Medicare in Florida: Key takeways
- More than 20 percent of Floridians are enrolled in Medicare.
- Florida adopted rule to ensure at least some access to Medigap for enrollees under age 65.
- In 2016, Original Medicare spent an average of $11,041 per Florida beneficiary.
- In 2018, about 1.5 million Florida Medicare beneficiaries were enrolled in stand-alone Part D prescription drug plans.
Medicare enrollment in Florida
As of November 2018, there were 4,415,447 Florida residents enrolled in Medicare. That’s more than 20 percent of the state’s total population, which is higher than the national average of a little more than 18 percent of the total population enrolled in Medicare.
Florida has the highest percentage of 65+ residents in the country, so not only does the state have a higher-than-average percentage of its population enrolled in Medicare, it also has a higher-than-average percentage of Medicare beneficiaries who are eligible due to age, rather than disability: 87 percent of Medicare beneficiaries in Florida are eligible due to age (ie, being at least 65), and the other 13 percent are eligible due to a disability. Nationwide, 84 percent of Medicare beneficiaries are eligible due to age, while 16 percent are eligible due to disability.
Medigap in Florida
Because Original Medicare has deductibles and coinsurance and doesn’t cap out-of-pocket costs, Medigap plans are available to serve as supplemental coverage, picking up some or all of the costs that beneficiaries would otherwise have to pay.
Medigap plans are standardized under federal rules, and coverage is guaranteed-issue during a six-month window that starts when a person is 65 and enrolled in Original Medicare. But federal rules do not guarantee access to a Medigap plan for people who are under 65 and eligible for Medicare as a result of a disability.
But Florida is one of 30 states that have enacted rules to ensure at least some access to Medigap plans for enrollees under the age of 65. Since 2009, Florida residents under age 65 have had a six-month window (starting when they’re enrolled in Medicare Part B) during which coverage under a Medigap plan is guaranteed-issue. Monthly premiums are higher for enrollees under age 65, but they have another enrollment window when they turn 65, so they can then switch to lower-cost Medigap coverage at that point (coverage is more expensive for the under-65 population because they’re all on Medicare as a result of a disability, which generally results in higher health care spending).
The Florida Office of Insurance Regulation maintains a website that residents can use to compare premiums for Medigap plans available in each county in the state.
Medicare spending per recipient
In 2016, Original Medicare spent an average of $11,041 per beneficiary in Florida. That’s based on standardized data that eliminated differences in payment rates from one area to another, but it did not include spending for Medicare Advantage enrollees).
Nationwide in 2016, average per-beneficiary Medicare spending stood at $9,533, so Medicare spending in Florida was 16 percent higher than the national average. Florida was one of just three states (the others are Louisiana and Texas) where Medicare’s average per-enrollee costs exceeded $11,000 in 2016.
Medicare Advantage in Florida
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). Beneficiaries can decide whether they want their coverage via Original Medicare or Medicare Advantage, and there are pros and cons to both options.
Some Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.
42 percent of Florida Medicare beneficiaries had their coverage through private Medicare Advantage plans in 2017. Mst of the remaining 58 percent of the state’s Medicare beneficiaries had coverage under Original Medicare, but there are also some Florida Medicare beneficiaries with Medicare cost plan coverage.
Nationwide, an average of 33 percent of Medicare beneficiaries have Medicare Advantage coverage. Minnesota is the only state where more than half (56 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. On the other end of the spectrum, Alaska has just one percent of its Medicare beneficiaries enrolled in private Medicare Advantage plans.
Depending on which county they live in, Florida residents can choose from as many as 68 different Medicare Advantage plans in 2019, although some counties only have eight or nine different options. As of 2019, there’s a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.
Stand-alone Medicare Prescription Drug plans
Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan.
About 1.5 million Florida Medicare beneficiaries were enrolled in stand-alone Part D prescription drug plans as of November 2018. That’s about 33 percent of the state’s total Medicare beneficiaries, as opposed to about 43 percent of all Medicare beneficiaries nationwide enrolled in stand-alone Part D plans. But another 1.9 million Florida Medicare beneficiares get Part D coverage integrated with their Medicare Advantage plans.
For 2019 coverage, there are 27 stand-alone Part D plans available in Florida, with premiums ranging from $13 to $156 per month.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. By the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries nationwide, including those who have Part D coverage as part of their Medicare Advantage plan.
For those under 65 in Florida
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.