Retirees Guide to Medicare in Florida
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Medicare in FL is clearly a hot topic with the immense amount of boomers calling FL their retirement home. We want to discuss Medicare in Florida in detail to ensure you have additional resources to help make informed decisions.
Medicare was created by the federal government in 1965 and is a health insurance program for people who are 65 or older and people younger than 65 with certain qualifying disabilities and conditions.
With a large retirement population, Medicare plays a vital role in health care delivery across the state. In fact, according to the Centers for Medicare and Medicaid Services, in 2018 there were more than 4.3 million beneficiaries currently enrolled in Medicare in Florida.
What is Medicare?
Medicare is administered by the federal government and is divided into four parts. If they qualify, eligible beneficiaries may choose to enroll in one or more of the possible coverages.
The four parts are:
Medicare Part A. This is hospital insurance that covers medically necessary hospital stays, hospice care, home health care and care in skilled nursing facilities.
Medicare Part B. This covers durable medical equipment such as wheelchairs, hospital beds, canes, crutches, ventilators, kidney machines, nebulizers and other similar devices. Part B also covers many doctors’ services, lab tests and x-rays, ambulance services, outpatient services, and preventative care. Part A and Part B are often referred to as Original Medicare.
Medicare Part C. Also known as Medicare Advantage, Part C is healthcare coverage offered by private insurance companies approved by Medicare to provide Part A and Part B coverage. Most of the time, people opt for a Medicare Part C plan because it offers benefits and coverage over and above what is offered by Original Medicare. Participants are required to pay a premium for this coverage.
Medicare Part D. This is stand-alone prescription drug coverage that provides specific benefits to go with Part A and Part B coverage. It is offered through private providers who contract with Medicare.
Who is Eligible for Medicare in Florida?
Medicare Part A Eligibility
Part A Medicare eligibility will depend on which of the two qualifying groups you are in:
If you are 65 or older:
Most people qualify for free Part A coverage, but some people will have to pay a premium.
You are eligible for free Part A coverage on if you are 65 or older and a citizen or permanent resident of the United States. You also qualify if you receive or you are already getting or are eligible to receive Social Security or Railroad Retirement Board benefits. Free Medicare based on Social Security eligibility can be based on your own earnings or those of a spouse, parent or a child. This applies to spouses who are living, deceased or divorced from the person seeking coverage.
To get free Part A coverage, a worker must have accumulated at least 40 quarters of coverage through the payment of Social Security payroll taxes during their working career. You earn one credit for each quarter you work and pay taxes as long as you meet minimum income amounts. This means that 40 quarters is the equivalent of paying taxes for 10 years of your work history.
If you do not meet the 40-quarter requirement, you can still get Part A benefits by paying a premium. If you paid Medicare taxes for 30 to 39 quarters, then for 2018, your premium will be $232. If you paid taxes for less than 30 quarters, then your premium will be $422.
In most cases, if you choose to buy Part A coverage, then you must also have Part B coverage which means you will be required to pay a premium for both parts.
If you are under 65 years old:
You are eligible to receive Part A Medicare in Florida at no cost if you have received or you are entitled to receive Social Security benefits for at least 24 months or you are getting a Railroad Retirement Board disability pension because you have met certain conditions. You are automatically enrolled in Part A and Part B after you get either of these benefits for 24 months. The 24 months do not need to be consecutive.
You also qualify for benefits if you have end-stage renal disease (ESRD), permanent kidney failure that requires either ongoing dialysis or a transplant or you receive Social Security disability benefits because you have amyotrophic lateral sclerosis (ALS, Lou Gehrig’s disease).
You are at least 50 years old and meet Social Security disability program requirements, and you are the child or the widow(er) of someone who worked in a government job long enough where they paid Medicare taxes.
Medicare Part B Eligibility
If you are eligible for Part A Medicare at no cost, then you are eligible to enroll in Part B Medicare in Florida by paying a premium. The amount of your premium will depend on your income. If you don’t sign up for Part B when you first become eligible, you might have to pay a late enrollment penalty.
