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Medicare Health Insurance in Florida

The Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS), is responsible for administering Medicare in Florida. Medicare Insurance is a federal health insurance plan that seeks to provide comprehensive health coverage at affordable rates for any of the following individuals:

  • Floridian seniors who are 65 years or older

  • Floridians under 65 years with specific disabilities

  • Floridians with End-Stage Renal Diseases (ESRD) (permanent kidney failure needing dialysis or a kidney transplant)

The best way to get your Medicare Insurance is through an insurance health agent. Eligible Floridians typically choose between using Original Medicare (Part A and Part B) and Medicare Advantage. Consult with a Florida-licensed health insurance agent before signing up for Medicare health plans.

What is Considered Medicare Insurance?

Medicare is the federal government health insurance program that subsidizes healthcare services for individuals who are 65 or older. It also provides healthcare coverages for younger people with certain disabilities and diseases like End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). In Florida, there are different types of Medicare Insurance:

  • Part A (Hospital Insurance): It is funded through a part of the federal income tax called the Federal Insurance Contributions Act (FICA) and offers premium-free services to eligible individuals. You can qualify for a premium-free Medicare Part A hospital insurance plan if you have worked for a minimum of 40 quarters (10 years) and paid Medicare taxes. Otherwise, you may have to pay a premium for your Part A hospital insurance coverage. Part A covers hospitalization, inpatient care in a skilled nursing facility, hospice care, and home health care.

  • Part B (Medical Insurance): This plan's funding is from monthly premiums paid by insureds and the federal government revenue. Part B covers services like doctor's office visits, outpatient care, home health care services, and preventive care services like screenings for cancers and mental illnesses, including depression.

  • Part C (Medicare Advantage): This plan enables individuals to get healthcare services from a network of available providers. Private Medicare-approved companies like the following provide Part C plans:

  • Health Maintenance Organizations (HMO)

  • Medicare Medical Savings Account Plans (MSA)

  • Preferred Provider Organizations (PPO)

  • Private Fee-for-Service Plans (PFFS)

  • Special Needs Plans (SNP)

  • Part D (prescription drugs): Private health insurance companies offer Part D plans and typically cover outpatient prescription drug costs.

What is the Purpose of Medicare Insurance?

The primary purpose of Medicare Insurance is to provide affordable access to health care and services at a time of life when health care and prescription costs typically increase due to age and health conditions.

Medicare provides health coverage to older adults (ages 65 and over) during retirement when their employer-sponsored health insurance coverage usually ends. It also provides health coverage to individuals who cannot work due to disabilities or kidney failure and cannot get health insurance through their employers.

What is Medicare Insurance for?

Medicare Insurance in Florida is for providing health coverage to:

  • Individuals under 65 years with certain disabilities

  • Adults who are 65 years and older

  • Individuals under 65 years and with End-Stage Renal Disease (ESRD)

In 2022, 4,849,005 Florida residents were enrolled in Medicare, with the following utilization:

Original Medicare 47%
Medicare Advantage 53%
Original Medicare Part A and Part B 41%
Medicare Advantage and Other Health Plan Part A and Part B Beneficiaries 53%
Medicare Part D 63%
Medicare Advantage Prescription Drug Plan 95%

What are the Types of Medicare Insurance?

There are different types of Medicare Insurance in Florida that provide various services for the insured. They are:

  • Original Medicare (Parts A and B): Original Medicare has two parts, which are Part A (Hospital Insurance) and Part B (Medical Insurance). Part A covers hospitalization, hospice care, inpatient care in a skilled nursing facility, and lab tests. On the other hand, Part B covers doctor's office visits, home health care services, and preventive care services, such as screenings for cancers and mental illnesses, including depression.

  • Medicare Advantage (Part C): These plans are sold by Medicare-approved private insurers. Part C includes Original Medicare coverage (excluding hospice care), prescription drugs, dental care, and vision care. It can also cover gym memberships and transportation to and from medical appointments. Medicare Advantage is good for individuals who want to bundle health care and drug benefits in one plan and are comfortable with the restriction on the choice of providers to save on costs. Florida's Medicare Advantage program has different types of plans:

    • Medicare Medical Savings Account Plans (MSA)

    • Health Maintenance Organizations (HMO)

    • Preferred Provider Organizations (PPO)

    • Private Fee-for-Service Plans (PFFS)

    • Special Needs Plans (SNP)

  • Part D (Prescription Drug): These plans are offered to all Medicare enrollees, but eligible individuals who sign up late are penalized. All Part D plans may not cover the same drugs or have similar costs. Medicare-approved private insurers offer standalone Part D coverage, and most plans have deductibles and copay for each prescription drug. Part D is good for individuals who have Original Medicare or Medicare Advantage Plan (excluding health maintenance organization (HMO) or preferred provider organization (PPO) that does not include Medicare prescription drug coverage).

