Medicare and Medicaid at 50: America's Entitlement Programs in the Age of Affordable Care
Short, readable essays by leading scholars tracing how Medicare and Medicaid started in 1965 and how they changed over 50 years.
Learn more ↗Library
Want to understand Medicare and health care better? These books and free guides are a good place to start.
Recommended Books
Available at bookstores and libraries.
History
How HMOs Work
The Social Transformation of American Medicine
The classic, Pulitzer-winning history of how American medicine went from small-town doctors to big hospitals, health plans, and corporations (updated edition, 2017).
Learn more ↗Why Health Care Costs So Much
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back
A doctor-turned-reporter explains in plain language why American health care bills are so high — and what patients can do about it.
Learn more ↗The Price We Pay: What Broke American Health Care—and How to Fix It
A surgeon travels the country showing where health care money really goes, and profiles people fixing the system from the inside.
Learn more ↗Practical Guides
Medicare For Dummies, 5th Edition
The friendliest step-by-step guide to enrolling in Medicare, avoiding penalties, and choosing between Original Medicare and Medicare Advantage.
Learn more ↗Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (Revised and Updated)
A consumer guide to getting the most from Medicare — when to enroll, how to choose plans, and how to use your benefits well.
Learn more ↗Free Official Resources
Medicare & You Handbook (2026 edition)
Centers for Medicare & Medicaid Services (CMS)FreeMedicare's official handbook, mailed to every Medicare household each fall — the definitive reference on your benefits, costs, rights, and protections. 2026 edition current.
Open resource ↗MedPAC Report to Congress (June 2026)
Medicare Payment Advisory Commission (MedPAC)FreeCongress's own Medicare advisory commission reports on what works, what doesn't, and where the $1.1 trillion program is headed. Latest: June 2026, “Medicare and the Health Care Delivery System.”
Open resource ↗An Overview of Medicare (KFF)
KFFFreeA clear, nonpartisan explainer of what Medicare is, who it covers, and how it's financed, from the health policy researchers at KFF.
Open resource ↗10 Things to Know About Medicaid (KFF)
KFFFreeTen plain-language facts about Medicaid — who it covers, what it pays for, and why it matters — from KFF's researchers.
Open resource ↗Medicare Interactive (Medicare Rights Center)
Medicare Rights CenterFreeA nonprofit helpline (800-333-4114) and searchable website answering real Medicare questions in plain English — no sales, no insurance ties, helping since 1989.
Open resource ↗Organizations That Help Seniors
Search trusted national and Florida organizations for benefits, caregiving, meals, fraud help, healthy aging, and more.
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- No insurance company or plan pays us for your plan choice.
- Plan information comes from official CMS data and is presented the same way for everyone.
- Before enrolling, verify plan details with Medicare.gov or the plan.
Senior Care
Your guide to healthcare after 65 — Medicare and Medicaid, side by side.
National enrollment trend
People covered (millions)
Medicare grows as baby boomers age in; Medicaid is projected to decline under the 2025 reconciliation law's eligibility changes (CBO).
National figures — no official county or state projections exist.
Source: 2026 Medicare Trustees ReportSource: CBO February 2026 baseline
Florida county coverage
Select a covered county on the map to open its data.
Counties covered
Not yet covered
Florida at a glance
County coverage—Florida residents—Loading covered population…
—Medicare beneficiaries—Loading covered beneficiaries…
—Medicaid enrollees—Loading covered enrollees…
Official source vintages: Florida EDR population, April 1, 2024 ↗ · CMS MA State/County, September 2026 · Florida AHCA Medicaid, June 30, 2026 ↗
Florida healthcare news
Recent reporting from major Florida newspapers
Free visibility report for healthcare businesses
Find out how your business appears on Google and in our directory. A free report, no obligation.
A claim form is coming soon. Please check back.
Headlines are shown with newspaper attribution; links open the original article and may require a subscription.
