Medicare is a fee-for-service federal health insurance program based in the United States, funded by the General Revenue and Federal Insurance Contributions Act.
Medicare plans provide coverage for prescription drugs, hospital bills, medical equipment, and inpatient and outpatient care for older adults aged 65 or above, people with disabilities, and people with end-stage renal disease (ESRD).
This health insurance company provides health insurance coverage for nearly 5 million residents in Florida alone.
Numerous Medicare plans such as Original Medicare, Medicare Advantage, Medicare Supplemental, and prescription drug coverage are available for Florida residents.
These plans help lower the costs associated with hospital bills and medical care. Let us learn about Medicare Advantage plans in Florida and how they benefit residents.
Medicare Advantage Plans in Florida
The southeastern US state of Florida boasts the highest proportion of senior adults aged 65 and above, with more than 4.9 million Medicare beneficiaries.
Florida’s life expectancy is just under 78 years. Since 19.36% of the State’s population is aged 65 and above, services such as Medicare plans become vital to mitigate the financial damage caused by healthcare expenses.
Most senior residents in Florida have access to Medicare plans for mental and physical well-being. About 42% of total Florida Medicare beneficiaries are enrolled in Medicare Advantage plans sold by private health insurance companies.
A Medicare Advantage plan, also known as Part C, is a health insurance program consolidating the benefits of Part A and Part B with supplemental benefits.
Part A is hospital insurance, while Part B works as your medical insurance. In addition to this, a Medicare Advantage plan offers coverage for hearing, vision, and dental care.
Some of the private health insurance companies also offer Medicare prescription drug coverage (Part D) under Medicare Advantage plans. Hence, Medicare Advantage plans are cheaper than Original Medicare plans as they work as bundled coverage for beneficiaries with additional benefits.
However, Florida Medicare Advantage plans have a limited network. Private health insurance companies collaborate with specific healthcare providers.
This means that beneficiaries can only seek treatment from a healthcare provider within the network of choice. These plan options are based on ZIP code.
In Florida, there are 613 Medicare Advantage plans, which are an excellent alternative to Original Medicare. The monthly premium for a Medicare Advantage plan is $10.38 in Florida. Supplemental benefits may or may not affect the cost of the plan.
General Analysis | Ratings of Medicare Advantage Plan Providers in Florida
| Insurance Company | Medicare Rating | A.M. Best rating | Better Business Bureau (BBB) rating | J.D. Power ranking |
| BlueCross BlueShield | 3.9 stars | A | B | 5th out of 9 |
| Humana | 4.2 stars | A- | A+ | 4th out of 9 |
| UnitedHealthcare | 4.2 stars | A | Not rated | 4th out of 9 |
| Wellcare | 3.7 stars | Not rated | A- | Not ranked in the top 9 |
Types of Medicare Advantage Plans
Several types of Medicare Advantage plans are available for Florida residents. You can choose a type of plan that best suits your healthcare needs.
Let us look into the primary types of Medicare Advantage plans available for Florida residents in 2024.
Health Maintenance Organizations (HMOs)
An in-network provider, typically called an HMO provider, is an approved healthcare expert within the plan’s network.
In an HMO plan, beneficiaries receive care from a doctor, healthcare physician, or a hospital within the network of choice.
In emergencies, beneficiaries require pre-authorization or referral from their primary healthcare provider to consult another specialist outside their network. HMO plans mostly include prescription drug coverage.
Preferred Provider Organizations (PPOs)
PPO, another type of Medicare Advantage plan, allows you to receive medical care from an out-of-network provider. But seeking out-of-network care typically costs more than your standard plan. But this plan doesn’t restrict you to your primary care doctor.
You also don’t require a referral from your primary care physician to consult physicians outside your network. However, you incur relatively lower costs for medical experts and hospitals within the plan’s network.
Special Needs Plans (SNPs)
SNPs are ideal for beneficiaries with specific diseases who require specialized healthcare. Individuals with chronic conditions, living in nursing homes, or those who have both Medicaid and Medicare receive tailored benefits.
Generally, beneficiaries are limited to the network of providers within the plan. Pre-authorization is required to consult physicians outside the network. SNPs also include prescription drug coverage.
Private Fee-For-Service Plans (PFFS)
PFFS allows you to consult any Medicare-approved provider within your State. Hence, you’re not obligated to see a specific healthcare expert. Thus, PFFS plans work the same as Original Medicare, but you can visit any doctor at any hospital if they agree with the plan’s payment terms and conditions. These plans have fewer restrictions.
However, this plan establishes the pay rate for the doctor, the hospital, and the healthcare provider, as well as your out-of-pocket expense for the care you receive. In some PFFS, you have a network of providers where you incur lower costs. However, your plan may not always have prescription drug coverage.
Comparison of the Top-Rated Medicare Advantage Plans in Florida
As of 2024, there are 613 Medicare plans in Florida. The following are the best Medicare Advantage plans in the State. Here’s a comparison.
| Insurance company | CMS Star Rating | States available | Members in high-rated plans | Member experience |
| Humana | 4.3 | 49 states | High (90% or more) | Above average |
| UnitedHealthcare | 3.8 | 49 states | Medium (50% to 89%) | Average |
| Blue Cross Blue Shield | 3.8 | 48 states | Medium (50% to 89%) | Above average |
| Aetna | 3.9 | 46 states | Medium (50% to 89%) | Above average |
| Wellcare | 3.0 | 37 states | Low (49% or less) | Below average |
| Cigna | 3.7 | 29 states | Medium (50% to 89%) | Above average |
| CarePlus | 4 | 1 state | High (90% or more) | Average |
Benefits Of Medicare Advantage Plans in Florida
Medicare Advantage plans provide a range of supplemental benefits with your standard coverage options.