No matter the type of Medicare insurance you get, ensure you file your Medicare options claims as soon as the medical services are provided. It should not be later than a year if you want Medicare to pay its share.

Do you Need Medicare Insurance?

Everyone residing in Florida needs health insurance to protect them from unexpected high medical costs. Hence it is vital to get Medicare Insurance if you are eligible and do not have any health insurance coverage. Generally, medical expenses can be costly, especially for adults and people with underlying health issues. However, with Medicare Insurance, individuals can have accessible and affordable healthcare coverage regardless of age and health status. You need Medicare Insurance if you are 65 years and older or a young person with specific disabilities or End-Stage Renal Disease (ESRD). In 2022, there were over 4.6 million seniors residing in Florida.

Why Do you Need Medicare Insurance?

You need Medicare Insurance in Florida because it is accessible and affordable. With Medicare Insurance, you will be able to get quality healthcare services that ought to be expensive from any doctor of your choice at an affordable rate. You will have access to a full range of quality healthcare services, both inpatient and outpatient. If you have Original Medicare, you will need Medigap to help prevent significant expenses and cover out-of-pocket bills. In addition, you need Medicare Advantage to have additional coverage outside the basic benefits of Original Medicare, like prescription coverage and vision, dental, and hearing benefits all in the same plan.

How Much Medicare Insurance Do you Need?

The amount of Medicare Insurance you need in Florida is mainly dependent on your income and how much coverage you need. Generally, Original Medicare costs and coverage are usually fixed, so you might want to find more information to know if you can afford the coverage and if it meets your needs. If not, you can opt for a Medigap plan or Medicare Advantage plan from a Medicare-approved private insurer. Discuss with a Florida-licensed health insurance agent who can access your health needs and help you determine the right amount of Medicare coverage that will suit your specific needs. They can also provide several Medicare coverage plans for you to choose from.

What Medicare Insurance Coverage Do you Need?

The Medicare Insurance coverage you need in Florida provides comprehensive health coverage like Original Medicare or Medicare Advantage plan. It is important to note that Original Medicare does not cover vision, hearing, and dental services. Individuals who desire to get coverage for those services can get supplemental insurance plans. Those with Original Medicare plans can purchase Medigap plans to cover their out-of-pocket expenses.

Individuals can also get Medicare Advantage as an alternative to Original Medicare. Medicare Advantage plans provide similar services and benefits that Original Medicare provides. It also provides services that Original Medicare excludes, like drugs, hearing, dental, and vision services.

Is Medicare Insurance Required by Law?

It is not mandatory to have Medicare Insurance in Florida, but there are some situations where it is automatically offered and may take some effort to decline. Choosing not to sign up or enrolling late in Medicare comes with many penalties depending on the program.

  • Part A: The penalty for not enrolling in Part A Medicare when you are eligible depends on why you chose not to sign up. If you decide not to enroll for no justifiable reason, your monthly premium for Part A Medicare insurance may increase by 10% for twice the number of years that passed without signing up. This simply means that if you wait three years to sign up, you will pay the late enrollment penalty for six years after signing up.

  • Part B: The penalty for not signing up for Medicare Part B when you first become eligible is that when you finally decide to sign up, you will have to pay 10% of the standard premium for each year you were not signed up. Also, you will have to continually pay this penalty as long as you are enrolled in Medicare. For instance, if you wait two years past your initial enrollment period to sign up for Part B, your premium will increase by 20% for the rest of the time you are enrolled.

  • Part C: Signing up for Medicare Part C is not mandatory and does not have penalties on its own. However, penalties may be included for late enrollment in the parts of Medicare included within your Medicare Advantage plan.

  • Part D: The penalty for not signing up for Medicare Part D (drug coverage) during your initial enrollment period is to pay 1% of the national base beneficiary premium multiplied by the number of months you decided not to sign up for the coverage. As of 2022, the national base beneficiary premium is $33.37. After the penalty calculation, the amount will be rounded to the nearest 10 cents, and the amount will be added to your monthly Part D premium throughout the time you are enrolled.

