How Does Florida Medicare Work?

The Florida Medicare Process

How Does Florida Medicare Work?

Good news — you’ll only need to enroll for Medicare Parts A & B once. Each year, you will be able to choose the method in which you get your health coverage (such as adding prescription coverage, or switching plans). Medicare is different from private insurance — there aren’t any plans for couples or families, which means you and your spouse have completely separate policies.

Original Medicare

Original Medicare covers most, but not all of the costs for approved health care services and supplies. After you meet your deductible, you pay your share of costs for services and supplies as you get them. Oh no! You just noticed that you’re responsible for 20% of the costs! Don’t stress! We take pride in finding you the specific plan that covers the remaining 20% at little to zero cost to you!

Long Term Care

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Medicare Advantage

Medicare Advantage bundles your Part A, Part B, and usually Part D coverage into one plan. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services. The great “advantage” to this plan is that some Medicare Advantage plans could have a $0 premium or may help pay all of your Part B premium. It’s important to note that you must have both Part A and Part B to join a Medicare Advantage Plan.

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How does Medicare work with my other insurance?

Are you approaching 65 and still working? That’s okay, most individuals nowadays are working and receiving health insurance through their employer. When you are eligible for Medicare and still have group health insurance, you can be covered by both; your “primary payer” insurance (usually your employer insurance) will pay first and your “secondary payer” (usually your Medicare plan) will cover the remainder.

Are you working past age 65, or getting ready to retire?

Generally if you have job-based health insurance through your (or your spouse’s) current job, you don’t have to sign up for Medicare while you (or your spouse) are still working. You are able to  wait to sign up until you (or your spouse) stop working or you lose your health insurance (whichever comes first).

A couple of notes:

  • If you’re self-employed or have health insurance that’s not available to everyone at the company: Ask your insurance provider if your coverage is employer group health plan coverage (as defined by the IRS.) If it’s not, sign up for Medicare when you turn 65 to avoid a monthly Part B late enrollment penalty.
  • If the employer has less than 20 employees: You might need to sign up for Medicare when you turn 65 so you don’t have gaps in your job-based health insurance. Check with the employer.
  • If you have
    COBRA coverage: Sign up for Medicare when you turn 65 to avoid gaps in coverage and a monthly Part B late enrollment penalty. If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up.

How does Medicare work with my job-based health insurance?

Most people qualify for part A without having to pay a monthly premium. If you qualify, you can sign up for Part A coverage starting 3 months before you turn 65 and anytime after you turn 65 — Part A coverage starts up to 6 months back from when you sign up or apply for benefits from Social Security. 

If you have a Health Savings Account, you and your employer should stop contributing to it 6 months before you sign up for Part A (or apply to receive Social Security benefits) to avoid a tax penalty.

Here’s a quick sheet that breaks it down:

I’m still working and…

How my coverage works with Medicare (Part A & B)

My (or my spouse’s) job has less than 20 employees

Medicare pays for services first, and your job-based insurance pays second.

If you don’t sign up for Part A and Part B, your job-based insurance might not cover the costs for services you get.

Ask the employer that provides your health insurance if you need to sign up for Part A and Part B when you turn 65.

My (or my spouse’s) job has more than 20 employees

Your job-based insurance pays first, and Medicare pays second.

If you don’t have to pay a premium for Part A, you can choose to sign up when you turn 65 (or anytime later).

You can wait until you stop working (or lose your health insurance, if that happens first) to sign up for Part B, and you won’t pay a late enrollment penalty.

I (or my spouse) get a stipend from my employer to buy my own health insurance OR I (or my spouse) am still working, but I don’t have health insurance through that job

Generally, Medicare doesn’t work with your insurance.

Once you sign up, Medicare pays first.

Some private insurance has rules that lower what they pay (or don’t pay at all) for services you get if you’re eligible for other coverage, like Medicare.

Ask your health insurance company if you need to sign up for Part A and Part B when you turn 65.

Questions? Call us today! (561) 665-7752.


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