Medicare
Coverage choices and plan data for Miami-Dade.
553plans for 2027
475$0-premium plans
457HMO-type plans
$3.14Average monthly premium (2027)
57.4%enrolled in a Medicare Advantage plan
—eligible for Medicare · Sep 2026
3,076,234enrolled in Medicare Advantage · Sep 2026
Oct 15–Dec 72026 Annual Enrollment Period
December 2025: 3,010,620 enrolled of 5,265,983 eligible (57.17%). September 2026: 3,076,234 of {stateMedicareTotal} (57.36%). State totals summed from county data.
Medicaid
Eligibility, senior programs, updates, events, and application help.
~3.9MFloridians covered
4senior programs
$202.902026 Part B premium QMB can pay
Jun 2026state enrollment snapshot
Have both? Start here
See if a D-SNP plan built for people with both Medicare and Medicaid fits you.
In 2026, 23% of Medicare Advantage enrollees are in Special Needs Plans, which accounted for 85% of net enrollment growth. Source: KFF, 2026 ↗
Medicare Parts
A simple guide to what each part covers and what you may pay.
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AHospital insurance
Part A
Covers hospital stays, skilled nursing facilities, hospice, and some home health care. Most people pay no monthly premium if they or their spouse paid Medicare taxes for at least 10 years.
BMedical insurance
Part B
Covers doctor visits, outpatient care, preventive services, and medical equipment. You pay a monthly premium and usually a yearly deductible.
DPrescription drug coverage
Part D
Helps pay for medications. Private Medicare-approved plans offer it, often as part of a Medicare Advantage plan or as a separate plan. You pay a premium and copays. A late-enrollment penalty may apply if you go without drug coverage for a long stretch.
Medicare Advantage (Part C): A private plan that bundles Parts A and B and usually Part D into one plan.
Supplemental coverage (Medigap)
Private plans that help pay some costs Original Medicare does not cover, such as deductibles, copays, and coinsurance. They work only with Original Medicare, not Medicare Advantage. You pay a separate monthly premium in addition to your Part B premium.
Original Medicare vs. Medicare Advantage
Original Medicare is Parts A and B, run by the federal government. You can use any doctor or hospital in the country that takes Medicare. If you want drug coverage (Part D) and supplemental coverage (Medigap), you add them separately. Private companies approved by Medicare offer Medicare Advantage (Part C). It combines Parts A and B and usually Part D, often with extra dental, vision, hearing, and over-the-counter benefits. You use the plan’s doctor network and follow its rules, including referrals or prior approval when required.
Good to Know About Medicare
Four important points that can help you avoid surprises and know what to do next.
Medicare Advantage vs. Medigap
Medicare Advantage
One private plan takes the place of Original Medicare. Many plans have a $0 plan premium and include drug coverage plus extras such as dental, vision, and hearing. You usually must use the plan’s doctors and follow its network rules.
Medigap supplement
You stay on Original Medicare and pay a separate monthly premium. Medigap helps cover the 20% Original Medicare usually leaves you to pay. You may see any doctor who takes Medicare, but you need a separate Part D plan for medications.
Trade-off: Medicare Advantage may cost less each month and offer extras, but uses plan networks. Medigap usually costs more each month, but gives you broader doctor choice and more predictable medical costs. Neither is best for everyone.
This dashboard shows Medicare Advantage plan details from CMS data. Medigap premiums vary by insurer and are not included here.
Late enrollment penalties
Part B
Your Part B premium can go up 10% for each full 12-month period you were eligible but did not enroll. You pay that higher amount for as long as you have Part B.
Part D
The penalty is 1% of the national base premium for every month you went without drug coverage. It is added to your Part D premium permanently.
Signing up on time matters. You generally avoid these penalties if you had creditable coverage, such as an employer plan that was at least as good as Medicare coverage.