If you disagree with your penalty assessment for not signing up for Medicare on time, you can appeal the decision. Some conditions might make you enroll late for Medicare without paying penalties. After the initial enrollment period, you can enroll during the Special Enrollment Periods (SEPs). You won’t have to pay the penalty for late enrollment in any of the Medicare programs if you continue working after your 65th birthday and have an employer-sponsored health insurance plan. However, you have an 8-month window to enroll for Medicare parts A and B without penalty, and this begins from the month after you end your employment or when your group health plan insurance from that employment ends. Additionally, you will be eligible for a special enrollment period for Medicare A and B without any late enrollment penalties if you volunteer in a foreign country during your initial enrollment period.

If you consider rejecting Medicare coverage, talk to a Florida-licensed health insurance agent who can give you more information regarding your decision. Understanding how Medicare works with other insurance policies is important to select the most comprehensive coverage available.

How Does Medicare Insurance Work in Florida?

According to the Centers for Medicare & Medicaid Services (CMS) report, more than 2.7 million Floridians enrolled for Medicare during the open enrollment for 2022 coverage. Some Floridians are automatically considered for Medicare if they are eligible, while others are not. Those who are not automatically enrolled can sign up for Medicare online or through a health insurance agent. At the point of enrollment, individuals would be required to either choose to purchase health coverage through Original Medicare (Parts A and B) or a Medicare Advantage Plan from a private insurance company.

  • Part A: This covers inpatient hospital stays, rehabilitation costs, certain home health services, and hospice services. Generally, Medicare part A plans are free for an individual:

    • Who has worked and paid Social Security and Medicare taxes for a minimum of 10 years

    • Aged 65 or above who had Medicare-covered government employment

    • Aged 65 or above who have retirement benefits from Social Security or the Railroad Retirement Board

    • Under 65 years old who have Social Security or Railroad Retirement Board disability benefits for two years

    • Aged 65 or above who are eligible to get Social Security or Railroad benefits but are yet to file for them

    • Under 65 years old who have End-Stage Renal Diseases (ESRD) and meet certain requirements.

People who do not qualify for a premium-free Medicare Part A plan in Florida can buy it. Part A premium costs either $274 or $499 per month, depending on how long the insureds and their spouses paid Medicare taxes while working. Individuals who choose to purchase Part A must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both Part A and Part B. Most times, Medicare Part A enrollment is automatic, but eligible individuals who do not receive automatic Medicare enrollment can sign up for it.

  • Part B: This covers medical treatment and preventive services like ambulance services, chiropractic services, clinical research services, diabetes supplies, emergency room services, medical equipment, mental health services, and screenings. Medicare Part B enrollment is automatic for some individuals, but other people will need to sign up for it. Part B Medicare requires individuals to pay monthly premiums, which are usually automatically deducted from the payments of their benefits if the benefits come from social security, the railroad retirement board, and the office of personnel management. Those without any of these benefits would be sent a bill. As of 2022, the standard Part B premium amount is $170.10 with a deductible of $233 and a 20% coinsurance charge on several outpatient services like doctor consultations and physical therapy.

  • Part C: This is also known as Medicare Advantage. Medicare Part C plans provide similar coverage as Parts A and B but may include prescription drugs, vision, hearing, and wellness services. Unfortunately, those with end-stage renal disease (ESRD) are not eligible for Part C plans. Part C premiums vary by plan and come with annual deductibles, copays, and coinsurance, whose cost varies by plan providers. The most common Part C plans in Florida include:

    • Health Maintenance Organization (HMO): This plan provides health insurance coverage through a network of doctors for a monthly or yearly fee. HMO plans require individuals to get medical care and services from providers in the plan’s network, excluding out-of-area urgent care, emergency care, and out-of-area dialysis. Some HMO plans in Florida may permit individuals to go out of network for some services, which are usually more expensive than health care obtained from HMO plan providers.

    • Preferred Provider Organization (PPO): Offers a network of providers like doctors, other health care providers, and hospitals to meet the insured’s medical needs in Florida. The insurer contracts with several healthcare providers to regulate the price of providing benefits to its insureds. The fees charged by these providers are usually cheaper than the normal rate.

