Medicare Providers & Carriers in Florida

The types of available Medicare plans offered by different Florida Medicare carriers and accepted by Florida Medicare providers include Medicare Advantage, Medicare Part D, and Medicare Supplement plans. Carriers and providers vary by location and may or may not be approved by Medicare. The PlanPrescriber Medicare comparison tool can help Florida residents discover the right plan for their needs offered by Medicare-approved carriers and accepted by most eligible Medicare providers.

What is a Florida Medicare carrier?

A Medicare carrier, also known as a Medicare Administrative Contractor (MAC), is a private insurance company contracted by the Center for Medicare and Medicaid Services (CMS) to oversee and process Medicare policies. This company also offers information on billing, coverage, and enrollment, and is able to answer any questions posed by beneficiaries on these subjects. Medicare carriers can locate billing errors as well as handle claims and appeals. Medicare carriers vary by state and have different network areas.

Examples of Medicare private insurance carriers in the state of Florida include:

  • Aetna
  • Coventry Health Care
  • Humana
  • Blue Cross and Blue Shield of Florida
  • United Healthcare
  • WellCare Health Plans

Florida Medicare carriers process claims submitted by Florida Medicare providersin their assigned area. Medicare carriers evaluate each claim to determine whether the claim qualifies for reimbursement through Medicare and the services provided are medically necessary and reasonable.

What is a Florida Medicare provider?

Florida Medicare providers offer services at different prices depending mainly on location and network availability. A Medicare provider is a medical practitioner or supplier who falls into a carrier network and performs services or offers supplies that are reimbursed by Medicare. To become a Medicare provider in Florida, a practitioner must submit an application, have a valid state medical license, and comply with United States non-discrimination standards. Examples of providers include fee-for-service providers, pharmacists, physicians, and skilled nursing facilities.

Before receiving services from any Medicare provider, it is in the best interest of the beneficiary to ask whether the provider accepts Medicare. Obtaining health services from a provider no covered by Medicare may mean high out-of-pocket expenses for the Medicare beneficiary.

Additionally, Florida Medicare beneficiaries should check to see if their doctor and preferred providers are enrolled with Medicare as a participating or nonparticipating provider. Participating providers have agreed to accept assignment and accept the Medicare-allowed amount for their services. Nonparticipating doctors may charge up to an additional 15% above the cost of service approved by Medicare. This charge is known as the Medicare excess charge and would be taken out of the beneficiary’s own pocket if they do not have additional Medicare coverage.

Resources for Florida Medicare beneficiaries

To learn more about Florida Medicare and Medicare providers and carriers in Florida, and what may be covered under different plans, beneficiaries and caregivers can consult the following resources:

  • Social Security: Apply for Medicare, request a replacement Medicare card, and read general information on different Medicare plans.
  • Long Term Care: Prepare for long-term care by learning about services and planning how to pay for long-term needs.
  • Extra Help: Learn about government financial assistance programs that offset the costs of premiums, copayments, and other out-of-pocket expenses.
  • State Health Insurance Assistance Program (SHIP): Receive one-on-one assistance and counseling that offers unbiased information on different Medicare plans.
  • Medicare’s Healthcare Provider Directory: Find physicians and healthcare professionals in your area that are enrolled in Medicare.