Medicare Plans in Florida: Coverage and Costs (2026)

If you're turning 65 in Florida or helping a parent sort out Medicare, you're choosing among four parts, hundreds of plan options, and costs that reset every January. The standard Part B premium for 2026 is $202.90 a month, the Part D donut hole is gone for good, and Florida is one of the most Medicare Advantage-heavy states in the country. One thing Florida does not give you: a yearly window to switch Medigap plans without a health screening.

This guide walks through every piece of Medicare as it works for Floridians in 2026, what it costs, the plan choices that define this state, and how to get help paying for it.

In This Guide

• Key Takeaways
• Original Medicare: Parts A and B
• Medicare Advantage in Florida (Part C)
• Medicare Part D: Prescription Drugs
• Medigap in Florida (and Why There's No Birthday Rule)
• Help Paying for Medicare in Florida
• If You Have Both Medicare and Medicaid
• Medicare Enrollment Periods
• Free Medicare Help: Florida SHINE
• Frequently Asked Questions

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Florida SHINE at 1-800-963-5337.

Original Medicare: Parts A and B

Original Medicare is run directly by the federal government, and it comes in two parts.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.

The hospital deductible went up $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.

• Monthly premium: $202.90 (higher if your income is above $109,000 single or $218,000 married, under the income-related adjustment)
• Annual deductible: $283
• After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.

Medicare Advantage in Florida (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.

Florida leans into these plans more than almost anywhere else. In 2024, 60% of Florida's Medicare beneficiaries were enrolled in Medicare Advantage, one of only seven states at or above that mark. The rate swings hard by county, from about 21% in Monroe County (the Keys) to roughly 80% in Miami-Dade. Nationally, the average beneficiary can pick from about 32 Medicare Advantage plans with drug coverage for 2026, and dense Florida metros like Miami, Tampa, and Orlando usually offer more.

The Major Insurers in Florida

The big Medicare Advantage names in Florida are Humana (including its CarePlus subsidiary, which is built around the Florida market), UnitedHealthcare, Florida Blue, and Aetna. Plans, premiums, and provider networks differ a lot from one county to the next, so a plan that's strong in Broward may not even be sold in the Panhandle.

How These Plans Work

• You keep paying your Part B premium ($202.90) on top of any plan premium, though many Florida plans charge $0 extra.
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors and hospitals are in-network before you enroll.
• Every plan caps your annual out-of-pocket spending. Original Medicare has no such cap.
• Extras vary widely. Compare the dental, vision, hearing, and transportation benefits, not just the premium.

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. If your current plan leaves your area for 2026, you get a Special Enrollment Period to pick a new one.

Medicare Part D: Prescription Drugs

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone. Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with inflation. The base premium is $38.99 a month, though actual plan premiums vary, and increases are capped at 6% a year through 2029. People who qualify for Extra Help often pay much less, sometimes nothing.

Medigap in Florida (and Why There's No Birthday Rule)

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.

Florida offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.

Your one strong opening to buy is the Medigap Open Enrollment Period, the six months that begin the first day of the month you're both 65 or older and enrolled in Part B. During that window, under Section 627.6741 of Florida law, an insurer has to sell you any plan at the standard rate regardless of your health.

Why Florida Has No Birthday Rule

A handful of states, like California, give Medigap holders an annual window to switch plans without a health screening. Florida is not one of them. Once your six-month open enrollment closes, a Florida insurer can medically underwrite your application, meaning it can charge you more or turn you down based on your health history. That makes the timing of your first Medigap purchase matter more here than in birthday-rule states.

Florida does extend guaranteed-issue rights in a few specific situations: six months from a delayed Part B effective date, two months after employer group coverage ends, and a six-month window for people who qualify for Medicare before 65 because of a disability or end-stage renal disease. Outside those windows, you're subject to underwriting. Florida Medigap policies are regulated by the Florida Office of Insurance Regulation, and consumer questions go to the Florida Department of Financial Services.

Medigap or Medicare Advantage?

You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. Without a birthday rule, the catch in Florida is that switching Medigap plans later can be hard, so weigh that lock-in before you decide.

Help Paying for Medicare in Florida

If you're on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

Florida's Medicare Savings Programs pay some or all of your Medicare premiums and cost-sharing based on income and assets. They're administered by the Florida Department of Children and Families through the MyACCESS system.

QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, which adds up to meaningful savings over a year. Unlike some states that dropped their asset test, Florida still applies a resource limit: $9,950 for one person and $14,910 for a couple in 2026. Florida also counts household size broadly, so a larger family with dependents at home can qualify at higher income figures than the table shows. The income limits track the federal poverty level and update each year, so confirm the current numbers with DCF before you rule yourself in or out.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.

• Resource limits: $16,590 for an individual, $33,100 for a married couple
• If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help

Apply through Social Security at ssa.gov or call 1-800-772-1213.

If You Have Both Medicare and Medicaid

Many people who have Medicare also qualify for Medicaid, and Florida coordinates those dual eligibles through its Statewide Medicaid Managed Care (SMMC) program, run by the Agency for Health Care Administration. SMMC has two parts that matter most here: Managed Medical Assistance for medical, hospital, and behavioral-health care, and Long-Term Care for home- and community-based services and nursing-facility care.

On the Medicare side, most dual eligibles get their benefits through a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP). Florida aligns the two: a full-benefit dual eligible in a D-SNP generally gets matching Medicaid managed care from an affiliated plan, so one organization can coordinate Medicare and Medicaid coverage. Florida rolled out updated six-year SMMC contracts (the SMMC 3.0 program) starting February 1, 2025, which tightened the care-coordination requirements for dual-eligible members. If your needs are more intensive, the PACE program is another fully integrated option in some Florida counties. For more on the Medicaid side, see our guide to Medicare vs. Medicaid in Florida.

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. The key dates:

Changes you make during Annual Open Enrollment take effect the following January 1. That's when most people review their plan and switch.

Free Medicare Help: Florida SHINE

You don't have to figure this out by yourself, and you don't have to pay a broker to help. Florida's SHINE program (Serving Health Insurance Needs of Elders) gives free, unbiased Medicare counseling. It's run by the Florida Department of Elder Affairs and delivered locally by trained volunteers through Area Agencies on Aging.

A SHINE counselor can help you:

• Understand your Medicare options and what each part covers
• Compare Medicare Advantage, Part D, and Medigap plans side by side
• Apply for Medicare Savings Programs and Extra Help
• Sort out billing problems, denials, and appeals
• Work out how Medicare fits with Medicaid if you have both

Call the Elder Helpline at 1-800-963-5337 (1-800-96-ELDER) and you'll be routed to your local SHINE program.

Learn More

• Medicare vs. Medicaid in Florida
• Florida Medicaid: Programs and Coverage
• Florida Medicaid Eligibility and Income Limits
• Florida Medicaid Long-Term Care Waiver
• Caregiver Support in Florida

Find personalized help comparing your Medicare options in Florida at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.