Medicare Eligibility in Florida

Learn about Medicare eligibility in Florida, find out how to apply for Medicare, and then what Medicare plan options you have.

The Medicare program was initially launched to help retirees aged 65 or older who lost employer-sponsored medical insurance. Over time, eligibility for Original Medicare in Florida expanded to include people younger than 65 with specific disabilities. The federal government does not guarantee a Medicare Supplement plan to beneficiaries under 65, but Florida offers some protection.

Medicare Eligibility in Florida

Eligibility for Medicare coverage 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?

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. Medicare and Medicaid cover some people at the same time. Eligibility for Medicaid is based primarily on your financial resources.

Resource Links

A licensed insurance agent can walk you through Florida’s plan options and enrollment periods.

In addition, there are other resources to guide you:

Choosing a Plan

Upon eligibility, sign up for Parts A and Part B. Medicare enrollment is automatic if you are already receiving benefits from the SSA or RRB.

Original Medicare

Medicare Part A is insurance coverage for 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 leaves gaps in health coverage. However, medicare-approved private insurance companies offer Medicare benefits that fill some gaps and reduce out-of-pocket expenses.

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.

Medicare Advantage Plan (Part C or MA)

Part C bundles Part A, B, and D under one health plan. The 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.

Ready to learn more?

Choosing between Medigap insurance plans is not an easy decision. However, educating yourself about the differences between the two types of insurance coverage, comparing different plans and policies, and talking to a licensed insurance agent will help you make the right choice.