IRMAA — higher premiums for higher incomes
If your 2024 income was above certain limits, Social Security adds an extra amount to your normal Part B and Part D premiums in 2026.
| 2024 income — single | 2024 income — joint | Part B premium | Part D extra |
|---|---|---|---|
| 2024 income — single≤ $109,000 | 2024 income — joint≤ $218,000 | Part B premium$202.90/mo | Part D extra$0 |
| 2024 income — single$109,001–$137,000 | 2024 income — joint$218,001–$274,000 | Part B premium$284.10/mo | Part D extra$14.50/mo |
| 2024 income — single$137,001–$171,000 | 2024 income — joint$274,001–$342,000 | Part B premium$405.80/mo | Part D extra$37.50/mo |
| 2024 income — single$171,001–$205,000 | 2024 income — joint$342,001–$410,000 | Part B premium$527.50/mo | Part D extra$60.40/mo |
| 2024 income — single$205,001–$499,999 | 2024 income — joint$410,001–$749,999 | Part B premium$649.20/mo | Part D extra$83.30/mo |
| 2024 income — single≥ $500,000 | 2024 income — joint≥ $750,000 | Part B premium$689.90/mo | Part D extra$91.00/mo |
Did your income fall because of retirement, divorce, or the death of a spouse? You can ask Social Security to lower the extra charge using form SSA-44.
If your plan says no — appeals
A denial is not the end. If your plan denies care or a medication, you can appeal.
- Ask the plan again.Request an appeal from the plan itself. Ask for a fast appeal if waiting could harm your health.
- Independent review.If the plan still says no, an organization not connected to the plan reviews the decision.
- More levels are available.You may continue to further review levels, including a hearing.
Deadlines are short, so act fast. Your doctor can help, and you can appoint someone you trust to appeal for you. Get free help from Florida SHINE ↗
How Medicare pays your health plan
Here’s the simple version: Medicare pays your health plan every month to help cover your care.
Capitation
Capitation is the monthly payment. Medicare pays a Medicare Advantage plan a set amount each month for each enrolled member. It is paid whether or not that person receives care during the month.
RAF score
RAF means Risk Adjustment Factor. It is a number Medicare uses to adjust the monthly payment for a person’s expected health needs. A score near 1.0 is average; a higher score generally increases the payment to the plan. It does not by itself change what the member pays.
- A monthly payment for you. Medicare pays your health plan a fixed amount each month for you—not for each doctor visit. The plan is paid whether you go to the doctor that month or not.
- It starts with your county. The starting amount is based on the average cost of care where you live.
- Your health needs matter. Everyone gets a health score. Around 1.0 means average health. A higher score means more health needs, so Medicare pays the plan more for your care.
- The score is updated each year. It comes from your age and the health conditions your doctors report each year.
- Your annual checkup helps. This is one reason your plan encourages you to use your free annual checkup: it keeps your health record up to date.
- Use the benefits you have. Your plan already gets paid for you every month. Use the dental, vision, checkup, gym, and other benefits that come with it—they are part of what Medicare is paying for.
An honest note: There is a public debate about this system. Some people say plans record more health conditions than needed so they receive more money. The government watches for this.
Your score is private. Only you, your plan, and Medicare can see your personal score. Nobody can look it up online.
Monthly payment at RAF score 1.0, by county
Compare the 2027 base monthly benchmark for all 67 Florida counties.
| With 3.5% quality bonus | With 5% quality bonus |
|---|
This number is CMS's per-county benchmark — what Medicare pays the plan each month for a member with average health (RAF score 1.0).
The base rate is before the plan's own bid and rebate adjustments. Quality bonus rates apply only to qualifying plans.
Source: CMS CY 2027 Medicare Advantage Ratebook, county monthly capitation rates (Parts A & B).
What Medicare Pays
A plain-language look at national average payments for common care.
These are national averages — what Medicare actually pays varies by where you live and where you get care.
| Service | What Medicare pays (national average) | Per |
|---|
Doctor's fee only — the facility charges separately.