    • Private Fee-for-Service (PFFS): PFFS plans are offered by private companies. It has similar coverage as the Original Medicare program (Part A and B) but with different rules and stipulations. The plan administrators determine how much doctors, hospitals, and other health care providers are paid and set how much individuals pay upon receipt of care in Florida.

    • Special Needs Plans (SNPs): These plans are specifically designed to provide targeted care and limit enrollment to individuals with specific diseases or characteristics. There are three different types of SNPs:

  • Part D: It is offered through private companies either as a stand-alone plan for individuals enrolled in Original Medicare or part of Part C benefits. All Part D plans must cover most vaccines and outpatient prescription drugs in the following categories:

    • Immunosuppressant drugs

    • HIV/AIDS treatments

    • Antipsychotic medications

    • Antidepressants

    • Anticonvulsive treatments for seizure disorders

    • Anticancer drugs (unless covered by Part B)

The combination of Medicare Part A and Part B is called Original Medicare. The initial enrollment period for Medicare Part A and Part B begins three months before a person turns 65 years old and ends three months afterward. Individuals who miss the initial enrollment period can sign up during the general Medicare enrollment period, between January 1st and March 31st, and their coverage will commence on July 1st. However, if individuals with special circumstances miss the initial enrollment period, they can sign up for Part A and Part B during the special enrollment period (SEP).

The best time to enroll for Medicare Part C and Part D plans in Florida is during the initial enrollment period. This will help individuals avoid paying a lifetime Part D late enrollment penalty. Those who miss the initial enrollment period would have to wait until Medicare’s annual Open Enrollment Period (from October 15 to December 7) to join a plan. During this time each year, people can also drop or switch their plans.

Individuals who enroll for Original Medicare are usually given Medicare cards with the colors red, white, and blue, which are the colors of the U.S. flag. Enrolled individuals would need to show their cards to their medical providers when receiving services. A Medicare card contains the holder’s personal information, Medicare number, the date coverage begins, and the type of Original Medicare Insurance they are entitled to. Medicare Advantage beneficiaries will also be given Medicare Advantage Plan cards in addition to the Original Medicare cards. They are to show their Medicare Advantage Plan cards when they get services from their providers.

Talk to a Florida-licensed health insurance agent to get specific details on your Medicare plans. A licensed agent can also compare quotes from multiple health insurance providers to ensure you get a comprehensive plan at an affordable rate.

What Does Medicare Insurance Cover?

Medical insurance in Florida covers both inpatient and outpatient services like inpatient care in a skilled nursing facility, hospice care, home health care, visits, lab tests, clinical trials, mental health care, preventive care, and surgeries. However, a typical Original Medicare plan does not cover prescription drugs and dental, hearing, and vision services, which are usually covered by Medicare Advantage plans. It is important to note that original Medicare may leave you with several out-of-pocket costs but purchasing a Medigap plan can help cover them.

What is Medicare Insurance Good for?

Medicare Insurance in Florida is good for providing accessible and affordable quality health coverage for eligible residents, including individuals:

  • 65 years old and above

  • With certain disabilities

  • With Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s diseases

  • With End-Stage Renal Diseases (ESRD) (permanent kidney failure requiring dialysis or transplant)

What Does Medicare Insurance Typically Include?

Medicare Insurance in Florida typically includes the following based on the plan:

  • Medicare Part A covers hospital insurance, such as home health care, hospice care, inpatient care in hospitals, and skilled nursing facility care.

  • Medicare Part B covers medical insurance like medical services and preventive services. Medical services include outpatient care, services from doctors and other healthcare providers, home health care, and durable medical equipment like crutches, wheelchairs, hospital beds, walkers, and other similar equipment. Preventive services include screenings, vaccines, and yearly “wellness” visits.

  • Medicare part C, also called Medicare Advantage, covers both hospital and medical insurance that Parts A and B cover. It also covers periodic vision, hearing, and dental checkups.

  • Part D covers prescription drugs, including shots and vaccines.

Who is Covered by Medicare Insurance?

Medicare Insurance covers the following individuals:

  • United States citizens or legal residents who have lived in the country for a minimum of five years

  • Adults who are 65 years or older

  • People with disabilities, based on the Social Security's definition of disability

  • People who have amyotrophic lateral sclerosis (ALS) diseases

  • People who have end-stage renal diseases (ESRD) (permanent kidney failure requiring dialysis or transplant)

  • People who have worked and paid for Medicare

What Types of Items Does Medicare Insurance Cover?

