Medicare and the Affordable Care Act

Many patients in Florida receive their insurance because of the Affordable Care Act (ACA), also known as Obamacare. One of the most important parts of the ACA is the Medicare program. While Medicare is very helpful, it can also be a confusing program, because it is divided into separate parts. In Florida, Medicare Part A and B are funded by the federal government, while Medicare Parts C and D are offered through private insurance plans. The type of services coveredcovered as well as the costs for insurance all vary, depending on the plan. In addition, Florida residents can enroll in multiple plans. While it can be confusing, Florida residents are strongly encouraged to learn more about what Medicare coverage is available to them. More information regarding Medicare is covered in the following subjects:

  • Who is eligible for Medicare coverage in Florida?
  • What does Medicare cover in Florida?
  • Enrolling in Medicare coverage

Who is eligible for Medicare coverage in Florida?

The eligibility requirements for Medicare coverage in Florida are fairly straightforward. In order to receive benefits, applicants must either be legal U.S. citizens, or have been permanent residents for at least five continuous years. Applicants must be eligible for Social Security benefits if they want access to Medicare benefits. Usually, applicants receive these benefits because of their age, but anyone receiving disability benefits for two consecutive years is also considered eligible. For the purpose of determining eligibility, applicants with Railroad Retirement benefits are considered to have Social Security benefits. Applicants with serious medical disabilities may automatically be enrolled for Medicare coverage, even if they are not actively receiving Social Security benefits.

What does Medicare cover in Florida?

Anyone applying for Medicare coverage in Florida should look over all the different plans to find which ones are best for them. Each Medicare plan has different costs, premiums, deductibles and co-pays. The most common type of Medicare coverage is Medicare Part A. Part A coverage is available to any applicant that worked a job for at least 10 years where he or she had to pay Medicare taxes. The years do not have to be consecutive, or from the same employer. Applicants that meet these qualifications do not have to pay anything for Medicare Part A coverage.

Medicare Part A primarily covers hospital insurance, which includes costs for impatient hospital care, some home health services and the cost of nursing facilities or hospice care. Medicare Part A also covers the cost of doctor-recommended services, such as physical or occupational therapy. Medicare Part B offers some of the same services as Part A, but it also covers general doctor visits and not just hospital services. For example, Medicare Part B covers the cost of physical exams, medical screenings and medical shots.

Medicare Part C is one of the more confusing plans. Medicare Part C covers the combined services of Medicare Part A and B, but it comes from a private insurance provider and not from the state. For some applicants, this may be a very important distinction. Private insurance providers have much more freedom in how their plans are customized, including the costs of the plans. Applicants that are not eligible for state discounts may benefit more from private insurance plans. In addition, private insurance plans allow for additional coverage, such as dental or vision plans. Whether or not Medicare Part C is better than Part A or B varies on a case-by-case basis, depending on the personal and financial situations of the applicant.

Medicare Part D covers the cost of prescription drugs. The payment plans for Medicare Part D work a little differently than other plans, since it uses a coverage gap instead of traditional payment options. The coverage gap is a certain amount that beneficiaries must pay out-of-pocket before the coverage from Medicare Part D begins.

Enrolling in Medicare Coverage

Enrolling in Medicare can be just as complicated as learning all of the different coverage options. There are a few different Medicare enrollment periods in Florida. The first period is known as the initial enrollment period, which begins three months before the applicant’s 65th birthday. These potential beneficiaries are notified by mail that the initial enrollment period is coming up. The notice also includes some general information regarding what plans are available to each applicant. The initial enrollment period ends four months after the applicant turns 65. The next time to enroll for Medicare is annual enrollment period. The annual enrollment period starts the same time every year, January 1st, and goes until the end of March. Applicants may be required to pay a small late fee during this time. When applying for Medicare, applicants may be eligible for a special enrollment period, which allows them to apply without any late fees, even if it outside the annual or initial enrollment period. Applicants may either apply for Medicare online, or they can apply by contacting the nearest Florida Social Security office.