Sources: CMS Physician Fee Schedule 2026, Medicare Procedure Price Lookup, CMS final rules. See each row's source.
How Miami-Dade compares
Figures summarized from KFF analyses; see sources.
Medicare Advantage enrollment
75.2%Miami-Dade enrollees
55%eligible beneficiaries nationally
Average monthly premium
$6.46Miami-Dade 2027 plans
$15national supplemental premium
$0 premium beyond Part B
79%of Miami-Dade 2027 plans
75%of enrollees nationally
HMO-type
79%of Miami-Dade 2027 plans
61%of MA drug-plan enrollees nationally
Best Medicare Advantage companies 2026
A company-level U.S. News rating — separate from the CMS plan ratings shown below.
National bests
Aetna Medicare3.9
Devoted Health4.0
UnitedHealth Group3.9
In Florida
Devoted Healthconfirmed
Other Florida designees for 2026 were not publicly confirmed in the sources reviewed.
Category awards
- Screening & prevention: Aetna Medicare, Devoted Health
- Care continuity: Aetna Medicare, Devoted Health
- Satisfaction: Aetna Medicare, Cigna Healthcare, Elevance Health, Molina Healthcare, UnitedHealth Group
Rated by U.S. News using CMS data and 37 quality measures.
Find a short list — then verify it
Answer a few practical questions to narrow the CMS plan and facility directories. This is a starting point, not an enrollment recommendation.
Find a plan
Search all 101 Medicare Advantage plans listed for Miami-Dade in 2027. Costs shown are plan-level amounts, not a personal quote.
In 2026, 68% of Medicare Advantage enrollees are in plans rated 4 stars or higher and eligible for bonuses — the lowest share since 2018. Federal quality-bonus spending is $13.4 billion. Source: KFF, 2026 ↗
PlanTypePremiumMOOP2027 ratingCompare
What do these terms mean?
HMOUsually requires in-network care and a primary care doctor.
PPOMay allow out-of-network care, often at a higher cost.
SNPA Special Needs Plan for people with specific conditions or circumstances.
MOOPThe annual in-network maximum you pay for covered medical services.
PremiumThe monthly amount for the plan; other costs can still apply.
Check Your Medications
Search one medication at a time to compare coverage across plans in the selected county.
Choose a name from the suggestions.
Choose a Florida county above, then search for a medication.
The amount shown is for a 30-day supply at a preferred retail pharmacy during the plan's initial coverage period. Your actual cost can vary by pharmacy and coverage stage. The tier shown is the most common tier across strengths; your exact strength may differ.
This search covers the most common ~500 medications. For rarer medications, use Medicare Plan Finder. Open Medicare Plan Finder ↗
Medication information comes from CMS's September 2026 formulary release. A 2027 update is planned.
Compare up to 5 plans
Use the plan list to add plans. Compare these core fields, then confirm doctors, prescriptions, pharmacies, and full benefits directly with Medicare or the plan.
What changed for 2027?
A plan appearing or disappearing from the county list does not tell you whether a similar replacement is right for you. Review your Annual Notice of Change.
Total plans
115 → 101
HMO-type plans: 94 → 80Premium increased10continued plans
Premium decreased18continued plans
Premium unchanged50continued plans
New for 2027 · 16
Not listed for 2027 · 30
· 0
Plan availability and enrollment
See how the comparable non-SNP market changed from 2021 through 2027, alongside Medicare Advantage enrollment in Miami-Dade.
Medicare Advantage penetration — Florida
Share of eligible seniors enrolled in a Medicare Advantage plan
County rankings
Compare the 21 covered counties using 2027 plan data and September 2026 enrollment.
Sources: CMS 2027 Landscape files and CMS MA State/County Penetration file, September 2026.