The items or services covered by Medicare Insurance in Florida are:

  • Acupuncture: Medicare Part B covers about 12 acupuncture visits in 90 days for chronic low back pain.

  • Alcohol misuse screenings & counseling: Medicare Part B (Medical Insurance) covers an alcohol misuse screening once per year for adults (including pregnant people) who use alcohol but do not meet the medical criteria for alcohol dependency.

  • Ambulance services: Medicare Part B can cover on-ground ambulance transportation when immediate medical attention is needed. Also, emergency ambulance transportation in an airplane or helicopter can be covered if an insured patient needs immediate and rapid transport that on-ground transportation can not provide.

  • Chemotherapy: Medicare Part A covers chemotherapy for inpatients with cancer, while Part B covers hospital outpatients or those in a doctor’s office or freestanding clinic.

  • Counseling to prevent tobacco use & tobacco-caused disease: Medicare Part B covers about eight smoking and tobacco-use cessation counseling sessions in a year for tobacco users.

  • Foot care: Medicare Part B covers podiatrist foot exams or treatment for insureds needing treatment for foot diseases, injuries, or damaged nerves due to diabetes.

  • HIV screenings: Medicare Part B covers one Human Immunodeficiency Virus (HIV) screening once yearly for individuals who meet the following conditions:

    • Those between the age of 15 and 65

    • Those younger than 15 or older than 65 who are at an increased risk for HIV

Insureds who are pregnant can get up to three HIV screenings during their pregnancies.

  • Sexually transmitted infection screenings & counseling: Medicare Part B covers sexually transmitted infection (STI) screenings for pregnant or at-risk insureds. Sexually active adults at increased risk for STIs can get two face-to-face, high-intensity behavioral counseling sessions per year. Part B covers STI screenings once per year or at specific times during pregnancy.

  • Sleep studies: Medicare Part B covers Type I, II, III, and IV sleep tests and devices for insureds with clinical signs and symptoms of sleep apnea.

  • X-rays: Medicare Part B (Medical Insurance) covers medically necessary diagnostic X-rays when the insured's health care provider orders them.

  • Prescription drugs: Medicare drug coverage (Part D) covers drugs in the categories of immunosuppressant drugs, HIV/AIDS treatments, antipsychotic medications, antidepressants, anticonvulsive treatments for seizure disorders, and anticancer drugs (unless covered by Part B).

Talk to a Florida-licensed health insurance agent to better understand the coverage of your Medicare Insurance and the test item or service covered by your policy in relation to your current health needs.

What is Not Covered by Medicare Insurance?

Medicare Insurance in Florida does not cover long-term care, most dental care (like fillings, cleanings, tooth extractions, dental plates, and dentures), cosmetic surgery, massage therapy, hearing aids, routine foot care, and eye exams. So insureds in need of these services would have to pay out of their pockets. Also, Original Medicare does not provide Medicare prescription drug coverage.

What Does Medicare Insurance Typically Exclude?

Medicare Insurance in Florida typically excludes:

  • Gym memberships & fitness programs: This is not covered by Original Medicare plans but may be covered by a Medigap plan.

  • Long-term care: This is also called custodial care and is covered by the insured. Individuals who need long-term care should consider getting long-term care insurance.

  • Most dental care: Dental procedures and supplies like fillings, cleanings, tooth extractions, dental plates, dentures, or other dental devices are excluded. You might have to purchase a dental insurance policy to get coverage for these services.

  • Cosmetic surgery: Except needed due to accidental injury or to improve the function of a malformed body part. Insurance policies do not cover cosmetic surgeries for purposes aside from medical reasons because they are considered alternative treatments.

  • Massage therapy: Insureds are responsible for massage therapy expenses because it is not covered in Medicare plans. Most health insurance policies do not cover massage therapies because they are seen as alternative treatments.

  • Medical expenses outside the United States: Except for medical services the insured gets while on board a ship within 6 hours away from a U.S. port. A Medigap policy can help cover emergency care received outside the United States.

  • Hearing aids: Original Medicare excludes hearing aids and the exams for fitting them. Medicare advantage insurance plans typically cover hearing aids.

  • Routine foot care: Insureds are responsible for paying periodic foot care expenses. Health insurance policies do not cover routine foot cares because they are considered alternative treatments.

