Florida Medicare: The Ultimate Guide

Not only is Florida the fourth most populated state with well over 20 million residents, but it also has the second largest Medicare population, right behind California.

Since there are well over four million Medicare beneficiaries in the state of Florida, there are ample Medicare-related resources available to Florida residents. Let’s discuss your Florida Medicare options.

A Guide to Florida Medicare includes:

• What are the Florida Medicare Eligibility Requirements?
• What is the cost of Medicare in Florida?
• Medicare Savings Options in Florida
• About Florida Medicare Plans
• Medicare Advantage Plans Florida
• Medicare Supplement Plans Florida (Medigap)
• Can I have Medicare and Medicaid in Florida?
• Additional Resources
• Florida Senior Fitness Programs
• Finding Medical Providers in Florida
• How do I apply for Medicare in Florida?
• Florida Medicare Help

What are the Florida Medicare eligibility requirements?

Most people become eligible for Florida Medicare by aging-in to the program. You can apply starting from three months before your 65th birthday. Some people, however, may meet other Florida Medicare eligibility requirements. You can also get Medicare benefits if you are diagnosed with ALS (Lou Gehrig’s Disease) or ESRD (End-Stage Renal Disease).

What is the cost of Medicare in Florida?

Your Medicare costs will differ based on your individual needs and the plan you choose. If you stick to Original Medicare (Parts A and B only), the costs are relatively standard.

For Part A, 2020 costs are as follows:

• $0 premium if you worked for at least 39 quarters
• $0 premium if you are eligible for Railroad Retirement or Social Security retirement benefits
• $252/month if you worked for 30 to 39 quarters
• $458/month if you did not work or pay Medicare taxes at all

You may face up to a 10% increase on your premium if you do not enroll when you are first eligible.

The standard Part B premium for 2020 is $144.60 per month, but you may owe more if you are still earning a high income. You may owe less if you have very low income and qualify for savings programs.

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Medicare Savings Options in Florida

You may qualify for Florida Medicare savings and not even know it! There are two main programs you may want to apply for: Medicare Savings Programs, and Extra Help (LIS). 

LIS (Low-Income Subsidies) for Prescriptions

Extra Help is the nickname for the LIS (Low-Income Subsidy) program. This program helps eligible Medicare beneficiaries afford their drug costs. The SSA says that through the program, most people save about $5,000 per year.

To be eligible for the LIS program in 2019, you must have:

• Income below $1,040.83/month for individuals or below $1,409.17/month for married couples
• No savings, investments, or real estate valuing more than $14,100 for an individual or $28,150 for a married couple.
• Some form of prescription drug coverage (like Medicare Part D or a Medicare Advantage plan with prescription benefits)
• Proof of American citizenship

To apply for LIS, complete one of the following steps.

1. Visit socialsecurity.gov/extrahelp
2. Print and mail in form SSA-1020
3. Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778)
4. Visit your local Social Security Office

When you complete your application, you may need legal documents such as proof of income, proof of citizenship, and proof of any insurance you have.

Your insurance agent can also help you apply.

Click here for more information on the Extra Help program for Medicare.

Medicare Savings Programs

There are four main Medicare Savings Programs. Each one requires different  qualifications and each one provides a different type of coverage. When you apply, you’ll apply for all four. You’ll be automatically placed into the program that best matches your qualifications.

1. QMB (Qualified Medicare Beneficiary) Program: Pays for Part A and B premiums, deductibles, copayments, and coinsurance. Single people must earn (2019) no more than $1,032/month and have less than $7,560 in resources and assets. Married people must earn less than $1,392/month and have less than $11,340 in resources and assets.
2. SLMB (Specified Low-Income Medicare Beneficiary) Program: Covers Part B premiums. Single people must earn (2019) less than $1,234/month and have less than $7560 in resources and assets. Married people must earn less than $1,666/month and have less than $11,340 in resources and assets.
3. QI (Qualifying Individual) Program: Pays for Part B premiums. Must reapply each year. Single people must earn (2019) less than $1,386/month and have less than $7,560 in resources and assets. Married people must earn less than $1,872/month and have less than $11,340 in resources and assets.
4. QDWI (Qualified Disabled and Working Individuals Program): Pays the Part A premium. Must be working, disabled, under 65, and have lost your premium-free Part A due to returning to work. You cannot be receiving state medical assistance or meet Florida Medicaid requirements. Single people cannot earn more than (2019) $4,132/month or have more than $4,000 in resources and assets. Married people cannot earn more than $5,572/month or have more than $6,000 in resources and assets.

To apply for Florida Medical assistance, click here. You should receive your approval or denial notice within 45 days.

Click here to read more about Medicare Savings Programs.

