Understanding Medicare in Florida: What Every Senior Needs to Know During Open Enrollment
By The Miller Elder Law Firm, Shannon Miller, Cheryl Harris
Navigating Medicare in Florida can be one of the most confusing parts of turning 65 – or helping a loved one do so. Between Parts A, B, C, and D, the alphabet soup of plans can quickly feel overwhelming. To make sense of it all, our founder Shannon Miller, Florida Bar Board Certified Elder Law Attorney, recently hosted a webinar with Cheryl Harris, liaison in Alachua County for the Florida SHINE program (Serving Health Insurance Needs of Elders) with Elder Options. Together, they broke down what every Floridian should know about Medicare options, costs, and coverage – especially during open enrollment between October 15th and December 7th.
The Basics: What Are the Four Parts of Medicare?
Part A covers hospital care, skilled nursing, and limited home health services.
Part B covers doctor visits, outpatient care, and preventive services.
Part C (Medicare Advantage) combines Parts A and B (and often Part D) into a single plan offered by private insurance companies.
Part D provides prescription drug coverage.
Most people choose between two paths:
- Traditional Medicare (Parts A + B), often paired with a Medigap (supplemental) policy and Part D prescription coverage.
- Medicare Advantage (Part C), a private plan that replaces traditional Medicare.
As Cheryl explains, “You can’t drive on both sides of the street at the same time. You choose one path for the year – either Traditional Medicare or Medicare Advantage.”
The Big Question: Medicare Advantage or Traditional Medicare?
Medicare Advantage plans can look appealing on paper, with low premiums and added perks like dental or vision coverage. But as Shannon cautioned, “When you have a major health event, that’s where things can get complicated.”
Here’s why:
- Medicare Advantage plans are managed by private insurance companies. Private insurers are paid a fixed monthly amount per enrollee to manage your care under Medicare Advantage. The less they spend on your care, the more profit they keep.
- Coverage limitations can delay care. Many Advantage plans require pre-approvals, referrals, or network restrictions that can delay treatment – especially for surgeries or specialist care.
- Traditional Medicare offers more flexibility. With a Medigap policy, beneficiaries have nationwide coverage and don’t need referrals to see specialists.
“If you want the largest network of providers throughout the U.S.,” Cheryl emphasized, “that’s going to be Original Medicare with a supplement.”
Why Open Enrollment Matters
Medicare in Florida Open Enrollment Period runs from October 15 to December 7.
During this window, you can:
- Switch between Original Medicare and Medicare Advantage.
- Change your prescription drug plan (Part D).
- Review annual changes in premiums, deductibles, and covered medications.
Even if your plan worked well this year, review your options. “Never assume your plan will stay the same,” Cheryl warned. “Formularies and premiums change every year.” If you take no action, you’ll generally stay in your current plan, but benefits and costs may change on January 1. SHINE counselors across Florida can review your medications, compare plans, and help you make an informed choice – all at no cost.
The Part D Penalty Trap
One of the most common mistakes new Medicare beneficiaries make is skipping Part D because they don’t currently take any prescriptions. But doing so can be costly later.
If you delay enrollment without having other credible drug coverage, you’ll face a lifetime penalty added to your monthly premium. The Part D late enrollment penalty equals 1% of the national base beneficiary premium ($36.78 in 2025) for each full month you went without creditable drug coverage, added to your Part D premium for as long as you have Part D. Cheryl reiterated that “even if you eventually sign up, that penalty never goes away.”
The good news? In many Florida counties, $0-premium Part D plans are available – check the Medicare Plan Finder for your ZIP code.
The “Golden Ticket” for Supplemental Coverage
When you first enroll in Medicare (Parts A and B), you have six months to purchase a Medigap (supplemental) policy without answering health questions or undergoing underwriting.
After that window closes, insurers can – and often will – deny coverage based on pre-existing conditions. “That six-month period is a gift,” Shannon emphasized. “Once it’s gone, you may never get that kind of access again.”
If you’re considering Medicare Advantage, understand that switching back later might leave you without affordable supplemental options.
When Life Changes: Moving, Illness, and Special Enrollment
Certain life events – like moving to a new county or your plan being discontinued – can trigger a Special Enrollment Period (SEP) that lets you change coverage outside the annual window.
For example, if you move to an area where your Medicare Advantage plan isn’t offered, you may qualify for guaranteed issue on a new Medigap policy. “That’s the golden ticket,” Cheryl said. “But you have to open your mail. Don’t miss those letters.”
How SHINE Can Help
The Florida SHINE program (Serving Health Insurance Needs of Elders) with Elder Options provides free, unbiased Medicare counseling through your local Area Agency on Aging. Trained counselors can:
- Review your current plan and medications.
- Compare coverage options for the new year.
- Explain eligibility and penalties.
- Assist with appeals and Medicare fraud concerns.
For Alachua County residents, SHINE counselors are available Tuesdays from 8:30 a.m. to 11:30 a.m. at the Senior Recreation Center in Gainesville – no appointment required. Or call 1-800-262-2243 or visit FloridaShine.org for statewide locations.
The Bottom Line For Medicare in Florida
Medicare isn’t one-size-fits-all. The best plan depends on your health, financial situation, and long-term goals. As Shannon put it, “You can’t plan for a crisis during a crisis. The best time to make informed decisions is before you need the care.”
At The Miller Elder Law Firm, we work every day with families navigating the intersection of healthcare, long-term care, and elder law planning. Whether you’re approaching 65, helping a parent enroll, or evaluating options after a health change, our team can guide you toward the best long-term choices for your situation.
Need help understanding your Medicare or long-term care options?
Call our Gainesville office at (352) 379-1900 or visit MillerElderLawFirm.com to schedule a consultation or complete the form below and we will contact you.