  • Routine eye exams: Any eye exams related to prescribing glasses and contacts are excluded. These services are typically covered by vision insurance.

What is an Example of Medicare Insurance?

Floridians can decide how they want to get their Medicare coverage policies upon enrollment. Medicare Insurance can be obtained in two ways:

  1. Original Medicare: This combines Medicare Parts A (Hospital Insurance) and B (Medical Insurance). They both cover inpatient and outpatient services that insureds receive from Medicare-approved hospitals. Original Medicare excludes prescription drug coverage, which is covered under Part D. Insureds are at liberty to purchase a different drug plan if they want drug coverage.

  2. Medicare Advantage: This is also called Medicare Part C and is provided by private Florida insurance companies. It is the only alternative to Original Medicare. It bundles the benefits of Medicare Parts A, B, and D. It sometimes offers extra benefits like vision, hearing, and dental services, which are not covered under Original Medicare.

There is a supplemental Medicare Insurance policy called Medigap that works only with Original Medicare. It helps pay Original Medicare out-of-pocket expenses such as copayments, coinsurance, and deductibles.

The type of Medicare coverage insureds purchase determines their premiums, covered services, access to doctors, and quality of care. For instance, insureds with Original Medicare have wide access to several healthcare providers all over the country, while those with Medicare Advantage can only access doctors within their insurer’s network. Find out more about Florida Medicare coverage choices and get help with comparing plans by talking to a licensed health insurance agent in Florida.

What is the Most Common Use of Medicare Insurance?

Medicare Insurance policies are mostly used by individuals above 65 years to get quality health coverage at affordable prices. This is because they might no longer be eligible for employer-sponsored health insurance coverage and health coverage for older adults is expensive in Florida.

What is the Difference Between Medicare Insurance and Medicaid Insurance?

Medicare and Medicaid are two different programs run and financed by different government sectors. Additionally, these insurance programs serve different groups of individuals in Florida. The differences between Medicare Insurance and Medicaid Insurance are:

  • Medicare is run by the federal government, while the state and federal governments jointly run Medicaid.

  • Medicare primarily serves individuals over 65 years, regardless of their income, younger disabled people, and dialysis patients. In contrast, Medicaid serves low-income earners of every age.

  • Medicare is funded by the Hospital Insurance Trust Fund (like payroll taxes and interest earned on the trust fund investments). It is also funded by Supplementary Medical Insurance Trust Fund (funds authorized by congress and premiums paid by Part B and D insureds). In contrast, Medicaid services are funded by both the federal and state government.

It is possible to be eligible for both Medicare and Medicaid coverages (dual eligibles) based on your age and income level. Discuss with a Florida-licensed health insurance agent for more information on both types of coverages, especially if you qualify for both. For more information on Medicare and Medicaid Services, you can call the Florida Agency For Health Care Administration at (877) 711-3662 or visit:

United States Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

You can also enter your email address on the official website of the United States Centers for Medicare & Medicaid Services (CMS) to signup for email updates regarding Medicare and Medicaid. You can contact CMS at (800) 633-4227 to call about Medicare options. The CMS is a federal government website managed by the U.S. Department of Health and Human Services (HHS). The United States Government runs CMS HHS websites.

Do I Need Long-Term Insurance if I Have Medicare Insurance?

Yes, individuals need long-term care if they have Medicare Insurance. This is because Medicare does not cover long-term care. People who have Medicare Insurance and need long-term care would have to get a separate plan from their insurers. Long-term care involves several services designed to meet the insured's medical or personal care needs during a given time. Individuals can purchase long-term insurance (individual or group) from private insurers and take advantage of its benefits for some treatments that are often not covered by Medicare. You should speak to a licensed insurance agent in Florida if you need long-term care.

Do I Need Medigap if I Have Medicare Insurance?

