Medicare Advantage plans, also known as Medicare Part C plans or MA plans, are government-approved private insurance plans that provide eligible Florida Medicare beneficiaries with all of their Part A and Part B coverage.
What do Florida Medicare Advantage plans cover?
Medicare Advantage coverage includes all hospital and medical coverage provided under Medicare Part A and Part B, except in the case of hospice care. Original Medicare will continue covering hospice care even if the Medicare beneficiary is enrolled in a MA plan. Some Medicare Advantage plans include additional benefits, such as dental, vision, or hearing coverage and health and wellness programs.
Most Medicare Advantage plans in Florida come with prescription drug coverage, in a plan better known as Medicare Advantage Prescription Drug plans or MAPDs. However, if a Florida Medicare beneficiary is already enrolled in a stand-alone Medicare Part D plan or already has existing credible drug coverage, an MA plan without drug coverage may be the better option.
How are Florida residents eligible to enroll in a Medicare Advantage plan?
As a resident of Florida, you are generally eligible to sign up for a Medicare Advantage plan if:
- You are enrolled in Original Medicare (Part A and Part B)
- You live in the service area of the plan. If you live in another state for part of the year, check to see if the plan will cover you there.
- You do not have End-Stage Renal Disease (permanent kidney failure or ESRD) except in certain circumstances. If you have ESRD, you can only join a Medicare Advantage plan if:
- You were already enrolled in a MA plan prior to being diagnosed with ESRD
- Your health coverage, including that through an employer or union, is from a company that offers Part C plans
- You’ve had a successful kidney transplant
- There is a Medicare Advantage Special Needs Plan available for individuals with ESRD in your area
What types of MA plans are available to Florida Medicare beneficiaries?
Florida Medicare Advantage plans come in several different types. Each type of MA plan has different regulations around obtaining services and charges different out-of-pocket costs. It is important for Florida Medicare beneficiaries to find the Medicare Advantage plans that best suit their health needs and cover their preferred health care providers.
- Health Maintenance Organization (HMO) PlansAn HMO is a health care plan that requires enrolled Florida Medicare beneficiaries to select a primary care physician (PCP) within its network of doctors and healthcare providers. In most cases, HMOs require a referral from the PCP to see any specialists. Care from a provider outside of the plan’s network is generally not covered.
- Preferred Provider Organization (PPO) PlansA PPO plan is generally less restrictive than an HMO plan. This type of plan does not require specialist referrals and Medicare beneficiaries in Florida are generally able to get care from any hospital or doctor of their choosing. However, the cost of receiving care from an out-of-network provider may be higher than from an in-network provider.
- Private Fee-for-Service (PFFS) PlansUnder a PFFS plan in Florida, Medicare beneficiaries do not have to select a primary care doctor or get a referral in order to see a specialist; however, not all Medicare providers accept PFFS plans.
Other less common types of Medicare Advantage plans available in Florida include:
- Special Needs Plans (SNPs)
- HMO Point of Service (HMOPOS) Plans
- Medicare Savings Account (MSA) Plans
Please note that Florida Medicare beneficiaries can only sign up for Medicare Advantage plans during enrollment periods for which they are eligible.