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Medicare FAQs for Florida Seniors

That time of year is here…Medicare’s annual open enrollment. So, we thought we would answer some common Medicare questions we receive from Florida seniors and their caregivers. You might also want to check out our previous article on What to Expect from Medicare in 2014.


Do I need to switch Medicare D plans during open enrollment? What if I am happy with my plan? No, you do not necessarily need to switch Medicare plans during open enrollment but we highly recommend everyone do a review to make sure there aren’t better options. Your plan may be changing or even going away in 2014. And, each year new plans come on the market and pricing changes. If you’ve had any health changes, a review is especially necessary. Various studies continue to show that many people are in the wrong (read: more expensive) plan. We have found over the years that a lot of people see a plan advertised or hear about a plan and go with it. And, many people don’t take advantage of the annual enrollment period because they don’t have any major concerns with their current plan and don’t feel like going through the hassle of comparing. Those are legitimate thoughts, but it may truly be worth your while to compare (or get help from someone).

What if I have a major change during the year when it’s not open enrollment time? For a lot of changes such as a new diagnosis or medication, there isn’t anything you can do but bear with your current plan’s coverage until the next open enrollment period (this is the good thing about having a yearly opportunity to change and lots of options). However, if you find that a drug is not covered or your costs are very high due to some health change, you may be able to work with your medical team and advocates on some temporary solutions. Can you doctor prescribe an alternative medicine? Can you request a plan exception due to medical necessity? Will the drug company offer special financial help if it’s not covered? Additionally, there are some changes which place you in to a SEP (Special Enrollment Period) for Medicare such as moving into/out of or residing in a nursing home, moving to an area that your plan does not cover, or changing employer coverage or losing creditable coverage. There are many of these SEPs, each with specific rules and timeframes. Seek help from a Medicare Advocate, like our Aging Wisely staff.

What if all these costs are too much for me and I’m struggling financially? There are a lot of options for special help. It is important to find out if you are eligible for assistance such as Medicaid or VA benefits. There are also Medicare savings programs for eligible seniors…these offer benefits like help covering premiums. These are generally accessed through the Florida Medicaid office. Pull together your financial information/records to seek out eligibility for these programs. You will have to provide information on income and assets (bank accounts, investments, etc.).

How do Medicare Advantage plans work? Medicare Advantage plans combine various aspects (parts) of Medicare in to one private plan. These can be HMOs, PPOs or fee-for-service style plans. The companies are paid a yearly amount for each enrollee and they provide/manage the various benefits for you. This can be a more simplified and cost-effective way to receive Medicare benefits, but can also have disadvantages. Most plans have a network of providers (or doctors may choose not to accept them even if there is no formal network). For some a Medicare Advantage Plan makes sense when relatively healthy, but may limit choice if medical needs are more substantial. Medicare Advantage Plans are also sometimes called “Part C”, which is a bit confusing because they are not really another “part” of Medicare such as Part A, B and D…but a different way for receiving the usual Medicare benefits via a private company.

For answers to all your Florida Medicare questions, contact Aging Wisely at 727-447-5845. Our expert care managers can provide a full Medicare analysis package for future/current retirees or help you with your specific Medicare advocacy issue. We also assist with benefits and resource access, covering programs ranging from Medicaid and VA benefits to state and community-based programs of all types.

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