Plan availability — Florida
All non-SNP plansHMO non-SNP plans
Scope note: CMS Landscape files for 2021–2024 exclude Special Needs Plans. The line chart therefore uses the comparable non-SNP series for every year. The all-plan totals below are shown only for 2025–2027, when SNPs are included.
2025 · 109all plans · 93 HMO-type
2026 · 115all plans · 94 HMO-type
2027 · 101all plans · 80 HMO-type
For context: December 2025 recorded 392,183 enrolled of 518,940 eligible (75.57%). September 2026 recorded 396,635 of 527,506 (75.19%).
Medicare Advantage enrollment by state
Compare September 2026 enrollment across HMO, PPO, and other Medicare Advantage plan types. Select a numeric column to sort the states.
Plan type
Source: CMS Monthly Enrollment by Contract/Plan/State/County (CPSC), September 2026; HMO includes HMO-POS; PPO combines local and regional PPO; Other = PFFS, MSA, and cost plans; CMS masks cells of 10 or fewer members so small-state totals run slightly below published totals. CMS source ↗
Organizations behind the plans
Fifteen parent organizations offer HMO-type plans in Miami-Dade for 2027. A stock ticker identifies a publicly traded parent—not a plan quality score.
Provider and facility categories
Choose a major category, then a subcategory. Real CMS directories are loaded for institutional providers and for clinics, group practices, and Part B suppliers; remaining directories are clearly marked as not yet loaded.
Where Medicaid is generally accepted
Medicaid acceptance varies by facility type. Nursing homes, hospitals, home health agencies, hospices, and dialysis centers generally accept Medicaid. Assisted living facilities are mostly private-pay, and medical equipment suppliers vary. Call the facility to confirm before you visit.
Directory listing is not plan-network status
These are CMS facility records, not a specific HMO network. Confirm coverage with the plan and facility before receiving care. Ratings and directory entries can change.
1Select a category
2Select a subcategory
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Coverage Gaps
What you get — and what you don't.
What Medicare covers
Part A — Hospital
Hospital stays, skilled nursing (up to 100 days), hospice, some home health.
Part B — Medical
Doctor visits, outpatient care, preventive services. Monthly premium $202.90 (2026) plus 20% of most services.
Part D — Drugs
Deductible up to $615 (2026), out-of-pocket cap $2,100 (2026).
The gaps
No annual out-of-pocket cap
Original Medicare has no yearly limit on what you pay. A bad year can cost tens of thousands.
How people fill itMedicare Advantage plans cap yearly spending (federal max ~$9,350 in 2026). Medigap also limits costs.
Routine dental
Cleanings, fillings, dentures — not covered.
How people fill itSome MA plans include dental. Standalone dental plans or Medicaid (if dual-eligible) can fill it. 98% of Medicare Advantage enrollees had dental benefits in 2025. Source: KFF, 2026 ↗
Routine vision
Eye exams for glasses and eyeglasses — not covered.
How people fill itSome MA plans include vision. Standalone vision plans or Medicaid (if dual-eligible) can fill it. 99% of Medicare Advantage enrollees had eye-exam or glasses benefits in 2025. Source: KFF, 2026 ↗
Hearing aids
Hearing exams and hearing aids — not covered.
How people fill itSome MA plans include hearing. Medicaid covers it if you are dual-eligible. 95% of Medicare Advantage enrollees had hearing-exam or hearing-aid benefits in 2025. Source: KFF, 2026 ↗
Long-term custodial care
Nursing home stays beyond 100 days and help with daily living — not covered.
How people fill itMedicaid long-term care if you qualify, long-term care insurance, or private pay.
Drug costs
Even with Part D: deductible up to $615 plus copays until the $2,100 yearly cap (2026).
How people fill itExtra Help (LIS) pays Part D costs for people with limited income — apply through Social Security.
Part B 20% coinsurance
You pay 20% of most outpatient services, with no annual cap.
How people fill itMedigap, a Medicare Advantage plan, or Medicaid (QMB covers it for duals).
Care outside the U.S.
