Medicare for Florida Snowbirds

Medicare Snowbird Takeaways

• For Florida snowbirds, Original Medicare (the federal program) plus a supplement will provide the best Medicare coverage for their travel plans. You will not be limited to a local network of medical providers.

• With Original Medicare, snowbirds get nationwide coverage and can see any doctor or medical facility that accepts Original Medicare in any state. You keep those benefits when you choose a Medigap plan as secondary Medicare coverage.

• Medicare Advantage Plans are local health insurance coverage that rarely works well for those who travel because of network limitations. Your Medicare Advantage Plan network may not offer health care coverage in Florida. Out of network services means higher out of pocket costs. This is seldom the best choice of your Medicare options. 

• Medicare Part D prescription drug coverage plans typically have a national pharmacy network of providers that work well for travelers who take prescription drugs. For example, if your local CVS or Wal-Mart is a preferred in-network pharmacy, all CVS’s or Wal-Mart’s across the country are preferred in-network pharmacies.

Florida Snowbirds

Florida Snowbirds are people who live in more than one location and come from all over the U.S. to Florida for the comfortable, balmy winters by the beach. They call Florida their second home.

This can create some confusion, particularly for Medicare beneficiaries whose home state is elsewhere. As they see different prices for medical supplement plans based on age a zip code, we are often asked if they can simply choose the lowest cost state to purchase their health insurance.

You do not have a choice of which address to use when applying for Medicare coverage.  

Which State Do I use to Enroll in Medicare Plan and Medicare Supplement?

Medicare is a subset of Social Security and the rules are very clear. Medicare . A Medicare beneficiary must use your principal residence when purchasing  Medicare coverage. That is the residence from which you file taxes, get your driver’s license, vote, etc.

If you declare a certain state as your state of residence or can show intent to make that state your primary residence, you must purchase your Medicare plan and Supplement from that single zip code.

Because Medicare is a subset of Social Security, the address that Social Security has on file for you should match the address used for Medicare.

Medicare Supplement Pricing

There are three different Medicare supplement (aka Medigap Plans) pricing structures allowed in the U.S. Over the long run, none of the pricing structures result in a lower lifetime cost to the consumer.

As I say in my videos, there is no pricing structure that turns an insurance company into a philanthropic organization.

Prices can and will increase over time. All an insurance company has to do is request a price increase from the state and show that such an increase is necessary to maintain a profit margin within the ranges set by the Affordable Care Act.

What Are the Three Supplement Pricing Structures?

Attained Age Pricing:

With Attained Age pricing your price is based on your current age, the age you have attained on your policy anniversary. In most years your premium will automatically increase a small amount based on inflation and age.

Issue-Age Pricing:

With Issue Age pricing your price is based on the age you were when first issued the policy. If you get a policy at age 65, you will always pay the 65-year old rate. That rate can and will increase over time when the insurance company requests price increases from the state.

Community Rated Pricing:

With Community Rated pricing everyone in the same region (community) is charged the same rate regardless of age or gender. There may be a difference in price from one company to another, but the same plan offered by the same insurance company will be the same price regardless of age or gender.

Some states have laws requiring that all Medicare supplement plans offered be priced as Issue Age or Community Rated. If there is no such state restriction, then supplements will be offered as Attained Age. That is the most efficient pricing model.

Can I Choose the Supplement Pricing Model I Want?

The short answer is not really, and it’s not a good idea to try. Be wary of insurance companies offering a Community rated or Issue age policy in Attained Age states. In my experience, these plans typically have a history of high price increases. One such company hides the price increase history suggesting that increased premiums are due to a “reversal of a discount”. Tell that to your pocket book.

Issue Age Pricing In Florida

All Medicare supplement plans offered in the state of Florida are priced as Issue Age. This makes choosing the right insurance company a more critical decision. Some insurance companies seldom increase their premiums, others increase premiums almost every year.

Why Choose a Medicare Supplement Plan?

As a Florida Snowbird or RV’er you spend much of the year in different states. With a supplement and Original Medicare you have no network limitations. You can see any Medicare provider or any hospital in the US or its territories no matter where your home state is, as long as they accept Original Medicare. you have coast to coast coverage.

Some supplements even offer coverage, albeit limited, when you travel abroad.

Although supplement plans are offered by private health insurance companies, because they are secondary to Medicare they have no say in your health care services. A supplement is your best Medicare option for snowbird Medicare coverage. 

What If I Move or Change My Legal Residence To Florida?

If you have Original Medicare coverage with a supplement and you move to another state, your insurance company is allowed to adjust the price of your supplement for your new zip code. Because supplement prices are higher than average in Florida, your cost may increase.

If you have a Medicare Advantage plan or a Medicare Part D Prescription Drug Plan and move to Florida, out of the plan’s network, you will be eligible for a Medicare Special Enrollment period.

A Special Enrollment Period (SEP) is a great time to re-shop your Medicare plans. As an independent Medicare insurance broker, we can help guide you through your choices. It doesn’t matter if you wish the same coverage or to improve coverage. We work with all major Medicare plans. Our role is to help you make an informed decision.

During this Special Enrollment, you can purchase a new Medicare Advantage plan or Part D Prescription drug plans based on your new zip code’s service area or go back to Original Medicare coverage and purchase a supplement and stand-alone Part D plan.

Snowbird and a Medicare Advantage Plan

Medicare Advantage (or Part C) plans don’t provide coverage and benefits that are ideal for Florida snowbirds because when you travel, you are likely to be out of network and pay a much higher price. Advantage Plans have limited service areas. You will have coverage in the case of a medical emergency, but you do not have a national network like Medigap plans.

Normally, Advantage Medicare plans have a limited service area and the out-of-pocket financial risk can be over $11,000 per year for a PPO and unlimited for an HMO. Also, you can’t choose a drug plan. You must use the prescription drug coverage bundled with your HMO or PPO.

Best Medicare Advantage Plans

Medicare Advantage in Florida is often better coverage than similar plans issue in northern states. Which is the best Advantage plan?

The best Advantage plan will be the one where your medical providers are all in-network, with a broad list of network providers from which to choose.  Networks are important when determining the quality of Advantage Plans.

The best Medicare Advantage plan will also cover all your prescriptions and include a regional pharmacy network or mail order pharmacy services you are comfortable with so you can easily fill prescriptions without going out of your way.

Your local hospital should be included as network coverage.

At Medigap seminars we have some of the most advanced software in the industry. It allows us to input your doctors, prescriptions and other needs, then automatically compare your MA plan choices.

Medicare Cost Plans

Medicare Cost plan provides Medicare benefits similar to Medicare Advantage plans yet allows you to keep your Original Medicare coverage. Medicare cost plans are being phased out and are available in only a few states.

Residents of Massachusetts, Minnesota, or Wisconsin

These states offer coverage with their own standardized Medicare supplement plans that are offered only to residents of those states. If you change your residence to Florida you do not need to make a change with your supplement. The supplements offered by these three states, and every other state are valid everywhere Original Medicare is accepted.

However, if your health is good you should shop the supplement plans offered in your new state. There is a reasonable probability that the plans offered in your new state will have a lower price and better price stability.

Contact Us today. Our mission is to help you make an informed Medicare decision.

All photography by Matthew Claassen