Medicare in Florida
Medicare insurance plans in Florida help meet the healthcare needs of individuals 65 or older or younger individuals with a disability or chronic illness. It's how the federal government provides healthcare administration for eligible individuals. This guide will help you navigate and understand Medicare plans in Florida.
Alignment Health Plan is here to help answer any Medicare questions you may have.
Original Medicare offers two parts:
- Medicare Part A: Covers hospital stays and visits at no cost to eligible Medicare beneficiaries.
- Medicare Part B: Covers doctor visits and other medical services. Part B requires a monthly premium deducted from Social Security payments or paid by personal check.
Original Medicare does not cover additional services like vision, dental, hearing, or prescription drugs. To account for the gaps in services, Medicare beneficiaries can enroll in Medicare Supplement insurance plans (Medigap) or Medicare Advantage plans.
Compare plans, enroll, or join us for a virtual or in-person seminar for more information. We are here to help you answer any questions you have about Medicare Advantage plans. We’ll even assist you with applying on the spot. We are dedicated to helping you find the best plan for you and getting the most out of your benefits.
Medicare Advantage Plans in Florida
Medicare Advantage plans are considered Part C plans. The government contracts private insurance companies to provide health insurance to Medicare beneficiaries. Part C plans combine Part A and Part B services while offering more health services.
Medicare Advantage Plans typically include additional coverage for:
- Prescription drug coverage (Part D)
Depending on eligibility and plan requirements, you may be required to pay a monthly premium to the insurance company.
A variety of Medicare Advantage Plans are available. Three types of Medicare Advantage Plans available in Florida are Health Maintenance Organization (HMO), Point of Service (POS), and Special Needs Plans (SNP).
We'll give a brief overview of each plan to help you determine your next steps.
Medicare Advantage HMO Plans
Health Maintenance Organization (HMO) plans give you access to doctors, specialists, hospitals, and other health providers within their network.
You'll select an in-network primary care provider (PCP) for general healthcare needs like wellness visits, checkups, and sick visits. If you need to see a specialist or go to the hospital, your PCP has to give you a referral. This ensures the medical service is covered by insurance.
You may visit out-of-network medical providers if it is for:
- Emergency care
- Out-of-area urgent care
- Temporary out-of-area dialysis
Certain HMO Point-of-Service (HMO-POS) plans may allow you to receive medical services from out-of-network providers for a higher coinsurance or copayment. Following plan requirements like receiving referrals or getting prior approval helps ensure your services are covered.
Typically, HMO plans will include Part D coverage for prescription drugs. Ask the insurance provider about your specific plan to be sure.
Medicare does not allow you to join a Medicare drug plan if enrolled in an HMO Medicare Advantage plan.
Point of Service
HMO Point-of-service (HMO POS) plans allow you to receive medical care outside the plan network. The plan may require you to pay a higher cost for out-of-network services. However, emergency visits are covered by insurance.
Medicare Advantage SNP
Special Needs Plans (SNPs) are intended for Medicare beneficiaries with special needs. To qualify, you must receive disability benefits or have a qualifying condition.
There are two types of SNP plans:
- Institutional SNP (I-SNP): For individuals needing long-term care, a nursing facility, intermediate care for those with intellectual disabilities, or an inpatient psychiatric facility.
- Dual eligibility (D-SNP): For individuals who qualify for Medicare and Medicaid.
- Chronic SNP (C-SNP): For individuals with chronic illnesses like end-stage renal disease (ESRD).
SNPs are offered as an HMO or a PPO. Depending on the specific plan, out-of-network services may not be covered. Or, if they are covered, they may cost more than in-network services.
SNPs in Florida
In Florida, the two SNPs provided are:
- Heart & Diabetes (HMO C-SNP) 003: individuals with chronic heart diseases or diabetes may qualify for this plan. It is tailored to be cost-effective for individuals who need unique care.
- The ONE (HMO D-SNP) 004: this plan is for individuals who qualify for both Medicare and Medicaid and have chronic conditions.
All SNPs include Part D drug coverage.
SNP plans typically offer additional benefits like a grocery allowance and unlimited one-way trips to approved locations for qualified medicare beneficiaries. Find out more about Special Needs Plans at medicare.gov or view Alignment Health Plan SNPs in Florida.
How do Medicare Advantage Plans Work?
Medicare-approved private insurance companies provide Medicare Advantage plans. The government contracts these companies to assist in healthcare administration.
Medicare pays a certain amount to companies offering Medicare Advantage Plans for your health services. These companies still have to remain compliant with Medicare rules.
Out-of-pocket costs vary by each Medicare Advantage plan.
Medicare Advantage plans bundle Medicare Part A (hospital coverage) and Part B (medical coverage) and typically include Part D (drug coverage). Medicare Advantage plans also offer additional benefits to help you stay healthy.
As a Medicare Advantage plan provider, Alignment Health Plan is committed to providing you with the care and resources you need most at an affordable rate. We’re here to help you navigate the paperwork and plan details so you understand your benefits and how to use them.
How Much Does a Medicare Advantage Plan Cost in Florida?
Monthly premiums, copayments, coinsurance, and deductibles vary depending on your chosen plan. Whether you seek care from providers in-network or out-of-network also affects your costs. Also, you will still have a set premium for Medicare Part B. However, some plans offer reductions to offset Part B premium payments.
Each plan has a specified out-of-pocket limit as well. After you've reached the out-of-pocket limit, insurance will cover 100% of the cost of eligible health services.
The Summary of Benefits and Coverage page breaks down cost details and benefits for a specific plan selection.
Learn more about the Medicare plans in your area and the benefits you qualify for by completing a brief Alignment Health Plan questionnaire.
Who Can Join a Medicare Advantage Plan
To join a Medicare Advantage plan, all of the following have to apply:
- You are enrolled in Medicare Part A and Part B
- You live in the plan's service area you want to join
- You're a US citizen or lawful permanent resident
Why Choose a Medicare Advantage Plan from Alignment?
At Alignment Health Plan, we put our patients at the center of everything we do. By combining technology and compassionate care, we offer extensive and quality care over the phone, online, in the doctor's office, and in senior homes.
Medicare Advantage Plans in Florida
We've created HMO C-SNP and HMO D-SNP healthcare plans to meet the needs of eligible Medicare beneficiaries in Florida. Our goal is to connect you with the right healthcare services when you need them.
Our SNP plans are designed to help those with chronic conditions and dual eligibility find quality care in their area.
Find out what plans are available in your area by visiting our Benefits Highlights page and completing a short questionnaire.