If you do not qualify for free Part A coverage, you can still be eligible for Part B if you are 65 years or older and are either a United States citizen or a lawful permanent resident who has lived in the United States continuously for five years prior to the month you apply to enroll in Part B.
Medicare Part C Eligibility
If you have Part A and Part B Medicare in Florida coverage, then you are eligible to enroll in Part C. the only thing you need to be aware of is that you must live in an area where Part C coverage is offered. While this is a bit of a problem in other states, in Florida 100% of beneficiaries have access to Medicare Advantage plans. Overall, there are 295 total Medicare Advantage plans available throughout the state, according to the Center for Medicare and Medicaid Services. In 2018, about 45% of all Medicare beneficiaries were in enrolled in Part C plans or in other similar health plans.
Patients with End-Stage Renal Disease usually get their benefits through Original Medicare. They can only enroll in a Part C plan in certain situations.
For Part C Medicare in Florida, once you have reached coverage limits provided by Original Medicare, then the enhanced benefits offered by Medicare Advantage will kick in. Because of these enhanced benefits, you’ll be required to pay an additional monthly premium.
Medicare Part D Eligibility
If you have Medicare Part A and Part B coverage, then you are eligible to enroll in Part D Medicare in Florida. You must live in the service area of the Part D plan that you want to enroll in. Because this coverage is optional, you will be required to pay a premium. The amount may vary depending on your level of income. About 75% of Medicare beneficiaries in Florida have Part D coverage, and in 2018 there were 21 Medicare prescription drug plans available statewide.
What Does Medicare Cover in Florida?
Coverage for some medical tests, services and items can vary depending on where you live. However, there are many things that are covered no matter where you live.
The following is a list of many of the services and items Medicare covers throughout the United States, and coverage will depend on what Part(s) of Medicare you have.
If you have questions about whether or not Medicare in Florida provides coverage for tests and items not listed here, it is best to talk to your healthcare provider as Medicare may actually provide coverage due to ongoing program changes
|· Abdominal aortic aneurysm screening
· Air-fluidized beds & other support surfaces
· Alcohol misuse screening & counseling
· Ambulance services
· Ambulatory surgical centers
· Artificial eyes & limbs
· Bariatric surgery
· Blood processing & handling
· Blood sugar (glucose) monitors
· Blood sugar (glucose) test strips
· Bone mass measurement (bone density)
· Braces (arm, leg, back, and neck)
· Breast prostheses
· Cardiac rehabilitation programs
· Cardiovascular disease (behavioral therapy)
· Cardiovascular disease screenings
· Cataract surgery
· Cervical & vaginal cancer screenings
· Chiropractic services
· Clinical research studies
· Colorectal cancer screenings
· Commode chairs
· Concierge care
· Continuous passive motion (CPM) machine
· Cosmetic surgery
· Custodial care
· Defibrillator (implantable automatic)
· Dental services
· Depression screenings
· Diabetes screenings
· Diabetes self-management training
· Diabetes supplies & services
· Diagnostic tests
· Dialysis (children)
· Dialysis (kidney) services & supplies
· Doctor & other health care provider services
· Durable medical equipment (DME) coverage
· EKG (electrocardiogram) screening
· Emergency department services
|· Enteral nutrition supplies & equipment (feeding pump)
· Eye exams
· Eyeglasses/contact lenses
· Federally qualified health center services
· Flu shots
· Foot care
· Foot exam
· Glaucoma tests
· Glucose control solutions
· Gym membership & fitness programs
· Health education & wellness programs
· Hearing & balance exams & hearing aids
· Hepatitis B shots
· Hepatitis C screening test
· HIV screening
· Home health services
· Hospice & respite care
· Hospital beds
· Hyperbaric oxygen (HBO) therapy
· Incontinence supplies & adult diapers
· Infusion pumps & supplies
· Inpatient hospital care
· Kidney disease education
· Kidney transplants (adults)
· Kidney transplants (children)
· Laboratory services (clinical)
· Lancet devices & lancets
· Long-term care
· Long-term care hospitals
· Lung cancer screening
· Macular degeneration
· Manual wheelchairs & power mobility devices
· Massage therapy
· Mental health care (inpatient)
· Mental health care (outpatient)
· Mental health care (partial hospitalization)
· Nebulizers & nebulizer medications
· Nursing home care
· Nutrition therapy services (medical)
· Obesity screening & counseling