These benefits include coverage for wellness programs, hearing services, dental care, vision care, transportation services, meal accommodation, telehealth services, OTC benefits, chronic condition management, etc. Hence, Medicare Advantage plans have a holistic approach to healthcare coverage.
Since Florida has about 600 Medicare Advantage plans, it’s vital to look into the benefits your plan of choice offers before enrolling yourself. Here are the common benefits offered with Medicare Advantage plans in Florida.
Hospital and Medical Insurance
Medicare Advantage plans combine hospital and medical insurance, providing the same coverage as Original Medicare. This ensures that you receive primary coverage with your healthcare services.
Prescription Drug Coverage (Part D)
Most Medicare Advantage plans include prescription drug coverage to lower the out-of-pocket costs associated with prescription medications.
Dental Care
Medicare Advantage plans also offer preventive dental services, including routine checkups, scaling, and medically deemed necessary dental procedures.
Vision Care
Certain Medicare Advantage plans provide coverage for routine eye examinations, eyeglasses, and contact lenses, promoting better eye health.
Hearing Services
Some Medicare Advantage plans offer coverage for hearing exams. These plans typically cover hearing aids and other necessary equipment.
Wellness Programs
Many Medicare Advantage plans include wellness programs, such as gym memberships, fitness classes, and yoga classes, to help beneficiaries achieve a healthy lifestyle and combat healthcare problems that arise from a lack of fitness.
Transportation Services
Some Medicare Advantage plans offer assistance with transportation services. These plans ensure you access medical care at facilities more conveniently.
Over-the-Counter Benefits
Medicare plans with OTC benefits allow beneficiaries to purchase over-the-counter items, non-prescription medications, drugs, and health-related products.
Chronic Condition Management
Chronic condition management includes specialized care for individuals with long-term health problems. Medicare Advantage plans with this benefit are ideal for individuals who require comprehensive healthcare.
Cost of Medicare Advantage Plan in Florida
In 2024, the average monthly premium for a Medicare Advantage plan in Florida is $10.38. However, all eligible people in Florida can access a $0 premium Medicare Advantage plan.
Some Medicare Advantage plans require out-of-pocket costs besides premiums. In some cases, you may even have to pay a separate premium for the plan. Hence, you should become familiar with deductibles, copays, and coinsurance before enrolling in Medicare.
Most Medicare Advantage plans have specific copayments for their services, as private health insurance companies offer these plans. Consequently, the costs vary from plan to plan, depending on your chosen provider.
Medicare Eligibility in Florida
What makes you eligible for Medicare in Florida? Medicare has the same eligibility criteria across all the States. You qualify for Medicare if:
- You are 65 years old or above
- You have a medical disability
- You have end-stage renal disease (ESRD)
- You have amyotrophic lateral sclerosis (ALS)
Approval from the Social Security Administration for your age or disability is also crucial to qualify for Medicare in Florida.
Why Is Medicare Vital for Florida Residents?
Florida is home to the largest retirement community, with 4,346,965 senior citizens. In Florida, 1 in 5 people are aged 65 or above.
These older adults seek healthcare coverage options every day, and an extensive healthcare system for these demographics has become necessary to combat high hospital bills.
Moreover, Florida’s climate plays a crucial role in aggravating health problems such as asthma, bronchitis, and other respiratory diseases. Changes in temperature, humidity, and breezes also affect the health of citizens.
Under these circumstances, seeking medical aid and having routine checkups becomes more important than ever.
Florida’s healthcare system addresses the needs of its senior residents by providing them access to healthcare programs such as Medicare.
Having access to a Medicare Advantage plan provides seniors with supplemental benefits as it works as an all-in-one healthcare coverage option. Therefore, enrolling in a Medicare Advantage plan not only saves senior citizens from skyrocketing hospital bills but also enhances the quality of life for residents aged 65 and above.
Medicare Florida Resources
Numerous organizations offer guidance and provide senior residents with additional information about Medicare plans in Florida. Here are some organizations to assist you.
| Organization | How you can get help | Website & Contact Info |
| Serving Health Insurance Needs of Elders (SHINE) | Shine counselors provide free guidance to Florida residents regarding Medicare. They have trained counselors throughout Florida, which makes it easier for residents to seek help in any county. They efficiently resolve all Medicare-related queries. | Website |800-963-5337 |
| Senior Resource Alliance | Senior Resource Alliance is a non-profit organization serving senior adults in Florida. It provides Medicare-related information and assists people in accessing local and federal services, including Medicare. | Website | (912) 285-6083 |
| Florida Office of Insurance Regulation | This department provides vital information to assist senior adults in avoiding scams and Medicare fraud. Therefore, it helps protect the interest of those looking to buy insurance. | Website | (850) 413-3140 |
| Area Agency on Aging for Southwest Florida | The Area Agency on Aging for Southwest Florida guides senior residents about Medicare plans and connects them with other necessary resources to help them access daycare, housing assistance, and medical assistance across Florida. | Website | (866) 413-5337 |
Besides these additional resources, Medicare.gov and CMS’s websites are two informational tools that provide detailed information regarding Medicare coverage in the State.
You can search for Medicare Advantage plans through your ZIP code. Medicare gov’s plan finder tool can also help you compare various plans in your region.
Unlock Your Health Potential: Choose a Medicare Advantage Plan With Silveredge’s Expertise in Florida
Accessing Medicare Advantage plans requires you to provide your Medicare number and the date your Part A and B coverage became effective.
But before you enroll yourself, you must familiarize yourself with all the available plans in your region. If you cannot choose the best plan for yourself, don’t hesitate to reach out for professional help.
Licensed advisors at Silveredge can provide you with the right guidance to help you choose a Medicare plan that best suits your needs. With Silveregde, explore your Medicare options today for a healthier future tomorrow!
