10 vital details all Floridians need to consider before choosing a Medicare Advantage Plan in 2026
- Joshua Randolph
- Jan 4
- 5 min read
Medicare Advantage plans bundle your Medicare Part A (hospital) and Part B (medical) coverage, and almost always include Part D prescription drug coverage. Some plans also offer extra benefits — dental, vision, hearing, telehealth, wellness programs and more. But every plan varies in cost structure, networks, benefits, quality and restrictions. Making the wrong choice can lead to higher costs, limited provider access, or gaps in coverage at a time when predictable, reliable healthcare matters most.
In 2026, Florida beneficiaries have access to more than 600 Medicare Advantage plans, with many offering $0 premiums and other perks — but wide variation still exists in what each plan actually delivers.
This article breaks down the key decision points Floridians should evaluate before selecting an MMA plan this year.
1. Understand Plan Costs: Beyond the Monthly Premium
When comparing plans, don’t focus only on the advertised monthly premium. Many MMA plans in Florida for 2026 list $0 premiums, but you may still pay significant costs through:
Deductibles
Copayments and coinsurance for doctor visits, procedures and hospital care
Prescription drug cost-sharing
Annual maximum out-of-pocket (MOOP) — this is crucial, because once you hit this limit the plan must cover all in-network Medicare-covered services.
Tips for cost evaluation:
Add up not just premiums, but expected care costs based on your typical usage.
Look at deductibles and copays for your most common services, not just the lowest premium.
Consider MOOP: a plan with a higher premium but a low MOOP may cost you less if you have frequent medical needs.
For prescription drugs, check your probable total annual costs, including cost tiers, deductibles and pharmacy networks.
2. Provider Networks: Who’s In and Who’s Out
Medicare Advantage plans contract with specific doctors, specialists, hospitals and other providers. Networks can be very narrow or broad, and they vary significantly by county in Florida — what works in Miami may not work in Tallahassee.
Types of Networks:
HMO (Health Maintenance Organization): Must use the plan’s network (except in emergencies). Requires referrals for specialists.
PPO (Preferred Provider Organization): Offers more flexibility to see out-of-network providers, usually with higher cost sharing.
PFFS (Private Fee-for-Service) and others: Less common, vary in rules.
Checklist:
Verify that your primary doctor, specialists, preferred hospitals and pharmacies are in-network.
Call provider offices directly to confirm 2026 participation — online directories can lag behind actual changes.
If you have existing or planned medical needs (e.g., specialist care, procedures), ensure the network adequately supports that care.
3. Prescription Drug Coverage (Part D) Is Not Automatic Without Verification
Although many Medicare Advantage plans include Part D drug coverage, the formularies (lists of covered drugs) differ dramatically. Even if a plan covers the same drugs as another, tier placement, copays, prior authorization and step therapy rules can make a major difference in overall cost.
What to do:
List all your current medications (brand and generic).
Use the Medicare Plan Finder tool or plan drug list to compare coverage costs by plan.
Check whether your drugs require prior authorization or step therapy (trying cheaper drugs first).
Identify preferred pharmacies and compare their pricing.
4. Extra Benefits: Perks That Don’t Always Equal Value
Medicare Advantage plans often advertise extras like:
These additional benefits can be valuable, especially if you use them, but they should not outweigh core coverage needs like durable medical equipment, specialist access or prescription coverage. A flashy extra benefit doesn’t compensate for poor provider networks or high out-of-pocket costs when you really need medical care.
5. Quality and Star Ratings: What They Really Mean
CMS assigns a Star Rating (1–5) to Medicare Advantage plans based on quality metrics such as preventive care, chronic disease management, customer satisfaction, and member complaints. Plans with 4+ stars are generally considered better performers.
Why ratings matter:
Higher-rated plans tend to deliver better coordination of care and preventive services.
In some cases, five-star plans allow special enrollment periods outside the usual windows.
Ratings can help compare plan quality once you’ve narrowed your options based on cost, network, and drug coverage.
6. Enrollment Periods: When You Can Make Changes
Timing is critical. For 2026, the main windows when Floridians can enroll, switch, or drop plans include:
Annual Enrollment Period (AEP): Oct 15 – Dec 7, coverage effective Jan 1, 2026.
Medicare Advantage Open Enrollment Period (OEP): Jan 1 – Mar 31, allows switching to another Advantage plan or to Original Medicare (with Part D).
Special Enrollment Periods (SEPs): Triggered by qualifying life events (e.g., moving, loss of coverage).
Missing these windows may delay coverage changes for months, so plan ahead and compare early.
7. Restrictive Rules and Prior Authorizations
Many Advantage plans use utilization management tools like prior authorization and step therapy to control costs. This can delay care or require additional paperwork for services that would be easily covered under Original Medicare.
Considerations:
Prior authorization can impact specialist visits, certain procedures, imaging tests, and some medications.
Ask how often authorizations are required and how easy it is to get them approved.
Compare appeals processes — how quickly can you challenge a denial? Detailed review before enrolling can preempt disruption mid-year.
8. Stability of Plans and Market Volatility
Florida’s Medicare Advantage market is one of the largest and most competitive in the nation, with frequent plan entries, exits and benefit changes from year to year. Some networks shrink or consolidate, and plans may adjust benefits or costs anew each enrollment period.
To mitigate risk:
Favor plans with consistent quality and stable provider networks.
Review historical changes for the plans you’re considering.
Be prepared to reassess annually during open enrollment.
9. Alternatives: Original Medicare + Supplement (Medigap)
For some beneficiaries, Original Medicare plus a Medigap policy and a separate Part D plan may offer broader provider choice and predictable costs compared to MMA plans — especially if you travel frequently, use out-of-network care often, or want fewer network restrictions. However, Medigap premiums can be higher overall.
Comparing long-term cost projections and personal health needs is crucial here — there is no one-size-fits-all answer.
10. Use Tools and Get Help
Don’t choose a plan based on name recognition or a friend’s recommendation. Insurance agents may not always show every available plan or might focus on certain carriers. Instead:
Use the Medicare Plan Finder tool at Medicare.gov.
Work with an independent, licensed Medicare counselor (SHIP in Florida).
Compare multiple plans side-by-side, especially drug costs and networks.
Conclusion: Start Early, Compare Deeply
Choosing a Medicare Advantage plan in Florida for 2026 isn’t just about finding the lowest premium. It’s about matching your health needs, providers, medications, and financial situation with a plan that offers real value — now and in the years ahead.
Floridians need to look holistically at costs, networks, drug coverage, quality ratings, enrollment rules, and annual plan stability. By investing time in comparison and getting unbiased help when needed, you can avoid surprises and secure coverage that works — not just looks good on paper.
Disclaimer
This information was provided by the Agency for Healthcare Administration (AHCA). The "Ask Medicaid Florida" website is intended for informational purposes only. "Ask Medicaid Florida" is not associated with any state agency including Medicaid Florida. Find all AHCA archived alerts here. Please feel free to read our full disclaimer here. If you have received this message in error, please immediately notify us at info@askmedicaidflorida.com and delete the original message. We regret any inconvenience and appreciate your cooperation.
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