Medicare And Medicaid In Florida


Where Can Medicare Beneficiaries Get Help In Florida

Medicare Help in South Florida from a Local UnitedHealthcare Agent

Florida SHINE

Free volunteer Medicare counseling is available by contacting the Florida SHINE at 1-800-963-5337. This is a State Health Insurance Assistance Program offered in conjunction with the State Department of Elder Affairs.

SHIPs can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. They may also be able to offer referrals to local agencies for services like home care and long-term care. This website has more information about the SHINE in Florida.

Elder Law Attorneys

Elder law attorneys can help individuals plan for Medicaid long-term care benefits. Use this National Academy of Elder Law Attorneys search feature beneficiaries to find an elder attorney locally.

Florida Long Term Care Ombudsman

Floridas Long Term Care Ombudsman Program helps individuals understand their options for long-term care and advocates for individuals receiving LTSS. This program investigates complaints made about a person who is receiving LTSS.

The Ombudsman Programs phone number is 1-888-831-0404. This website has more information about the program.

How To Apply For Long

For those applicants who are already at or below the income and asset levels, it is very typical that the nursing home does the application for you/the resident. Typically, the business office and/or social worker can do this when the resident’s income and assets are already below the applicable limit. If you/the elder is at home and looking to apply for Medicaid, then you would call your local Aging Resource Center to get placed on the long-term care wait list. There is no waitlist for nursing home Medicaid but there is a very long waitlist for assisted living and in-home Medicaid assistance.

If the elder’s assets are above the minimum level, then it is highly likely that the family will want to consult a good elder law attorney to learn legal ways to protect assets. Here, the elder law attorney would do the application for the elder after assets are legally protected, when appropriate.

Can Our Law Firm Help

Regardless of where you are in the state of Florida, our law firm may be able to help protect assets and apply for Medicaid. We have been protecting assets to benefit the elder and their family for over 20 years and we have successfully completed thousands of Medicaid applications. We charge $200 for an hour long consultation with an elder law attorney who is glad to review your family’s situation to see if we can help.

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How To Apply / Learn More

When the applicant senior is not in a nursing home, the application process starts with a call to the Florida seniors local Area Agency on Aging. One can also call the Elder Helpline. Find the number by county here. Callers should request a screening for home and community based services. The representative schedules a time for the phone screening with the primary caregiver or closest family member, usually one to two weeks out. The screening interview typically lasts 30 to 40 minutes. The interview covers basic demographic information for the applicant as well as his/her income and assets. The interview mostly asks about the elders needs for care, including his/her ability to perform Activities of Daily Living.

Following the interview, the elder receives a prioritization decision. This letter indicates whether services can begin immediately or whether the senior needs to be waitlisted. If the senior is prioritized for home or community supports to start immediately, he/she must apply to the Department of Children and Family Services through the ACCESS System for their formal Medicaid approval.

To learn more about SMMC LTC, .

Like Floridas HCBS Medicaid Waivers that served this population before the creation of this program, SMMC LTC has a limit on the number of persons who can receive assistance at the same time. Waiting lists for some services likely exist in areas throughout the state.

Medicare Enrollment In Florida

Florida House Debates Medicaid Work Requirements While ...

Medicare enrollment in Florida stood at 4,672,774 as of October 2020.Thats more than 21 percent of the states total population, compared with about 19 percent of the United States population enrolled in Medicare.

For most people, Medicare coverage enrollment happens when they turn 65. But Medicare eligibility is also triggered for younger people if theyre disabled and have been receiving disability benefits for 24 months, or if they have ALS or end-stage renal disease. Individuals in these situations are eligible for Medicare benefits even if theyre not yet 65 years old.

87 percent of Medicare beneficiaries in Florida are eligible due to age, while the other 13 percent are under 65 and eligible due to a disability. Nationwide, 85 percent of Medicare beneficiaries are eligible due to age, while 15 percent are eligible due to disability. But Florida has the second-highest percentage of 65+ residents in the country, so it makes sense that a greater percentage of the states Medicare beneficiaries are eligible due to age.

Time to sign up for Medicare? Find Medicare Advantage and Medicare supplement insurance plans in your area.

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Florida Has Not Accepted Federal Medicaid Expansion

  • 4,956,941 Number of Floridians covered by Medicaid/CHIP as of September 2021
  • 1,378,000 Number of additional Florida residents who would be covered if the state accepted expansion
  • 415,000 Number of people who have NO realistic access to health insurance without Medicaid expansion
  • $6.6 billion Federal money Florida is leaving on the table in 2022 by not expanding Medicaid

What Is The Difference

Often people misunderstand the difference between Medicaid and Medicare. Although they both help senior and disabled citizens cover many health-related expenses, they are separate and very different programs.

Medicare is a type of health insurance for seniors, disabled individuals, or anyone with permanent kidney failure. Medicare is funded by Social Security tax contributions . Unlike Medicaid, Medicare is an entitlement program that most senior citizens enroll in at age 65.

Florida Medicaid is a needs-based program with benefits determined by the individuals financial and medical position.

Do Both Medicare and Medicaid Pay for Nursing Home Care?

