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Medicare Advantage (also known as Medicare Part C) plans cover all the same services that Original Medicare (Part A and Part B) plans do. Still, they also often include prescription drug coverage and other extra benefits. For this reason, Medicare Advantage plans are a popular selection for Medicare coverage.
In Florida, residents have many options regarding Medicare Advantage plans. With numerous insurance giants in the mix, it is essential to cut through the clutter and pinpoint the providers and plans that best suit individual needs.
Florida hosts a diverse selection of Medicare Advantage plans from well-known insurance companies. To assist you in this decision-making journey, we’ll focus on streamlining comparisons in key areas such as drug coverage, member experience, and the availability of cost-effective plans. We will also present key plan data for select providers, including monthly premium and out-of-pocket cost information.
Compare Medicare Advantage Providers in Florida
Before viewing the important statistics of key Medicare Advantage plan providers in Florida, let’s learn more about some key metrics to consider when selecting a Medicare plan:
CMS Star Rating: Published annually by the Centers for Medicare & Medicaid Services (CMS) to measure the quality of health and drug services customers receive. The overall star rating, between 1 (low) and 5 (high) stars, considers up to 40 quality and performance measures and is a strong point of comparison for plan selection.
Monthly Premium: The amount you would pay to a provider for monthly health insurance plan coverage.
In-Network Max Out-of-Pocket Amount: The maximum amount of money you would pay to a provider for in-network services you received during a coverage period (usually one year).
Note: All statistics in the charts below were calculated using plan data specific to Florida.
National Providers
| Provider Name | Average CMS Star Rating | Median Monthly Premium | Median In-Network Max Out-of-Pocket $ |
| UnitedHealthcare | 3.9★ | $0.00 | $4,900 |
| Humana | 4.2★ | $0.00 | $5,500 |
| Aetna | 3.8★ | $0.00 | $5,000 |
| Wellcare | 3.3★ | $0.00 | $3,900 |
Regional Providers
| Provider Name | Average CMS Star Rating | Median Monthly Premium | Median In-Network Max Out-of-Pocket $ |
| Devoted Health | 5.0★ | $0.00 | $4,850 |
| Optimum HealthCare | 5.0★ | $0.00 | $1,900 |
| Simply Healthcare | 5.0★ | $0.00 | $3,450 |
| Florida Blue | 3.5★ | $0.00 | $5,500 |
| CarePlus | 4.0★ | $0.00 | $3,500 |
Please also note that while some smaller providers may offer 5-star CMS rated plans, they will likely have a limited, much smaller network of physicians than the much larger national health insurance providers.
Top-Rated Medicare Advantage Providers in Florida
Humana
Humana is a massive health insurance company in the United States which offers a diverse range of healthcare insurance and related products, one of which is Medicare.
They service two million members statewide in Florida across three partner communities (Broward County, Jacksonville, and Tampa Bay). By market share, they are the second largest provider of Medicare Advantage plans in the United States (17.8%), but the largest in Florida (32%).
Optimum HealthCare, Inc.
Optimum Healthcare is a health insurance company that focuses entirely on providing Medicare Advantage plans, including Medicare Advantage Prescription Drug (MAPD) plans.
Optimum has over 59,000 members and provides service in 24 counties throughout Florida.
Simply Healthcare Plans, Inc.
Simply Healthcare is a Florida-licensed health maintenance organization established to meet the needs of Floridians enrolled in government-sponsored healthcare programs.
They are headquartered in Miami and have regional offices in Orlando, Tampa, and Sunrise. They are well-connected with physicians and hospitals statewide and service 11 counties in Florida.
United Healthcare
UnitedHealthcare is a national provider of health insurance and related products. It is also the market share leader (28.5%) in the competitive Medicare Advantage segment, providing service to over 9 million enrollees across the country.
Additionally, they are also the fastest-growing MA plan provider, having grown 12.7% year over year in 2023 from 2022 (the second fastest-growing MA provider was Humana, at 10.1%).
Aetna
Aetna is a national provider of health insurance and related products. They operate as a subsidiary of CVS Health Corporation.