· Orthotics, artificial limbs, & eyes
· Ostomy supplies
|• Outpatient hospital services
• Oxygen equipment & accessories
• Pancreas transplants (adults)
• Patient lifts
• Physical therapy/occupational therapy/speech-language pathology services
• Pneumococcal shots
• Prescription drugs (outpatient)
• Preventive & screening services
• Preventive visit & yearly wellness exams
• Prostate cancer screenings
• Prosthetic devices
• Pulmonary rehabilitation program
• Radiation therapy
• Religious non-medical health care institution (RNHCI) items & services
• Rural health clinic services
• Second surgical opinions
• Sexually transmitted infections (STI) screening & counseling
• Shingles shot
• Shots (vaccinations)
• Skilled nursing facility (SNF) care
• Sleep apnea & Continuous Positive Airway Pressure (CPAP) devices & accessories
• Sleep study
• Smoking & tobacco use cessation (counseling to stop smoking or using tobacco products)
• Substance-related disorders
• Suction pumps
• Supplies (you use at home)
• Surgery (estimating costs)
• Surgical dressing services
• Tdap shot (tetanus, diphtheria, & pertussis shot)
• Therapeutic shoes or inserts
• Traction equipment
• Transplants (adults)
• Travel (when you need health care outside the U.S.)
• Urgently needed care
• Yearly eye exam
NOTE: The following chart was reproduced in its entirety from Medicare’s website.
Medicare Part A Coverage
Part A Medicare in Florida provides hospital, skilled nursing, hospice and some types of home health care.
For inpatient hospital care, Medicare covers semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes care you receive at acute care hospitals, critical access hospitals inpatient rehabilitation facilities and long-term care hospitals. In also includes inpatient care as part of qualifying clinical research studies and inpatient mental health care. It does not cover private duty nursing, private rooms, a television or phone, or personal care items. Your doctor must make an official order that says you need at least two or more nights of medically necessary impatient hospital care and you need the kind of care that can only be given in a hospital.
For skilled nursing facility care, Medicare covers semi-private rooms, meals, skilled nursing care, physical and occupational therapy, speech language pathology services, medical social skills, medications, medical supplies and equipment, ambulance transportation and dietary counseling.
For long-term care hospitals, Medicare in Florida will only cover patients who may have more than one serious condition and they may improve with time and care so that they can return home.
Hospice care is usually given at home, but Medicare will also cover hospice in an inpatient facility. A hospice team will create a plan that can include doctor and nursing services, medical equipment and supplies, prescription drugs, hospice aide and homemaker services, physical and occupational therapy services, speech language pathology services, social work services, dietary counseling, grief counseling for family members, short-term respite care, and any other Medicare-covered services to manage pain and symptoms related to a terminal illness. Hospice care coverage is only provided once the decision has been made to no longer attempt to cure a terminal illness and a doctor determines that efforts to cure an illness are no longer working.
Home health services covered by Medicare include part-time or intermittent skilled nursing care or home health aide care, physical therapy, occupational therapy, speech language pathology services, and medical social services. Medicare does not pay for 24-hour care at home, meals delivered to your home, personal care services, or homemaker services. Your doctor must certify that you are homebound in order to receive benefits.
Medicare Part B Coverage
Part B Medicare in Florida provides medically necessary services and supplies that are required to diagnose and treat medical conditions. This includes doctors’ services, outpatient care, lab and clinic services, surgeries, and durable medical supplies. Part B also covers preventative services to prevent illnesses or to detect them when they are in early stages, minimizing illnesses and providing treatments when they are most likely to work the best.
Part B also covers ambulance services to the nearest appropriate medical facility, including hospitals, critical access hospitals or skilled nursing facilities. Medicare only helps to pay for ambulance services when using other transportation could put your health at risk. Medicare may also cover emergency air transportation in an airplane or helicopter when your health is in serious danger and you can’t be transported safely by ground transportation.