With regards to long term care costs for our elder or disabled clients, Medicaid does cover nursing home care for applicants who meet the eligibility requirements for Medicaid coverage.

Medicare provides coverage for skilled nursing care in a nursing home however, this care is limited to 20 days of coverage. In certain circumstances, an additional 80 days may be partially covered. This is an important distinction between limited skilled nursing home stays and long term nursing home care coverage.

Here is a summary of the two programs:



  • Medicare is federally controlled, with uniform application in all 50 states
  • Skilled nursing care benefits through Medicare are as follows:
  • Up to 100 days of skilled nursing care are available per period of illness.
  • Recommended Reading: How Much Does Medicaid Cover For Childbirth

    Medicare Part D In Florida

    Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan , or a stand-alone Medicare Part D plan.

    As of late 2020, there were nearly 1.5 million Florida Medicare beneficiaries who were enrolled in stand-alone Medicare Part D prescription drug plans. Thats about 32 percent of all the people enrolled in Medicare in Florida, as opposed to about 40 percent of all Medicare beneficiaries nationwide enrolled in stand-alone Medicare Part D plans. But in Florida, where Medicare Advantage enrollment is higher than the national average, nearly 2.2 million Medicare beneficiaries get their Part D coverage under a Medicare Advantage plan, which accounts for about 46 percent of the states Medicare beneficiaries.

    The number of people with stand-along Part D coverage in Florida had declined by about 30,000 people from late 2019 to late 2020, while the number of people with Part D coverage as part of an Advantage plan had increased by nearly 152,000 .

    For 2021 coverage, there are 28 stand-alone Medicare Part D plans available in Florida, with premiums ranging from about $7 to $172 per month. Medicare Part D enrollment is available during the same fall enrollment window that applies to Medicare Advantage plans.

    Background And Related Court Rulings

    Facing South Florida: Social Security & Medicare In New Federal Budget

    The CMS mandate is, in reality, an Interim Final Rule with Comment Period , entitled “Medicare and Medicaid Programs Omnibus COVID-19 Health Care Staff Vaccination.” It requires vaccination for all “facility staff” who provide care, treatment or other facilities regardless of patient contact and applies to 15 categories of Medicare- and Medicaid-certified providers and suppliers. Florida Senate Bill 2-B enacted Florida Statute 381.00317, which prohibits employers from terminating or functionally terminating an employee who presents a form invoking one of five exemptions to an employer’s COVID-19 vaccination mandate.

    On Nov. 20, 2021, the U.S. District Court for the Northern District of Florida denied Florida’s request for a Temporary Restraining Order against the CMS mandate. The court ruled that the state failed to show irreparable injury. Initially, the court did not consider the impact of SB 2-B because Florida’s briefing preceded its passage and the state did not update the court upon its enactment. However, the court issued a supplemental opinion after learning of SB 2-B that doubled down on its initial ruling. Florida appealed during the interim.

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    What Does Medicaid Cover In Florida

    The amount and type of services that will be covered by Medicaid will depend on things like how old the beneficiary is, which program the beneficiary is actually enrolled in, and even the type of services that will be necessary medically. These services might include community behavioral health, prescription medications, visual, dental, transportation, hospice, nursing home, home health care, family planning, hospital, doctor visits, and more.

    Florida Medicaid Dental Coverage

    Florida Medicaid dental coverage is different for kids and adults. Those ages 20 and under can have coverage for:

    • Exams, cleanings, and fluoride
    • Space maintainers, orthodontics, prosthodontics, and periodontics
    • Root canals, extractions, and any required sedation

    Adults ages 21 and over can have coverage for:

    • Limited dental exams
    • Extractions and related sedation/pain management
    • Dentures

    If you are age 21 or over and need more dental services through Medicaid, you may qualify if you are pregnant or lack other options.

    As of 2018, FL Medicaid dental plans are managed through a separate dental plan. to find a dental plan that accepts Medicaid Florida.

    Recommended Reading: How To Find Your Medicaid Number

    Medicare Spending In Florida

    In 2018, Original Medicare spent an average of $11,565 per beneficiary for people with Medicare in Florida . The national average that year was $10,096 per enrollee, so Medicare spending in Florida was 15 percent higher than the national average. Florida was one of just five states where Medicares average per-enrollee costs exceeded $11,000 in 2018.

    Medicare Costing Savings Programs

    Medicaid and Medicare

    The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services or Medicare Part B premiums only. The Qualified Medicare Beneficiary program pays for Medicare Part B premiums, coinsurance, and deductibles for eligible persons enrolled in Medicare Part A. The Specified Low Medicare Beneficiary program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program, except for excess income.

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    How To Apply For Medicare In Florida

    The Medicare enrollment process is the same no matter what state you live in. To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years. Florida residents may be enrolled automatically a few months before they reach age 65, provided they already receive benefits through the Social Security Administration or the Railroad Retirement Board . Others may be enrolled sooner if they receive SSA disability benefits or certain disability benefits from the RRB for more than 24 consecutive months. If you have ALS amyotrophic lateral sclerosis, also known as Lou Gehrigs disease youll be enrolled in Medicare the same month that you start receiving disability benefits. No action is generally required in these cases, and residents will receive their red, white, and blue Medicare cards in the mail a few months prior to their start dates.

