Florida Medicare
Readiness Score
Most Florida seniors are in the wrong Medicare plan — overpaying, missing benefits, or carrying coverage gaps they don't know about. Use this checklist to find out where you stand.
67%
of Medicare beneficiaries are in the wrong plan for their needs
$1,800
average annual overpayment by Florida seniors who don't compare plans
0
cost to work with a licensed Medicare agent — carriers pay us, not you
10 min
average time for Jaime to find a better plan during a free review
Is Your Medicare Coverage Right for You?
Review each item. Any "Action Needed" or "Coverage Gap" flag is worth a free conversation with Jaime.
Eligibility
Turning 65 within the next 3 months
Your Initial Enrollment Period opens 3 months before your birthday
Currently on employer coverage and approaching 65
Understand how employer coverage coordinates with Medicare before you miss your window
On Social Security Disability (SSDI) for 24+ months
You qualify for Medicare before 65 — confirm your Part A & B enrollment status
Have End-Stage Renal Disease (ESRD) or ALS
Special eligibility rules apply — you may qualify immediately
Coverage Gaps
No dental coverage under your current Medicare plan
Original Medicare does not cover routine dental — you need a separate plan or MA plan with dental
No vision coverage
Routine eye exams and glasses are not covered by Original Medicare
No hearing coverage
Hearing aids can cost $3,000–$7,000 — check if your plan includes hearing benefits
No out-of-pocket maximum on Original Medicare
Original Medicare has no cap — a Medigap or MA plan protects you from unlimited costs
Drug Coverage
Your prescriptions are not on your plan's formulary
Check your plan's drug list every AEP — formularies change annually
You're in the Medicare Part D coverage gap ("donut hole")
You pay 25% of drug costs in the gap — Extra Help may reduce this
You haven't compared Part D plans this year
The best plan for your drugs last year may not be the best this year
You qualify for Extra Help (Low Income Subsidy)
Extra Help can save you $5,000+ per year on drug costs — apply through SSA
Plan Fit
Your primary doctor is not in your plan's network
Out-of-network costs can be significant — verify every year before AEP ends
Your plan's star rating dropped below 4 stars
CMS star ratings reflect quality and member satisfaction — lower ratings may signal problems
Your premium increased more than $50/month at renewal
Significant premium increases are a signal to shop — better options may exist
You've had difficulty getting referrals or prior authorizations
Frequent denials may indicate a poor plan fit for your health needs
Medicare Readiness — Common Questions
When is the best time to review my Medicare coverage?
The Annual Enrollment Period (Oct 15 – Dec 7) is the primary window to switch plans. However, you should also review when you receive your Annual Notice of Change in September, when your health situation changes, or when you move to a new area.
Can I switch from Medicare Advantage to Original Medicare at any time?
You can switch during AEP (Oct 15 – Dec 7) or during the Medicare Advantage Open Enrollment Period (Jan 1 – Mar 31). Outside these windows, you generally need a Special Enrollment Period qualifying event.
What is the Medicare Initial Enrollment Period?
Your IEP is a 7-month window: 3 months before your 65th birthday month, your birthday month, and 3 months after. Missing this window without creditable coverage can result in permanent late enrollment penalties.
Does Medicare cover long-term care?
Medicare covers short-term skilled nursing facility care (up to 100 days) after a qualifying hospital stay, but does NOT cover custodial long-term care. A separate long-term care insurance policy is needed for extended nursing home or home care.
Ready for Your Free Medicare Readiness Review?
Jaime Avila is CMS-certified and bilingual. He'll compare available plan options based on your doctors, prescriptions, and budget — at no cost to you.
Licensed in Florida · CMS-certified · Bilingual · No obligation