One of the most important elements of Part B Medicare coverage is for durable medical equipment for use in your home. Only a doctor can prescribe durable medical equipment for you and it must meet certain criteria to be covered by Medicare Part B. Those criteria include: that the equipment is durable, meaning that it can withstand repeated use; it can be used in the home and must be used for a medical reason; that it is not generally useful to someone who is not sick or injured; and it has an expected lifetime of at least three years.
Some examples of durable medical supplies covered by Medicare Part B include:
- Canes and crutches
- Hospital beds
- Infusion pumps and supplies
- Nebulizers and nebulizer medications
- Oxygen equipment
- Traction equipment
- CPAP devices
- Commode chairs
Part B covers many other types of durable medical equipment, but Medicare will only cover these items if your doctors and durable medical equipment suppliers are enrolled in Medicare. Typically, if a supplier accepts assignment, then you will pay 20% of the Medicare-approved amount after meeting your Part B deductible.
Outpatient mental health services are also covered under Part B. This includes visits to psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners and physician’s assistants. Mental health services are also covered for the treatment of alcohol and drug use. Mental health services that are covered may include depression screenings, family counseling, psychiatric evaluation, group and individual psychotherapy, medication management, diagnostic tests, partial hospitalization, and others.
Inpatient mental health services are covered under Part A Medicare in Florida.
Most prescription drugs are not covered under Part B, but some outpatient prescription drugs are covered under certain conditions. These drugs are usually those that must be administered by a doctor, instead of those you would give to yourself. Some examples of drugs covered under Part B include:
- Drugs used with a durable medical equipment devices
- Injectable osteoporosis drugs
- Blood clotting factors
- Oral End-Stage Renal Disease drugs
- Transplant drugs
- Oral cancer drugs
- Oral anti-nausea drugs
Determining exactly what is covered under Part B Medicare can be complicated at times. To find out exactly what services and supplies are covered, you may need to talk to your doctor or health care provider to determine if Medicare covers the things you need.
Medicare coverage is determined by state and federal laws, national coverage decisions made by Medicare and local coverage decisions made by companies in each state that process claims for Medicare in Florida. When in doubt, be sure to ask about coverage or you may end up being responsible for paying for the item, service or supply in its entirety.
Medicare Part C Coverage (Medicare Advantage)
Medicare Part C is also known as Medicare Advantage and offers an alternative and enhanced way to receive Medicare benefits in Florida. Private companies contract with Medicare to provide Part A and Part B benefits. These companies must offer the same level of coverage as Original Medicare at a minimum. However, most Part C Medicare plans offer more coverage than Original Medicare, covering things such as vision, hearing, dental and several health and wellness programs.
Benefits will vary by provider so if you are interested in enhanced coverage, you will need to shop around for a Medicare Advantage plan that best meets your needs. You will need to pay a premium for Medicare Part C plans and premiums will vary depending on the plan, out-of-pocket expenses and types of benefits that you choose.
If you are considering a Medicare Advantage plan, one thing to consider is that most include prescription drug coverage, known as Medicare Advantage Prescription Drug Plans.
Another advantage of enrolling in a Medicare Advantage plan is that most include a yearly out-of-pocket maximum amount. Once this limit is reached, there will be no additional charge for covered services. Original Medicare does not offer this as a benefit.
Medicare Part D Coverage
Part D Medicare in Florida provides additional stand-alone prescription drug coverage that works in concert with Medicare Part A and Part B. Private insurance companies contract with Medicare to provide a higher degree of coverage and with limits to out-of-pocket expenses. Coverages and premiums will vary from policy to policy, so you will need to shop around for coverage that best suits your specific needs.
Where Do I Apply for Medicare in Florida?
Because Medicare is administered at the federal level, applying is the same in all jurisdictions.
