Center for a Secure Retirement
What To Look For in a Medicare Advantage Plan in Florida

What To Look For in a Medicare Advantage Plan in Florida

If you've retired in Florida, it's important to figure out how to cover your health care expenses, as Medicare will not pay for everything. One way to stay protected is through Medicare Advantage coverage — enrolling in a Medicare Advantage plan in Florida presents many more options to navigate compared with other states.

Here's what to know about these plans and how to find the right fit for you.

What Is Medicare Advantage?

Although Traditional Medicare covers most health care expenses, enrollees may still be responsible for sizable out-of-pocket bills. For example, Medicare Part B coverage pays 80% of doctor services like surgery, but that additional 20% can add up to thousands of dollars.

To help avoid large surprise bills, you can opt out of Medicare and sign up for private insurance such as Medicare Advantage. Under these plans, you leave Medicare and are fully covered by the private insurance company. They receive money from the government and in exchange agree to create a plan that offers similar coverage to Medicare.

Often, these plans provide even better coverage. Not only can they reduce your out-of-pocket expenses, but joining a Medicare Care Advantage plan in Florida could also mean gaining access to additional benefits like prescription drug coverage, dental, vision and even gym memberships. These are perks you wouldn't receive from regular Medicare.

What Should You Look for in a Medicare Advantage Plan?

Insurance companies have a good amount of flexibility to design their Medicare Advantage plans, which increases the number of possible options. However, not all of them will be a good fit for your needs. While the right match depends on your personal goals and situation, here are some factors to consider:

  • Provider network: A Medicare Advantage plan's provider network sets the rules for which doctors and hospitals you can go to. In an HMO, you can only see in-network providers unless it's an emergency, whereas a private fee-for-service (PFFS) plan lets you see any provider that accepts the plan terms without a referral. Some PPOs also include the ability to go outside your network, although doing so may come with additional out-of-pocket costs.
  • Premium cost: Many Medicare Advantage plans charge a monthly premium in exchange for your membership — but not all do. It is possible to find $0 premium plans. Generally, the more you pay for a plan, the more coverage and benefits you'll receive.
  • Out-of-pocket charges: Besides a premium, you may also owe money out of pocket for deductibles, co-payments and coinsurance when you need health care. Look for a plan that keeps these fees low and has a reasonable out-of-pocket maximum for the year.
  • Extra benefits beyond health care: Some Medicare Advantage plans include prescription drug coverage, waiving the need to sign up for a separate Part D plan. Plans' coverage can also include extra benefits like dental, vision, gym memberships and basic long-term care coverage. Although you should prioritize a plan that has health care coverage, these benefits are a nice bonus.
  • Customer service: What kind of support will your Medicare Advantage insurance company offer? Do they simply provide a phone line, or do they have trained health insurance agents in Florida who can meet you in person? Having agents available makes it easier to sign up and ensures you have a contact you can turn to for help managing your policy.
  • Company reputation and history in Florida: Not all insurance companies are equal in quality. Check reviews from past local customers using services such as the Better Business Bureau and Consumer Affairs. It's also helpful to find an established company that's operated in Florida for many years, because it shows their commitment to the market and indicates they're less likely to leave in the future.

How Does the Florida Market Compare With Other States?

As the most popular state in the country for retirees, Florida has a large and thriving Medicare Advantage market. Since there are more potential customers, insurance companies are better motivated to create plans for this area.

There are more than 4.6 million Florida residents on Medicare. Of this group, 43% signed up for a Medicare Advantage plan in 2018, according to the Kaiser Family Foundation. This is significantly higher than the national average for retirees, where 34% have Medicare Advantage coverage.

In 2021, there were 527 different Medicare Advantage plans available in Florida, according to data from CMS. However, not every plan is available in every part of the state — your options will depend on your county. Some areas have close to 100 plans available, while others have fewer than 20. Still, regardless of where you live in Florida, you'll generally have more options compared with residents in less populated states.

How Can You Compare Plans?

Medicare.gov offers an online tool to help compare plans in your area. Enter your zip code to see plans in your area along with their monthly premium, copayments, annual out-of-pocket limits and any extra benefits for prescriptions, vision and dental.

Medicare also rates each Medicare Advantage plan in Florida using a five-star system, with one being the worst and five being the best. This can give you a quick metric for comparison based on the quality of the plan coverage and its customer service. If you take any prescription drugs, you can enter them into this website and Medicare will also estimate roughly how much you would owe per year with each plan, so that you can easily compare with your retirement budget.

Once you've found a few plans that show potential, pull up each insurance company's website for more specific details about coverage. It could help to schedule a meeting with the insurance companies you like best so you can learn more. When you're ready to sign up, you can apply through the company website, by phone or through a paper application.

How Can You Find the Best Plan for You?

Medicare Advantage is based on customer choice, and living in Florida gives you plenty of options to choose from. Here are a few strategies that can help you find the best match.

Start Your Research Early

You can only sign up for a Medicare Advantage plan in Florida at specific points, like when you first join Medicare at age 65. An open enrollment period also begins at the end of each year — for 2022 plans, you can sign up from October 15, 2021, to December 7, 2021. Research plans ahead of time to avoid rushing your decision; details go out even before the enrollment period starts.

Keep an Eye on the Provider Network

The monthly premium and extra benefits are important, but pay close attention to the provider network, especially if you have a favorite doctor you want to keep seeing.

Coordinate With Other Benefits

You might not need all the benefits from a Medicare Advantage plan, such as if you already have dental or prescription drug coverage. In cases like these, you could possibly save money by finding a plan without these features.

Reach Out for Help

The Florida government offers support through a service called SHINE, which helps answer questions about joining Medicare Advantage. You could also schedule a meeting with a health insurance agent.

Keep Shopping Around

Each year, the Florida Medicare Advantage market reveals new and different plans. Even if you find something you like this year, it may be worth checking to see if you can get an upgrade next open enrollment.

By following these strategies, Floridians can make the most of the benefits the Medicare Advantage program offers.

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