As of March 2023, they were the third-largest provider of Medicare plans (10.6% market share) and the largest provider of Medicare prescription drug plans (27.2% market share).
Devoted Health
Devoted Health is an all-in-one healthcare company for Medicare beneficiaries. It delivers health insurance and strives to provide access to high-quality medical care.
Additionally, despite being smaller than national providers, they nevertheless have a strong presence in Florida as it is their longest-served market.
Florida Blue (Blue Cross Blue Shield)
Florida Blue, Florida’s Blue Cross Blue Shield company, has over 75 years of experience as a leading health insurer in the state.
The Company serves over 5 million healthcare members across the state and is headquartered in Jacksonville, FL. Florida Blue and its affiliated companies serve 27 million people in 35 states.
CarePlus
CarePlus is another large provider of Medicare-related products for Florida residents. The company is headquartered in Miami and has over 20 years of experience serving roughly 200,000 Floridians across 20 counties statewide.
Wellcare
Wellcare is a large Healthcare enterprise that provides health insurance and related products to Americans nationwide. Medicare Advantage is a key product offering of Wellcare, which has a market share of 4.3%.
Additionally, as of 2023, they are the second-largest provider of prescription drug plans (PDPs) (19.9% market share). As with the other large health insurance providers, they have a strong presence in Florida with deep connections to hospitals, services, and physicians statewide.
How to Choose the Best Medicare Advantage Plan
Choosing the right Medicare Advantage plan, tailored to fit your unique needs, is critical to maintaining a healthy lifestyle. Let’s review the key steps to simplify the decision-making process.
From understanding your healthcare needs to exploring plan specifics, our goal is to empower you with the knowledge necessary to navigate the array of options.
- Assess Your Healthcare Needs: Determine your specific medical needs, including prescription medications, anticipated doctor visits, and any specialized care requirements.
- Review Plan Options: Explore available Medicare Advantage plans in your area, considering coverage, costs, and additional benefits. Check for plans offered by reputable insurance companies.
- Check Network Providers: Confirm that your preferred doctors, hospitals, and healthcare providers are included in the plan’s network to ensure convenient and cost-effective access to care.
- Evaluate Drug Coverage: If you take prescription medications, assess each plan’s formulary to ensure your drugs are covered. Consider copayments, coinsurance, deductibles, and any restrictions.
- Consider Additional Benefits: Medicare Advantage plans often include extra benefits like dental, vision, or wellness programs. Evaluate these perks based on your individual needs.
- Examine Cost Structures: Compare premiums, deductibles, copayments, and coinsurance for each plan. Consider your budget and how these costs align with your expected healthcare usage.
- Check Star Ratings: Refer to Medicare’s Star Ratings for plans. Higher-star-rated plans typically offer better quality, customer satisfaction, and healthcare outcomes.
- Understand Plan Rules and Restrictions: Familiarize yourself with the plan’s rules, including any prior authorization requirements or referrals for specialists. Ensure you understand how the plan operates.
- Review Out-of-Pocket Maximums: Identify the plan’s annual out-of-pocket maximum, which limits your spending on covered services. This can provide financial predictability in case of unexpected healthcare expenses.
- Get Personalized Assistance: Reach out to CoverRight for personalized assistance. We can help clarify any doubts and guide you through the enrollment process.
Remember that individual preferences and healthcare needs vary, so the best Medicare Advantage plan for you depends on your unique circumstances. If you have questions unique to your situation that you would like answered, we recommend scheduling a call to speak with a licensed insurance agent.
Additionally, if you are evaluating your drug coverage, we recommend looking into switching to the generic version of your drugs. The generic version will be much cheaper if available than the brand-name version.
What Medicare Advantage Plans Cover
Medicare Advantage plans (a.k.a. Medicare Part C plans) are offered by Medicare-approved private insurance companies.
These plans provide all the coverage of Original Medicare (Part A and Part B) and often include additional benefits. Here’s an overview of what Medicare Advantage plans typically cover:
- Hospital Coverage (Part A): This includes inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Medical Coverage (Part B): This covers outpatient care, doctor visits, preventive services, and some home health care.
- Prescription Drug Coverage (Part D): Many Medicare Advantage plans include prescription drug coverage. If not, beneficiaries can usually purchase a standalone Medicare Part D prescription drug plan.
