providers in the network.

This includes:

  • Primary care physicians
  • Referrals for specialists
  • Prior authorizations for treatments and some prescriptions
  • Drug coverage is usually included with this type of plan, so you do not need to purchase a standalone drug coverage.
  • The upside to this policy is that costs tend to be lower if you stay within the network of approved providers.

Preferred Provider Organization (PPO) -You will have a network of preferred providers, but you can see doctors or hospitals outside the network for additional costs. You don't need to designate a primary care doctor or get specialist referrals.

  • Drug coverage is usually included in these plans.
  • You cannot purchase standalone drug coverage with PPOs.
  • The drawback to this type of plan is higher premiums and out-of-network costs.

Private Fee-For-Service (PFFS) - PFFS plans don't require a primary care physician or referrals for specialists.

  • Here's how it works: you can go to any Medicare-approved healthcare provider or facility that accepts the plan's payment terms and agrees to treat you. However, it's essential to know that some providers may not agree to the plan's terms, which could result in higher out-of-pocket costs for you.
  • Another thing to remember is that these types of plans may include drug coverage, or you can purchase a standalone drug plan.

Special Needs Plan (SNP) - SNPs are for people with pre-existing conditions or other specific health needs.

They include care coordination and benefits that target your individualized needs, such as:

  • You will be assigned a Primary Care Physician (PCP) and referrals to any specialists you need.
  • All of your drugs will be covered under this insurance plan.
  • If you believe you meet the criteria for an SNP, you can enroll at any time throughout the year.

Your network's care providers' levels of flexibility differ between each type and the price. Although all Medicare Advantage plans cover the same services provided in Original Medicare, you may be required to pay a higher premium for extra benefits.

What Does It Cost?

On average, premiums for a standard Medicare Advantage plan range from $0.00 - $111.00 per month.

Here's how you can figure out your total cost.

There are four costs to consider:

  • The Medicare Part B premium - you will still have to pay your Part B premium after buying an Advantage plan. The 2023 premium is $164.90 per month.
  • Monthly premium - many Advantage plans have no monthly premium, but several of them do, so always make sure to check. Premiums vary by provider.
  • Deductible - the amount you must pay out-of-pocket before your Advantage plan starts covering your care.
  • Copays and coinsurance - what your Advantage plan charges you each time you see a medical provider.

When Am I Eligible?

To be eligible for a Florida Medicare Advantage plan, you must enroll in Parts A and B of Original Medicare. You also cannot have a Medigap policy. If you're 65 or older or receive disability benefits from Social Security or the Railroad Retirement Board (RRB), you qualify for enrollment. However, two groups can enroll at any age: those with End-Stage Renal Disease (ESRD) and those with amyotrophic lateral sclerosis (ALS).

When Can I Sign Up?

There are three periods when you can enroll:

  • The Initial Coverage Election Period is when you first become eligible. This includes the three months before your 65th birthday, the month of your birthday, and the three months following. If you have a disability, this period will occur during your 25th month of receiving benefits.
  • The Annual Election Period is the time of year when you can switch your Medicare coverage. If enrolled in Original Medicare, you can switch to a Medicare Advantage plan during this period. If you're already enrolled in a Medicare Advantage plan, you can shop around and switch to another plan that better meets your needs during this time. The Annual Election Period runs from October 15 to December 7 each year.
  • The Open Enrollment Period is the time of year when you can change your Medicare Advantage plan or go back to Original Medicare. This period takes place between January 1 and March 31.

Medicare allows for a special enrollment period under extraordinary circumstances, such as job loss or moving to an area where your current carrier does not service.

How to Choose a Medicare Advantage Plan in Florida

When choosing a plan, you should consider the following before buying:

Provider Network: To keep costs down, ensure your doctors, hospitals, and pharmacies are all in-network.

Out-of-pocket max: Following the plan's rules for in and out-of-network coverage, this is the most you'll spend on Medicare-covered services, besides your premium, deductible, and drug costs.

Deductibles, coinsurance & copays: Cost-sharing expenses are charged when you use your benefits. Review your plan to see what it costs for doctor's visits, services, treatments, and prescription drugs.

Drug coverage/formulary: Use the plan's formulary to see if your drugs are covered and how much they cost per prescription. You might want to discuss generic or alternative options with your doctor.

Additional benefits: In addition to basic coverage, think about what other benefits are most important. For example, many plans require using network providers and may have additional charges for more comprehensive protection.

Ready to Learn More?

We help educate Medicare beneficiaries on their options and help them go through the process of reviewing and comparing plans. We work with most of the nation's top-rated insurance carriers, such as Aetna, Cigna, Mutual of Omaha, and Florida Blue. So, give us a call today, or request a quote online to learn more.

FAQ

You can drop your Medicare Advantage plan and return to Original Medicare during periods such as the first three months of your Initial Election Period, Medicare Advantage Open Enrollment Period, Annual Election Period, and your twelve-month trial right period.

It is projected that over 50% of Medicare beneficiaries will be enrolled in Medicare Advantage plans by 2025, up from 45% in 2022.

Medicare Advantage plans replace Original Medicare, whereas Medicare Supplement plans fill in the gaps of Original Medicare.

The two most prominent insurance providers in Florida are Humana and UnitedHealthcare.

Matt Kiggins
Matt Kiggins
Senior Editor
SimpleAdvisor.com

For over 15 years, Matt Kiggins has been the senior editor at Simple Advisor, giving detailed advice on Medicare, life insurance, and dental coverage to thousands of clients in more than forty states. His demonstrated expertise in assisting people with their health plan selection is remarkable — it’s evident that he stands out among competitors as the go-to source for knowledge and support.

Matt holds a resident 2–15 Florida Health & Life (Including Annuities & Variable Contracts) Agent License in Florida, his state license number is P116762 (Issued 10/1/2007).

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Matt Kiggins
Matt Kiggins
Senior Editor
SimpleAdvisor.com

Matt Kiggins is the producer appointed to oversee the content written on SimpleAdvisor.com.

Every agent representing PG holds a state-issued producer license for the states they serve.

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Article Resources:

Your local State Health Insurance Assistance Program (SHIP) can help you understand your options. Additionally, you can visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) for more information.

Florida "Key Take Aways" data pulled from U.S. News and World Report. The lowest yearly out-of-pocket max numbers did not include SNP plans.

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