Yes, you need Medigap (also known as Medicare Supplement Plan) even if you have Medicare Insurance. Although Original Medicare (Part A and Part B) pay for most healthcare costs, there are still leftover costs that can quickly amount to high expenses, which Medigap helps cover. Medigap helps pay for out-of-pocket expenses not covered by Original Medicare plans like deductibles, copays, and coinsurance. It is important to note that you can only combine Medigap with Original Medicare plans and not Medicare Advantage plans. Generally, Medigap plans do not cover prescriptions, so you may want to consider signing up for Medicare Part D, which covers prescription drugs, or a Medicare Advantage plan that includes drug coverage. It excludes long-term care, dental care, vision, hearing aids, eyeglasses, and private nursing. Medigap plans help to cover the cost of:

  • Medicare Parts A and B coinsurance or copayments

  • Healthcare expenses during foreign travel

  • Medicare Parts A and B deductibles

  • Medicare Part B excess costs

  • The first three pints of blood

You can purchase your Medigap plan through a private insurance company, and you will have to pay a premium every month for the policy. This premium is paid directly to the insurance company. The costs of Medigap plans vary depending on the type of plan and the insurer. Medigap insurance companies decide your premiums based on your location, age, gender, lifestyle, health status, and when you buy the plan. Medigap plans only cover a person, so married couples must purchase separate policies. Always discuss your needs with a Florida-licensed health insurance agent who can give you adequate recommendations on the available options.

When Does Medicare Insurance Coverage Begin?

In Florida, when Medicare insurance coverage begins largely depends on when you sign up for the coverage in relation to your 65th birthday. For instance, if a person signs up three months before their 65th birthday, the initial enrollment period, coverage will begin on the first day of the month of their 65th birthday. Individuals who could not sign up during the initial enrollment periods can apply during the special enrollment periods. Coverage for the special enrollment period typically begins on the first day of the month the interested persons sign up.

What Happens if you Don’t Use Medicare Insurance?

Generally, individuals who do not use at least 80-85% of the total premiums of their ACA-compliant plans on health costs are entitled to premium rebates. A rebate is a partial premium reimbursement that insurers pay to the insured. An insurer can pay a rebate through a lump-sum check, premium credit, or lump-sum reimbursement to the account used to pay the premium (when the insured consumer paid premiums using a credit or debit card). In 2020, according to the Centers for Medicare & Medicaid Services (CMS), about 9.8 million insured Medicare users received about $2 billion in rebates.

Who Can Get Medicare Insurance?

A citizen or legal resident of the United States who qualifies for Medicare by age and/or health conditions can get Medicare Insurance. However, consult with a Florida-licensed health insurance professional to get more information about your eligibility status.

Who Qualifies for Medicare Insurance?

Individuals who have lived in the United States legally for a minimum of five years and are 65 years old or older qualify for Medicare Insurance. Individuals under 65 years can only qualify for Medicare if they have Social Security Disability Insurance (SSDI). However, they would have to wait 24 months before becoming eligible for Medicare. This requirement is not for anyone with Amyotrophic lateral sclerosis (ALS) or permanent kidney failure.

Who Needs Medicare Insurance?

You need Medicare Insurance if you are:

  • 65 years and over; or

  • under 65 but have a qualifying disability or condition like Lou Gehrig’s Disease (ALS) or End-Stage Renal Disease (ESRD)

Additionally, you need Medicare Insurance if you do not currently have any employer-sponsored health plans.

Who Should Get Medicare Insurance?

Individuals who are eligible and do not have good health insurance should get Medicare. Those who qualify can choose to get Original Medicare or Medicare Advantage. Getting Medicare Advantage offers extra benefits that Original Medicare would not cover, such as prescription drugs and hearing, vision, and dental services. Individuals signing up for Original Medicare should consider getting a Medigap plan to cover their out-of-pocket expenses. Insureds can talk to Florida-licensed health insurance agents to know whether they can get Medicare Insurance. They can also get more information about its benefits from health insurance agents.

What are the Benefits of Medicare Insurance?

The benefits of Medicare Insurance are listed below:

  • Medicare provides coverage for many people: Over 4.4 million Florida seniors (approximately 21% of the population) receive Medicare benefits. Younger Floridians with disabilities and critical diseases like Lou Gehrig’s Disease (ALS) or End-Stage Renal Disease (ESRD) also benefit from Medicare. Individuals who decide to get private health insurance plans would have to pay more for similar coverages that Medicare provides.

  • Medicare combines both public and private coverage: Most medical services under original Medicare are public health coverages. At the same time, Medicare Part D plans, Medicare Advantage (Part C) plans, and Medicare supplement (Medigap) plans are private. Beneficiaries can easily assess various Medicare options based on their location.

  • Inexpensive premiums: Most Medicare subscribers qualify for premium-free Part A Medicare Insurance. As of 2022, those who are not eligible for premium-free Part A hospital insurance pay either $274 or $499 per month, depending on how long they paid Medicare taxes while working. The standard monthly premium for Part B in 2022 was $170.10. Medicare Advantage (Part C) Plans also have very low monthly premiums, going for as low as $0 monthly.

