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 and limited skilled nursing facility care, and Original Medicare also covers hospice care.1,6

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. Original Medicare doesn't cover routine dental, vision, or hearing care; most Medicare Advantage plans offer some of these extras, but check what each plan covers.7,6

• 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.6

In Florida, more than half of Medicare beneficiaries have already chosen one. As of March 2026, CMS reported 5,319,592 people with Medicare in the state: 3,028,133 enrolled in Medicare Advantage and other health plans, and 2,291,459 in Original Medicare.3 That balance swings hard by county. In Miami-Dade, 391,562 of 522,329 beneficiaries were enrolled in Medicare Advantage and other health plans; in Monroe County (the Keys), only 4,530 of 19,093 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 national average Medicare Advantage premium at about $14 a month in 2026.6,1 In Florida, CMS puts the average plan premium at $2.11 a month for 2026, and says every person with Medicare in the state has access to a plan with a $0 monthly premium.3
• 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.6
• Plans may require prior authorization for certain services, which Original Medicare generally does not.6
• 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 yearly out-of-pocket limit unless you have supplemental coverage like Medigap, Medicaid, or employer, retiree, or union coverage.6

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. Certain life events, like moving or losing other insurance coverage, may open a Special Enrollment Period to change your Medicare health and drug coverage.9

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).10
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

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.11,6

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, 2020.12 People new to Medicare can buy Plan G instead.12 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.11,1

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 offer you enrollment and can't turn you down or charge you more because 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 group health insurance 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.6 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.13

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 ("Financial Standards Effective April 2026"), runs exactly $20 lower, the bare poverty-guideline figures: $1,330, $1,596 and $1,796 for an individual and $1,804, $2,164 and $2,435 for a couple at the 100%, 120% and 135% tiers. It doesn't say whether the $20 exclusion is added on top, and neither DCF nor SSA states which income is counted. So don't screen yourself out on a number: Social Security tells its staff to encourage people to apply even if their income or resources look somewhat higher than the state limits. DCF's descriptions of SLMB and QI-1 name only the Part B premium.13

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.13 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. Neither DCF nor SSA says which resources are counted, so a homeowner with a car should still apply and let DCF do the math.13 QI also has to be reapplied for every year; being approved one year does not carry you into the next.13 Enrolling in QMB, SLMB, or QI automatically qualifies you for Extra Help with Part D.13

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.13

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, helps pay Part D premiums (up to a regional benchmark), deductibles, and copays for people with limited income and resources.14 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). The limit rises with household size, so apply even if you look a bit over14
• Resource limits: $18,090 for an individual and $36,100 for a married couple living together ($16,590 and $33,100 only if you tell Social Security none of your resources will pay for funeral or burial costs); your home and car don't count14
• If you qualify for QMB, SLMB, or QI, you're enrolled in Extra Help automatically13
• 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 separately13,14

Apply through Social Security at ssa.gov or call 1-800-772-1213.14 Extra Help isn't available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa, where residents should ask their Medicaid office about other programs.14,15

If You Have Both Medicare and Medicaid

Many people who have Medicare also qualify for Medicaid. Most Florida Medicaid recipients are enrolled in Statewide Medicaid Managed Care (SMMC), run by the Agency for Health Care Administration.16 Its Managed Medical Assistance component covers services such as hospital, physician, and behavioral health care; its Long-Term Care component covers services such as assisted living, personal care, and nursing facility care.16

On the Medicare side, a dual eligible can join a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP). A Florida Medicaid recipient in a D-SNP is exempt from enrolling in an SMMC Managed Medical Assistance or Dental plan, because the D-SNP itself provides or arranges the Medicare and Medicaid benefits that person is entitled to; how much of the Medicaid side it covers depends on your Medicaid category (full Medicaid, QMB, SLMB, QI or QDWI).16 You can still be enrolled in a Medicaid Long-Term Care plan for long-term care services.16 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.9

Changes you make during Annual Open Enrollment take effect the following January 1.9 If you're already getting Social Security or Railroad Retirement Board benefits at least 4 months before you turn 65, you're enrolled in Parts A and B automatically; if not, you sign up through Social Security.15 If you (or your spouse) are still working past 65 and you're covered by a group health plan 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, and confidential help with Medicare questions.5 It's part of the State Health Insurance Assistance Program (SHIP) network, offered by the Florida Department of Elder Affairs and your local Area Agency on Aging, with specially trained volunteers providing one-on-one counseling.5

The Florida State Plan on Aging lists these subject areas for SHINE counseling:5

• Medicare and Medicaid
• Supplement insurance and long-term care insurance
• Prescription assistance and preventive benefits
• Cost saving programs
• Fraud prevention and beneficiary rights

Call the statewide, toll-free Elder Helpline at 1-800-963-5337 (1-800-96-ELDER) for free and confidential counseling through SHINE.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.