There are several ways you can apply for Medicare in Florida. If you are already getting Social Security or Railroad Retirement Board benefits, you will automatically be contacted about enrolling in Medicare about three months before you turn 65. You will be enrolled automatically in Part A and Part B if you live in one of the 50 states, Washington, D.C., the Northern Mariana Islands, American Samoa, Guam or the U.S. Virgin Islands. Because there is a premium required for Part B coverage, you will be given the opportunity to opt out when you are contacted.
There are several ways you can apply for Medicare if you are not automatically enrolled.
If you are not getting Social Security or Railroad Retirement benefits, you can apply during the Initial Coverage Election Period which begins three months before the month you turn 65 and ends three months after the month you turn 65.
You can apply online through the Social Security website by going here.
You can also apply in person at any Social Security office in Florida. To find the office nearest to you, use the Social Security Office Locator.
Social Security Office Locations in FL
Below are the largest cities in the state of Florida and most likely to have a social security office near by you can visit.
- St. Petersburg
- Cape Coral-Fort Myers
- Palm Bay-Melbourne
- Port St. Lucie
- Palm Coast-Daytona Beach-Port Orange
- Bonita Springs
- Winter Haven
- Fort Walton Beach-Navarre-Wright
- North Port-Port Charlotte
You can also apply by calling Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) between 7 am and 7 pm, Monday through Friday.
If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772.
How Do I Apply for Medicare in Florida?
To avoid disruptions in your healthcare coverage or to avoid paying penalties for late enrollment, it is important that you know when and how to enroll in Medicare. There can be numerous enrollment periods that may affect you, depending on your particular situation.
If you are already getting Social Security or Railroad Retirement benefits, you will automatically be contacted and automatically enrolled three months before your 65th birthday during what is known as an Initial Coverage Election Period. Those who are under 65 and have received disability benefits from Social Security or the Railroad Retirement Board will automatically get Part A and Part B benefits after 24 months of receiving disability payments. In addition, people with Lou Gehrig’s disease will also get Part A and Part B the month that their disability benefits begin.
You can also apply for Medicare in Florida before age 65 if any of the following special situations are applicable to you:
- You’re a disabled widow(er) between 50 and 65.
- You work for the government and became disabled before turning 65
- You or an immediate family have permanent kidney failure
- You had Medicare Part B coverage in the past but dropped coverage
- You turned down Medicare Part B coverage when you first got Medicare Part A coverage.
- You or your spouse worked for the railroad industry.
If you decline to enroll in Medicare Part A or Part B during your Initial Coverage Election Period, you can choose to sign up during an Annual Enrollment Period from January 1 through March 31 each year. Coverage begins on the following July 1 of the year you sign up.
Important! If you are not automatically enrolled in Medicare and you do not sign up during the Initial Coverage Enrollment Period, you may have to pay late enrollment penalties and have a gap in your coverage.
There is also a Special Enrollment Period for Part B. You can enroll in Part B without paying a penalty after 65 if you can show you or your spouse had group health insurance from an employer. This Special Enrollment Period runs for eight months following the time that you or your spouse stopped working.
Every year, current Medicare beneficiaries are given the opportunity to review their existing coverage for all Parts and make changes during an Annual Open Enrollment Period. This takes place October 15 through December 7.
If you can show you have drug coverage from another source, you can delay enrolling in Part D coverage after age 65 as long as you can show that the coverage is equal to what you would get if you had Part D coverage.
If you are enrolled in a Medicare Advantage Plan and want to drop coverage and switch back to Part A and Part B coverage only, you can do so during the Annual Disenrollment Period that runs from January 1 through February 14 each year. You can also use this period to enroll in Part D coverage as well. In both cases, new coverage begins the first day of the month after you make your changes.
There are also many Special Enrollment Periods that apply in a number of specific circumstances for Part C and Part D coverages, such as if you move out of a coverage area or the provider changes their agreement with Medicare. You can check directly with Medicare or with Social Security to find out more information about these SEPs and whether or not they could apply to you.
What is the Cost of Medicare in Florida?
Those who qualify for coverage will not have to pay any premiums for Part A Medicare. However, they may be deductibles that need to be met for some services.