  • Simple eligibility requirements: Medicare eligibility requirements are not complicated or strict. You only need to meet the following requirements to qualify:

    • Be a 65-year old U.S. citizen or legal permanent resident who has been in the U.S. for at least five years

    • Have disability benefits from Social Security or the Railroad Retirement Board

    • Be under 65 years with diseases like end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS, popularly known as Lou Gehrig’s disease)

  • A broad range of coverage: Medicare covers many services like ambulance services, inpatient hospital stays, outpatient procedures, preventive care, health screenings, and medical equipment like crutches, wheelchairs, and walkers. In addition, Medicare began paying COVID-19 diagnostics, treatments, antibody tests, and vaccines for all eligible beneficiaries during the COVID-19 pandemic of 2020 and 2021.

PROs and CONs ofWhy is Medicare Insurance in FloridaGood?

PROs of Medicare Insurance:

Medicare Insurance is good because it grants eligible enrollees access to a broad range of medical care at very affordable costs.

CONs of Medicare InsuranceWhy is Medicare Insurance Bad?

  • Medicare is expensive to run: Medicare spending in 2020 was estimated to reach $858.5 billion, with a projection of exceeding $1 trillion in 2023.

  • Hospital stays can be expensive: Hospital stays can be expensive for Medicare enrollees because it usually sums up to about hundreds of thousands of dollars. Most hospitalized insured have an issue with the high out-of-pocket Medicare expenses. Hence, although Medicare can assist in paying for inpatient care in hospitals, it can place huge pressure on enrollees who cannot afford to fund such hospital stays.

  • Medicare is expensive for taxpayers: Individuals employed in jobs covered by Social Security (regardless of your age) pay the Federal Insurance Contribution Act (FICA) taxes. A portion of these taxes is used to finance the Medicare system.

  • Limited coverage of certain important health needs: Original Medicare often does not cover prescription drugs and routine dental, vision, and hearing care. Unfortunately, most older adults who have Original Medicare require these services. This would require them to get other Medicare coverage plans or pay out of pocket for these treatments. One can resolve this by getting Medicare Supplement Insurance or signing up for a Medicare Advantage plan that covers these needs.

You should talk to a Florida-licensed insurance agent who can help you evaluate the benefits and shortcomings of Medicare and determine whether it is a good fit for you. They can also help clarify any questions that you may have about Medicare Insurance.

Is Medicare Insurance Worth it?

Yes, Medicare is worth it because everyone who qualifies pays less for health care expenses than they would pay for similar health coverage outside of the Medicare system. Typically, individuals who refuse to get Medicare coverage when they are eligible tend to face penalties and higher out-of-pocket costs.

What Happens if you Don’t Have Medicare Insurance in Florida?

If you are 65 years and older and do not have Medicare Insurance, you would have to find another way to get coverage for health care costs, which might increase with age. Also, if you want to enroll for Medicare after your initial enrollment, you may face late enrollment penalties (Part A, Part B, Part D)

Why is Medicare Insurance Important?

Medicare is important because it provides comprehensive health coverage at affordable rates for individuals who would have had to pay a lot more if they got such quality coverage outside Medicare.

What Happens When your Medicare Insurance Lapses?

Generally, Medicare Insurance lapses due to failure to pay premiums. This puts insureds at risk of losing coverage. However, insurance providers would not discontinue their coverage without proper notice and grace periods. For instance, there is usually a three-month grace period for Original Medicare, and all Part C and D plans have a two-month grace period. If you fail to pay your premiums when due, your insurer will send a notice of non-payment and inform you when your grace period ends. However, you will be at the risk of disenrollment if you fail to pay your premiums by the end of your grace period.

If your Medicare Advantage, Medigap, or Prescription Drugs disenroll you, you cannot join another plan until the next enrollment period. However, you will automatically be enrolled in Original Medicare, but you may lose drug coverage during that time. You can later enroll in Medicare Advantage again during the Annual Election Period (October 15 to December 7). If you are disenrolled due to a failure to pay your premiums, you may be required to pay your outstanding premiums before getting back on the plan you once had. Also, if you go without drug plan coverage for about three months or more, you may be liable for a Part D late enrollment penalty once you enroll for a new plan.