Medicare Plans in Florida: Coverage and Costs (2026)

Medicare in Florida has two defining features: more than half of its Medicare beneficiaries are in Medicare Advantage, not Original Medicare, and Florida has no annual Medigap birthday rule. That second point matters, because your one protected window to buy a Medigap plan without a health screening is the six months after you turn 65 and enroll in Part B. The standard Part B premium for 2026 is $202.90 a month, and the Part D donut hole is gone for good.1,2,3,4

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
• What Do Parts A and B Cost in Florida?
• Medicare Advantage Plans in Florida (Part C)
• How Do Medicare Part D Drug Plans Work in Florida?
• 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
• Key Florida Medicare Contacts
• 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 or Florida SHINE's Elder Helpline at 1-800-963-5337.1,5

What Do Parts A and B Cost in Florida?

Original Medicare is run directly by the federal government, and it comes in two parts. The costs and mechanics are identical in Florida and every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.1

The hospital deductible rose $60 from 2025. A benefit period starts the day you're admitted and ends once you've gone 60 days in a row without inpatient hospital care or skilled care in a SNF. Get readmitted after that, and the deductible applies again.1

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. Part B doesn't cover routine dental, vision, or hearing; most Medicare Advantage plans do.6,7

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)1
• 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 qualifying for a Special Enrollment Period or a Medicare Savings Program 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.8

Medicare Advantage Plans 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, except hospice, which Original Medicare keeps covering, and most bundle in Part D drug coverage along with extras like dental, vision, and hearing.7

In Florida, more than half of Medicare beneficiaries have already chosen one. As of March 2026, CMS reported 5,311,804 people with Medicare in the state: 3,031,070 enrolled in Medicare Advantage and other health plans, and 2,280,734 in Original Medicare.3 That balance swings hard by county. In Miami-Dade, 392,607 of 522,295 beneficiaries were enrolled in Medicare Advantage and other health plans; in Monroe County (the Keys), only 4,532 of 19,161 were.3

How Many Plans Can You Choose From?

A lot of them. CMS lists 611 Medicare Advantage plans available in Florida for 2026 and reports that 100% of people with Medicare in Florida have access to a Medicare Advantage plan.3 Counting only the plans open to general enrollment, KFF's analysis of the CMS landscape files finds 314 in Florida and reports that the average Florida beneficiary can choose from 47 plans offered by an average of 9 insurers.3 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 CMS says some plans may help pay all or part of it. CMS estimates the average Medicare Advantage premium at about $14 a month in 2026, and many Florida plans charge $0 extra.7,1
• Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors and hospitals are in-network before you enroll. Emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered whether you get them in or out of the plan's network.7
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.7
• Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap. CMS puts it this way: there is no yearly limit on what you pay out of pocket unless you have supplemental coverage like Medigap, Medicaid, employer, retiree, or union coverage. With none of those, your exposure is open-ended.7

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.

How Do Medicare Part D Drug Plans Work in Florida?

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.2 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).9
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.2

That $2,100 cap is the number that matters most in Part D. The national base plan premium is $38.99 a month for 2026, though actual plan premiums vary.1 Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year rather than paying in full at the pharmacy.2 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 with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.10,7

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, 2020.11 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.10,1

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.4

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.4 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.

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.4 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?

That's a fork in the road, but the choice isn't permanent. If this is your first Medicare Advantage plan and it doesn't suit you, federal law gives you a trial right to buy a Medigap policy and a separate drug plan if you return to Original Medicare within 12 months of joining, and if you dropped a Medigap policy to join, you may get that same policy back if the company still sells it. Miss that window and in most cases you can't.7 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 tradeoff in Florida is that switching Medigap plans later can be hard. For a full comparison, see our guide to Original Medicare vs. Medicare Advantage.

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. Florida runs them as SSI-Related Medicaid coverage groups with limited benefits. The Florida Department of Children and Families determines Medicaid eligibility, except for people who receive Supplemental Security Income, and the Agency for Health Care Administration manages Medicaid services.12

Those are the federal limits SSA publishes for all states except Alaska and Hawaii, and they already include the $20 of monthly income these programs disregard. DCF's own chart, Appendix A-9.1, labeled "Interim Effective January 2026," lists slightly different numbers: $1,342, $1,609 and $1,811 for an individual and $1,813, $2,175 and $2,447 for a couple at the 100%, 120% and 135% tiers. Those state figures do not reconcile with the official 2026 federal poverty guideline, and neither DCF's fact sheet nor SSA's page states which income is counted or excluded in applying any of them. So do not self-screen out on a number: Social Security's own instruction to its staff is that even if an individual's income or resources appear somewhat higher than the state limits, they should be encouraged to apply. DCF's descriptions of SLMB and QI-1 name only the Part B premium.12

QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing.12 DCF states each program's test as an upper bound: income below 100% of the federal poverty level for QMB, below 120% for SLMB, and below 135% for QI-1, with assets that must not exceed the limit for the coverage group. Appendix A-9.1 publishes those asset limits as $9,950 for an individual and $14,910 for a couple, identical to the federal figures, so Florida has not used the option SSA describes for states to disregard resources and effectively end the resource test. But neither DCF's fact sheet nor SSA's page says which resources are counted, which is precisely why a homeowner with a car in the driveway should apply and let DCF do the arithmetic.12 QI also has to be reapplied for every year; being approved one year does not carry you into the next.12 Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D.12

How to Apply for Florida's Medicare Savings Programs

You apply through the Department of Children and Families, and free help is one phone call away if you'd rather not do it alone.12

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.13 Since 2024, the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

• Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple, the figures for the 48 contiguous states and DC (Alaska and Hawaii are higher)13
• Resource limits: $16,590 for an individual, $33,100 for a married couple, or $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses13
• If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically12
• QDWI, the Medicare Savings Program for people who lost premium-free Part A after returning to work, pays the Part A premium but does not carry Extra Help with it, so a QDWI enrollee has to apply to Social Security for Extra Help separately12,13

Apply through Social Security at ssa.gov or call 1-800-772-1213.13 Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, where residents apply through their local Medicaid office instead.13,14

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.15 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.15 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.15 If your needs are more intensive, the Program of All-Inclusive Care for the Elderly (PACE) 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. These dates are federal and the same in Florida as everywhere else.16

Changes you make during Annual Open Enrollment take effect the following January 1. If you're already receiving Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up through Social Security. If you're still working past 65 with group health coverage based on that current employment, you can delay Part B without penalty and use an eight-month Special Enrollment Period to sign up, counted from the month that job or coverage ends, whichever comes first. COBRA and retiree coverage do not count as coverage based on current employment, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).17

Free Medicare Help: Florida SHINE

You don't have to figure this out alone, or pay a broker to help. Florida's SHINE program (Serving Health Insurance Needs of Elders) gives free, unbiased Medicare counseling. It's the state's federally funded State Health Insurance Assistance Program (SHIP), run by the Florida Department of Elder Affairs and delivered locally by trained volunteers through the state's Area Agencies on Aging.5

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.5

Key Florida Medicare Contacts

Learn More

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.