Medicare Eligibility in Florida
Eligibility for Medicare in Florida is the same as in every other state. If you are a U.S. citizen or a permanent legal resident for five years or more, you only need to satisfy one of these additional requirements:
- You are 65 years of age or older.
- You are under 65 with a qualifying disability and received Social Security Administration (SSA) or Railroad Retirement Board (RRB) disability benefits for 24 months.
- You have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) at any age.
How Do I Apply for Medicare in Florida?
There are three ways you can apply for Medicare in Florida:
1. Sign up online for Medicare
2. By phone, Call 1-800-772-1213. TTY users can call 1-800-325-0778.
3. In person with the Social Security Administration.
Apply for Medicare through Social Security within the three months before your 65th birthday. Although you have until the end of the three months following the month of your birthday, Part B may start late if you delay. Eligibility for Medicaid is based primarily on your financial resources.
Choosing a Plan
Medicare Part A covers inpatient care in a hospital or skilled nursing facility.
Medicare Part B helps with the cost of doctor visits, outpatient care, durable medical equipment, and mental health services.
Original Medicare Part A and B leave gaps in health coverage. However, medicare-approved private insurance companies offer additional plans to fill gaps and reduce out-of-pocket expenses.
Medicare Advantage Plan (Part C or MA)
Medicare Advantage (Part C) bundles Part A, B, and D under one health plan. HMO and PPO plans are the most common types of MA insurance plans, and these plans partner with a network of providers to reduce costs. Some MA plans do not charge a monthly premium, but you maintain responsibility for your Part B premium. In addition, low-income Medicare beneficiaries may qualify for a Special Needs Plan (SNP).
If you miss signing up during your Initial Enrollment Period, you will have another opportunity during the Open Enrollment Period in the fall.
Medigap (Medicare Supplement)
There are ten standardized Medigap policies on the market with varying levels of coverage for deductibles, coinsurance, and copays.
Non-participating health care providers can bill you up to 15% over the amount approved by Medicare for covered services. These fees are known as excess charges, prohibited in some states but not in Florida. Two plans, F and G, cover Part B excess charges.
Florida grants guaranteed issue rights, also known as Medigap protections, for Medigap applicants younger than age 65 who have a disability or ESRD. Florida Medicare insurers must offer applicants with guaranteed issue rights at least one of the Medigap policies, and the policy must cover preexisting conditions.
Prescription Drug Plans (Medicare Part D)
Enrollment in the Part D plan (prescription drug coverage) is optional. Still, a late enrollment penalty may be imposed if you don’t sign up during your Initial Enrollment Period and then decide to enroll later. Low-income Medicare beneficiaries who need help paying for prescription drugs can apply for the Extra Help program.
Ready to Learn More?
Choosing the right Medicare Plan is not a decision that should be taken lightly. With Policy Guide’s assistance, you will have access to the knowledge and expertise of professional agents who can help you compare different health plans, prices, and policies to ensure that you make an informed decision. Let us guide you through this process, so that your chosen plan best suits your needs.
A licensed insurance agent can walk you through Florida’s plan options and enrollment periods.
In addition, there are other resources to guide you:
- Florida State Health Insurance Assistance Program (SHIP): Ask a representative about “Serving Health Insurance Needs for Elders” (SHINE).
- U.S. Department of Health & Human Services: Find tools to determine Medicare eligibility and premiums.
- Medicare: Learn more about guaranteed issue rights.
- Social Security: Apply for Medicare online, or contact your local Social Security office.