About Florida Medicare Plans

Every Florida resident will begin with Original Medicare. Original Medicare includes Part A, hospital coverage, and Part B, medical coverage. Once you have Original Medicare, you’ll need prescription drug coverage. You can purchase a Part D, or prescription drug plan, at any time (but you’ll be charged more if you wait too long).

If you’re looking for more coverage, Medicare Advantage plans in Florida (otherwise known as Part C) are great options. Medicare Advantage plans in Florida include Part A, Part B, and some include Part D. Some plans also include dental, vision, hearing, and even fitness benefits. If Medicare Advantage is more than you need, you may want to consider Florida Medicare Supplement plans (also called Medigap – more info below).

Medicare Advantage Plans Florida

There are four main types of Medicare Advantage plans in Florida: HMO, PPO, PFFS, and SNP. SNP plans are for those with specific special needs, and PFFS (Private Fee-for-Service) plans don’t require any specific doctors, but not many doctors will accept this type of plan. Most people will select either an HMO or PPO Florida Medicare Advantage plan.

PPO (Preferred Provider Organization) plans have specific provider networks designed to help save you money (but you’ll have to use a doctor within the network). HMO (Health Maintenance Organization) plans require that you select one doctor to use for all of your primary needs. With an HMO plan, to receive care from another doctor, you’ll need a referral from your primary physician.

Medicare Supplement Plans Florida (Medigap)

Florida Medicare Supplement plans (Medigap) are sorted by letter: A, B, D, G, K, L, M, and N.

There were two others before 2020 – F and C – but they were discontinued. Some people might still have Plan F or Plan C, but no new members can enroll.

Florida Medicare Supplement plans are additions to your Original Medicare (Part A and Part B). They provide coverage for your deductible, copayments, and coinsurance. Some Medigap plans can also provide prescription drug coverage, but it’s not as common as it is with Medicare Advantage plans.  

Click here to start researching available Medicare Supplement plans in Florida.

Can I have Medicare and Medicaid in Florida?

Yes! If you are eligible for both Medicaid and Medicare in Florida, you can have both. In most cases, your Medicare coverage will provide coverage for services before your Medicaid coverage kicks in. If you do have both Medicare and Medicaid, you can qualify for a DSNP (Dual-Eligible Special Needs Plan).

Additional Resources

Since Florida has the second highest population of Medicare-eligible people, it’s no wonder there are so many resources available for seniors and Medicare beneficiaries! Take a look and see if any of the below resources can be of use to you.

Florida Health Finder

Use the Florida Health Finder tool to find a provider in your area. You can search for anything from a hospital to a homemaker help service.

Florida Department of Veterans Affairs

You can find your local VA office here. Not only are there several Veterans Affairs offices throughout Florida, but the VA also has seven veteran nursing homes. To qualify to live in a Florida VA nursing home, you must be a Florida resident who was honorably discharged from service. You also must have a VA doctor sign off that you require skilled nursing care.

Find a Ride Florida

If you need help getting to your doctor’s appointment or if you have another transportation need, Find A Ride Florida can help. You’ll just enter where you are and where you need to go, and check the boxes to indicate whether you are over 60, whether you need help getting in the vehicle, and whether or not you need a wheelchair-accessible vehicle. The site will provide you with ride services that can get the job done for you.

Flu Shot Locator

This website lists all the places you can get a flu shot in Florida. Don’t forget that Medicare allows for one free wellness visit every year, and most plans include preventative services like flu shots! Take advantage of these services.

Florida Discount Drug Card

All Floridians are eligible for the Florida Discount Drug card. Just apply online! You can also use their website to search for participating pharmacies and check drug pricing.

Hospice Care Finder

Use the Hospice search tool to find Florida hospice care in your city.

Florida Senior Fitness Programs

As you age, it becomes increasingly important to stay active. Your activity level can be as simple as walking around the mall or running marathons. Talk to your doctor to find out what types of physical activities may be best for you and your health.

Some Medicare Advantage plans include a fitness program as part of the benefits package. If you have a plan that includes it, you may not have to pay any additional fees to join a gym or attend fitness classes.

What is the SilverSneakers® program for seniors in Florida?

SilverSneakers® is just one of many fitness programs designed with seniors in mind. SilverSneakers® provides its members with access to local gyms & exercise facilities and even coordinates fitness classes just for seniors. You can use programs like SilverSneakers® to make new friends, get out of the house, and stay active – and it may be included in Medicare Advantage plans available near you!

Is Silver & Fit® the same as SilverSneakers®?

Silver & Fit® is not the same as SilverSneakers®. It’s a very similar company that offers fitness programs for seniors and is included as a benefit in some Medicare Advantage plans. Uniquely, the Silver & Fit® program includes a home fitness option where you can order a home fitness kit to complete your workouts at home!