    On the other hand, if you have End-Stage Renal Disease , you qualify for Medicare, but you need to enroll manually. If you need to apply for Medicare manually, then you may visit your local SSA office or enroll online or over the phone.

    • Visit the Social Security website.
    • If you worked for a railroad, call the RRB at 1-877-772-5772 , Monday through Friday, 9AM to 3:30PM.

    New To Medicare?

    Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.

    Florida Medicare And Medicaid Providers Vaccine Mandate Dilemma Jd Supra

    Florida healthcare providers billing federal programs may again face a complicated COVID-19 quandary. The U.S. Court of Appeals for the Eleventh Circuit has denied the state of Floridas request for an injunction against the Centers for Medicare & Medicaid Services mandate requiring all staff of Medicare- and Medicaid-certified providers and suppliers to be vaccinated. As a result, the CMS mandate will come back to life in Florida if the nationwide injunction of a district court located outside of the state is lifted by the U.S. Court of Appeals for the Fifth Circuit or other judicial action is not forthcoming. Should this occur, Florida healthcare providers will once again have to make a choice between complying with the CMS mandate or Floridas newly enacted law granting employees exemptions from federal vaccination mandates.

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    Income Requirements For Florida Medicaid

    There are income requirements for Medicaid in Florida. You need to earn an income that is within the federal poverty level for your group. This is calculated by a specific system that is known as the Modified Adjusted Gross Income, or MAGI.

    Basically, before taxes, income needs to be under these amounts, according to

    Household Size Maximum Income Level

    1 $15,000

    • Speech-language pathology, respiratory, physical, and occupational therapy services

    Floridas Requirements For Medicaid Qualification

    COVID-19: Florida Makes Medicaid Changes (CMS Approves)

    In order to get Medicaid in Florida, you have to meet certain eligibility requirements. You have to be a certain type of patient for one thing. These include:

    • Pregnant women
    • Parents or relatives who are caretakers
    • Families who might have lost Medicaid because of an increase in income or alimony
    • Florida residents who receive SSI through the Social Security Administration
    • Patients who are disabled or over the age of 65
    • Children under 21
    • Those who are eligible to receive Temporary Cash Assistance
    • People under age 26 who were in a foster home
    • People in nursing homes or those who receive community or home-based care.

    You also have to be a Florida resident who has a valid social security number and a citizen of the U.S.

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    Medicaid Spending In Florida

    This article does not contain the most recently published data on this subject. If you would like to help our coverage grow, consider donating to Ballotpedia.

    Medicaid spending in Florida
  • 9Footnotes
  • Florida’sMedicaid program provides medical insurance to groups of low-income people and individuals with disabilities. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children’s Health Insurance Program , which covers low-income children above the poverty line and is sometimes operated in conjunction with a state’s Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

    This page provides information about Medicaid in Florida, including eligibility limits, total spending and spending details, and CHIP. Each section provides a general overview before detailing the state-specific data.


  • As of June 2017, Florida had not expanded Medicaid under the Affordable Care Act.
  • In February 2013, GovernorRick Scott voiced support for a three-year expansion of the program, but in April 2015, stated that he was opposed to Medicaid expansion because it was unclear that the federal government would continue to fund the expansion.
  • Medicaid For Parents And Caretaker Relatives Of Children

    Parents and other caretaker relatives of children up to age 18 that live with them may be eligible for Medicaid if the familys countable income does not exceed certain limits. Individuals who receive Temporary Cash Assistance are automatically eligible for Medicaid. Families that lose Medicaid eligibility due to earned income may be eligible for up to 12 additional months of Medicaid if certain requirements are met. Families that lose Medicaid eligibility due to the receipt of alimony may be eligible for four additional months of Medicaid.

    Read Also: Pregnancy Medicaid Florida Phone Number

    What We Can Offer Our Health Care Clients

    One of the most valuable skills we can offer our health care clients is our understanding of how the governmental health care programs and their bureaucracy are structured, and we know how to efficiently navigate the maze of regulations and bureaucracy as your advocate. We speak the same language that program administrative officials and contractors speak, and we routinely seek to engage in dialogues with such persons in our efforts advocating for and counselling our health care clients.

    Medicare Advantage In Florida

    What is the Difference Between Medicare and Medicaid?

    Medicare Advantage plans are plans offered through private insurance companies and are a full replacement for original Medicare. These plans cover all of the same benefits of parts A and B, and then some.

    Medicare Advantage plans typically include coverage for prescription drugs, vision and dental care, health management, and fitness programs, plus additional perks.

    If you decide to go with a Medicare Advantage plan, you have plenty of choices in Florida. Keep in mind, though, that not all of these plans are available in all counties. Availability varies depending on where you live.

    A number of insurance carriers are offering Medicare Advantage plans in Florida. Here are some of the private insurance companies offering Medicare Advantage plans in Florida for 2021:

    These companies offer plans in many counties in Florida. However, Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.

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