Those who don’t qualify will have to start paying a premium when they sign up. The cost of coverage will depend how many quarters you paid Medicare taxes. If you paid Medicare taxes for 30 to 39 quarters, your premium for 2018 will be $232. If you paid taxes for less than 30 quarters, your premium will be $422.
Those who pay for Part A coverage must also enroll in Part B coverage and pay an additional premium. If you are eligible for premium free Medicare Part A coverage, then you have the option of deciding whether you want Part B coverage by paying a monthly premium. The standard premium for Part B coverage in 2018 is $134 per month. However, you could pay more if you have a higher income, and some people who get Social Security benefits could pay less.
The chart below indicates how much your Part B premium costs will be based on your income as reported on your IRS return for two years ago.
|If your yearly income in 2016 (for what you pay in 2018) was||You pay each month (in 2018)|
|File individual tax return||File joint tax return||File married & separate tax return|
|$85,000 or less||$170,000 or less||$85,000 or less||$134|
|above $85,000 up to $107,000||above $170,000 up to $214,000||Not applicable||$187.50|
|above $107,000 up to $133,500||above $214,000 up to $267,000||Not applicable||$267.90|
|above $133,500 up to $160,000||above $267,000 up to $320,000||Not applicable||$348.30|
|above $160,000||above $320,000||above $85,000||$428.60|
The Part B annual deductible is $183. After that, you pay 20% of the Medicare approved amount for most doctor services, durable medical equipment and outpatient therapy.
If you do not sign up for Part B when it is initially offered, when you do sign up your monthly Part B premium may increase by 10% for each 12-month period that you decided not to enroll. That penalty is permanent for as long as you have Part B.
Costs for Part C Medicare coverage will vary based on several things. For example, certain Part C plans will pay for some or all of your Part B premiums. Part C plans will have varying amounts for deductibles, copayments or coinsurance costs. Costs may also vary depending on how often you use covered services and whether or not you use the insurer’s network providers or seek treatment out of network. There are many other variables to consider which is why it is critical to do your homework when you shop for a Medicare Advantage Plan.
Costs for Part D drug coverage also have several variables to consider. These will include the type of drugs you use, whether you use drugs that are in your plan’s formulary, and whether or not you go to a pharmacy that is in your plan’s network. Like Part C, you will need to shop for coverage based on your individual needs and make the decision that best suits your situation.
If you have limited resources, then the state of Florida may have programs in place that can help you offset the costs of Part A and Part B coverage. Check with your local Social Security office to see if you qualify for any financial assistance.
The Extra Help Program
Some people can get help paying for their Medicare drug plan through the Extra Help Program. Beneficiaries qualify if they meet any of the following conditions:
- Have full Medicaid coverage
- Get Supplemental Security Income benefits
- Get help from their state Medicaid program to pay Medicare Part B premiums
If you don’t automatically qualify for Extra Help Program benefits, you can still apply to receive assistance. You will need to meet income restriction and asset limits. Even if you exceed these limits you may still qualify for benefits if you support other family members who live with you, you have work earnings, or you live in Alaska or Hawaii.
If you qualify under any of these scenarios, your Part D premium may be lowered, and you will pay less for prescription medications.
The Florida Department of Elder Affairs
Because Florida has such a large elderly population, the Florida Department of Elder Affairs plays a critical role in helping this segment of the populations with a variety of health and wellness issues. The goal is to assist elders to stay in their homes and their communities by providing a variety of important information and linking elders with other targeted agencies in Florida.
The Agency oversees the Serving Health Insurance Needs of Elders (SHINE), a free program for all Medicare in Florida beneficiaries that offers one-on-one counseling regarding Medicare questions and issues through trained counselors.
Can I Have Medicare and Medicaid in Florida?
In certain qualifying instances, a beneficiary can have both Medicare and Medicaid in Florida.
Medicare is an insurance program that serves people 65 and older, or people with certain qualifying disabilities. Medicaid is an assistance program that has no age restrictions and serves people based on income levels. Medicare is administered on a federal level while Medicaid adheres to federal guidelines but is administered on a state level.
If someone qualifies for benefits under both programs, they are said to be “dual eligible” and will get blended assistance from both programs.
What Medicare Plans are Available in Florida?