- Additional Benefits: Depending on the exact plan, Medicare Advantage plans can often offer extra benefits not covered by Original Medicare, such as dental care, vision care, hearing aids, fitness programs, and wellness services.
- Out-of-Pocket Maximums: These plans have yearly limits on out-of-pocket costs for medical services, providing financial protection for beneficiaries.
It’s important to note that coverage can vary between different Medicare Advantage plans, so individuals should carefully review plan documents, including the Summary of Benefits, and consider their specific healthcare needs when choosing a plan.
Additionally, beneficiaries must continue to pay their Medicare Part B premium and any premium charged by the Medicare Advantage plan.
When to Enroll for Medicare Advantage Plans in Florida
Enrollment for Medicare Advantage Plans in Florida takes place during specific timeframes.
Initial Enrollment occurs when you’re first eligible for Medicare, usually around age 65. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year, allowing you to switch, drop, or add Medicare Advantage plans.
The Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31, permits plan changes or a return to Original Medicare.
Special Enrollment Periods may apply in certain circumstances, such as moving, losing employer coverage, or qualifying for Medicaid. It’s crucial to be aware of these periods to make informed decisions about your Medicare Advantage coverage in Florida.
Medicare Advantage vs. Medigap
Choosing between Medicare Advantage (Part C) and Medigap (Medicare Supplement) involves being aware of key distinctions between the two categories of plans. Medicare Advantage combines Part A and B benefits, often incorporating extras like prescription drug coverage.
These bundled plans are typically more affordable and administratively convenient despite potentially having some network restrictions.
Overall, Medicare Advantage plans are very popular in Florida. As of May 2023, nearly 55% of Florida residents with Medicare were enrolled in private Medicare Advantage plans, a figure slightly higher than the 2023 national average of 51%.
On the other hand, Medigap plans work in tandem with Original Medicare, covering out-of-pocket costs. While offering greater flexibility in healthcare provider choice, Medigap plans generally come with higher premiums.
Here is a breakdown of the two types of plans:
| Medicare Advantage (Part C) | Medigap (Medicare Supplement) | |
| Coverage | – Bundled coverage, often includes prescription drugs and extras. – Limited to network providers; may require referrals. | – Comprehensive coverage of out-of-pocket costs. – Greater flexibility in choosing healthcare providers. |
| Costs | – Lower premiums, but potential for higher out-of-pocket costs. | – Higher premiums but lower out-of-pocket costs. |
| Prescription Drugs | – Often includes prescription drug coverage. | – Doesn’t typically include prescription drug coverage. |
| Network Restrictions | – Limited to network providers; may require referrals. | – No network restrictions; can see any doctor accepting Medicare. |
| Administration | – Requires managing multiple aspects (Part A, B, and sometimes D). | – Simplifies administrative processes with a single plan. |
| Flexibility | – May be limited to specific geographic regions or networks. | – Freedom to use healthcare services nationwide. |
| Additional Benefits | – May include extra benefits like dental, vision, and wellness programs. | – Focuses solely on medical costs; no additional benefits. |
| Decision Criteria | – Attractive for those seeking bundled coverage with potentially lower costs. | – Suited for those who prioritize flexibility and are willing to pay higher premiums. |
The decision here hinges on your priorities: Medicare Advantage for cost-effective bundled benefits with some network constraints or Medigap for more flexibility in provider selection, albeit at a potentially higher cost.
All Medicare Advantage Providers in Florida for 2024
- Aetna Medicare
- Alignment Health Plan
- AvMed Medicare
- BayCare Health Plans
- Capital Health Plan
- CarePlus Health Plans
- Cigna
- Devoted Health
- Doctors HealthCare Plans
- Florida Blue
- Freedom Health
- Gold Kidney Health Plan
- Health First Health Plans
- HealthSun Health Plans
- Humana
- Leon Health Plans
- Optimum Healthcare
- Prominence Health Plan
- Simply Healthcare Plans
- Solis Health Plans
- Ultimate Health Plans
- UnitedHealthcare
- Wellcare
- Wellcare by Allwell