What is Renew Active™?

Renew Active™ is another senior fitness program, similar to Silver & Fit® and SilverSneakers®. The program is owned by UnitedHealthcare so it will only be found in UHC or AARP health plans.

Can I get Go4Life® in Florida?

Unlike Renew Active™, Silver & Fit®, and SilverSneakers®, Go4Life® is not necessarily a Medicare Advantage plan benefit. Go4Life® is a fitness program run by the National Institute on Aging. They encourage physical activity in the form of endurance, strength, balance, and flexibility exercises. Try these exercises from Go4Life!

Finding Medical Providers in Florida

You can find Florida Medicare providers who accept Medicare by visiting https://www.medicare.gov/physiciancompare/.

In the top left-hand corner, you’ll see the Medicare.gov logo and then a dropdown meun that says “Physician Compare.” Click on that, and you can choose from Home Health, Hospital, Nursing Home, Dialysis Facility, Inpatient Rehabilitation Facility, Long-Term Care Hospital, Suppliers, and Hospice as well as physicians.

There are 221 hospitals accepting Medicare in Florida. We’ve selected some of the top three rated* hospitals (according to Medicare.gov) in major Florida cities for your reference.

Jacksonville

• Mayo Clinic (4500 San Pablo Rd, Jacksonville, FL 32224) – 4 stars
• Baptist Medical Center – Beaches (1350 13th Ave. S, Jacksonville Beach, FL 32250) – 4 stars
• Baptist Medical Center Jacksonville (800 Prudential Dr., Jacksonville, FL 32207) – 4 stars

Miami

• Doctors Hospital (5000 University Dr., Coral Gables, FL 33146) – 4 stars
• Memorial Hospital Miramar (1901 SW 172nd Ave, Miramar, FL 33029) – 4 stars
• Palmetto General Hospital (2001 W 68th St., Hialeah, FL 33016) – 3 stars

Tampa

• St Josephs Hospital (3001 W Martin Luther King Jr Blvd, Tampa, FL 33677) – 5 stars
• Adventhealth Carrollwood (7171 N Dale Marby Hwy, Tampa, FL 33614) – 4 stars
• Memorial Hospital of Tampa (2901 W Swann Ave., Tampa, FL) – 4 stars

Orlando

• Orlando Health Orlando Regional Medical Center (52 W Underwood St., Orlando, FL 32806) – 4 stars
• Adventhealth Orlando (601 E Rollins St., Orlando, FL 32803) – 3 stars
• Health Central (10000 W Colonial Dr., Ocoee, FL 34761) – 2 stars

St. Petersburg

• Palms of Pasadena Hospital (1501 Pasadena Ave. S, Saint Petersburg, FL 33707) – 3 stars
• St. Anthony’s Hospital (1200 Seventh Ave N, Saint Petersburg, FL 33705) – 3 stars
• St Petersburg General Hospital (6500 38th Ave N., Saint Petersburg, FL 33710) – 2 stars

Tallahassee

• Tallahassee Memorial Hospital (1300 Miccosukee Rd., Tallahassee, FL 32308) – 3 stars
• Capital Regional Medical Center (2626 Capital Medical Blvd., Tallahassee, FL 32308) – 2 stars

Fort Lauderdale

• Memorial Hospital Miramar (1901 SW 172nd Ave., Miramar, FL 33029) – 4 stars
• Holy Cross Hospital (4725 N Federal Hwy, Fort Lauderdale, FL 33308) – 4 stars
• Memorial Regional Hospital (3501 Johnson St., Hollywood, FL 33021) – 3 stars

*We found these hospitals and their ratings in January of 2020. Ratings can always change.

How do I apply for Medicare in Florida?

You can apply for Original Medicare only by calling or visiting your local Social Security office or by visiting www.SocialSecurity.gov. If you’re interested in enrolling in Medicare Advantage plans in Florida or Florida Medicare Supplement plans, you should meet with a licensed agent who can sell plans from multiple carriers in your area. That’s where Medicare Plan Finder comes in. We have agents who sell from every major carrier, so there is no bias when they help you find the plan that truly works for you and your needs.

Florida Medicare Help

If you’re enrolling in Florida Medicare for the first time or if you have questions about your existing policy, we can help. We can help you find Medicare savings in Florida by figuring out what you are eligible for and then walking you through all of your options. If we find that you are already receiving the best possible coverage, we’ll let you know! We have your best interest at heart.

We have agents all throughout the state of Florida itching to help you. To set up your free, no-obligation appointment, request a call here or call us at 844-431-1832.