Medicare has a search function on its website that allows people to find out about what providers serve Florida by completing a general or a personalized plan search. To access the Medicare Plan Finder tool, go here.
Below is a list of many of the Medicare plans available in Florida:
- AARP, insured by United Health Care
- BayCare Plus Medicare Advantage
- Blue Cross and Blue Shield of FL
- Colonial Penn
- Florida Blue
- United Health Care
- United American
- United of Omaha
What is the Best Medicare Plan in Florida?
Because every person has unique health issues and financial resources, there is no single answer as to what the best Medicare plan is in Florida.
Like any other major decision, you must do your homework, add in your personal factors and make a decision based on the best information you have at the time.
When you are eligible, you will automatically receive Part A coverage, but you will then need to decide if you want Part B, and/or a Medicare Advantage Plan and/or a Medicare Prescription Drug Plan to provide you with additional coverage.
If you have questions, make sure to talk to Medicare staff, private insurance providers, your personal medical providers and others so that you can reach the best possible decision.
What is the Best Medicare Supplement in Florida?
To assist beneficiaries in paying for Medicare coverage, there are several possible options to help offset costs. These are known as Medicare supplements and will help fill the gaps in coverage when Medicare does not provide full healthcare coverage.
Determining which Medicare supplement is the best will be determined by eligibility and availability.
Many people are able to combine Medicaid assistance with Medicare coverage to provide a greater degree of coverage at greatly reduced costs.
Medicaid is an assistance program administered at the state level that assists eligible low-income adults, children, pregnant women, people with disabilities and the elderly.
In Florida, Medicaid is administered through the Florida Department of Children and Families. To apply for Medicaid assistance, go here.
Because there are some healthcare costs not covered by Medicare in Florida, private companies offer supplemental health insurance known as Medigap plans. These fill in the gaps in costs such as those associated with copayments, coinsurance and deductibles. It may also play for services that are not covered at all by Medicare Part A and Part B.
To qualify for a Medigap policy, you must already have Part A and Part B coverage. You cannot purchase a Medigap policy if you have a Medicare Advantage Plan. Because there are no out-of-pocket limits for Original Medicare, buying a Medigap policy to provide additional coverage may make good sense for some individuals.
You will pay a monthly premium for a Medigap policy and that cost will vary depending on the types of coverage you receive. If you want this added protection and coverage, you will need to shop around to make sure you are getting exactly what works best for your situation. Medigap policies are generally purchased during the Initial Coverage Enrollment Period but may also be purchased later. If you do purchase a policy after the fact, there’s a good chance the Medigap policy will cost more.
To get an idea of what a Medicare Supplement policy may cost in Florida, you can go to the Florida Office of Regulation website and use their Medicare Supplement Sample Rate Search tool.
What are the Medicare Savings Programs in Florida?
Medicare Savings Programs help low-income beneficiaries with some of the costs for Medicare. Generally, this includes assisting with Medicare Part A and Medicare Part B premiums, coinsurance, deductibles and copayments.
There are four types of Medicare Savings Programs in Florida:
Qualified Medicare Beneficiary (QMB) Program
This program pays for Medicare Part A and Part B premiums and cost-sharing expenses. Individuals must currently be enrolled in Medicare Part A to qualify for this program.
Specified Low-Income Medicare Beneficiary (SLMB) Program
People who earn slightly more than the maximum for the QMB program may qualify for this program which helps with Medicare Part B premiums.
Qualifying Individual (QI) Program
People who do not meet eligibility requirements for the QMB or the SLMB program can apply to this program. It helps with Part B premiums and automatically qualifies people for the Extra Help program. Demands for this program often exceed resources and funding is available on a first-come, first-served basis.
Qualified Disabled and Working Individuals (QDWI) Program
This only pays for Medicare Part A premiums.
These savings programs are administered by state Medicaid agencies and to apply, you will need to contact Florida Medicaid. You can also get more detailed information on Medicare Savings Programs on the Medicare website.
For more information on Medicare in Florida, please contact us and someone on the PolicyZip team will be happy to help you navigate your questions.