Medicare generally doesn't cover care abroad.
How people fill itSome Medigap plans cover foreign travel emergencies (limited); otherwise travel insurance.
Prior authorization
A Medicare Advantage plan may require approval before it covers some doctor-ordered care. This affects 99% of MA enrollees for at least some services. Source: KFF, 2026 ↗
How people fill itAsk your plan which services need advance approval. If coverage is denied, you can appeal; SHINE offers free help.
Sources: Florida SHINE 2026 chart; CMS Medicare prescription drug coverage; J.D. Power 2026 Medicare Advantage study document.
Where Medicaid has limits
Fewer providers accept Medicaid
Many doctors and dentists don't take Medicaid, and networks are narrower. Always check your MMA plan's directory.
How people fill itUse your plan's provider finder or call Choice Counseling: 1-877-711-3662.
You must stay eligible
Income and assets must stay under the limits, with yearly renewal. A raise or an inheritance can end coverage.
How people fill itReport changes promptly and keep your DCF information current; a Miller Trust can help for long-term care.
Waiver waitlists
Some programs that pay for home-based care have waits stretching years. Apply as early as you can.
How people fill itAsk the Alliance for Aging about current timelines for the program you need.
Adult dental & vision limits
Adult Medicaid dental and vision benefits are narrower than children's — often emergencies and basics only.
How people fill itCommunity health centers (FQHCs) offer sliding-scale dental; D-SNP plans may add more.
Emergency-only outside Florida
Medicaid generally covers only emergency care outside your state.
How people fill itPlan ahead when traveling; consider travel insurance.
What's covered between the two
Part B premium → paid by Medicaid (QMB)
Deductibles & copays → paid by Medicaid
Nursing home beyond 100 days → Medicaid
Dental, vision, hearing → Medicaid or D-SNP extras
Gaps that can remain
Finding doctors who take both programs
Many doctors and dentists don't take Medicaid, and networks are narrower. Always check your MMA plan's directory.
How people fill itUse both program directories; SHINE counselors help for free.
Waiver waitlists for home-based care
Some programs that pay for home-based care have waits stretching years. Apply as early as you can.
How people fill itAsk the Alliance for Aging about current timelines for the program you need.
Coordinating two programs
Two cards, two sets of rules, two phone numbers.
How people fill itA D-SNP plan puts both under one roof — check the finder.
Check my gaps
Answer five questions for a quick coverage check. Verify benefits with your plan before making a change.
What you're paying
A rough guess is fine.
Your results
Per month—
Per year—
Since you turned 65—
So far this year—
Estimated — assumes today's amounts held steady. Actual premiums were lower in earlier years.
Medicaid itself usually has no monthly premium — these are Medicare costs. If Medicaid pays your Part B premium, check the box above.
Free Medicare and health events near you
Find free Medicare information sessions, health screenings, workshops, and online events for Miami-Dade seniors.
Updated weekly
Every event listed is free
Check the organizer's page before attending because schedules, locations, and registration requirements can change.
Recurring series
Important Medicare dates
Mark these dates if you are reviewing 2027 coverage.
Oct 152026
Annual Enrollment begins
From October 15 through December 7, 2026, you can join, switch, or drop a Medicare Advantage or Part D plan for 2027 coverage.
Dec 72026
Annual Enrollment ends
Your last day in the Annual Enrollment Period for changes that generally begin January 1, 2027.
Jan 12027
2027 coverage begins
New plan-year coverage starts. The Medicare Advantage Open Enrollment Period also begins.
Mar 312027
Medicare Advantage Open Enrollment ends
This period is for people already enrolled in Medicare Advantage; eligible changes are more limited than during fall enrollment.
2027 market news
A dated snapshot of news relevant to Florida Medicare Advantage choices. This feed does not update automatically.
Florida has fewer Medicare Advantage plans for 2027
CMS data show a statewide change from 600 plans in 2026 to 553 in 2027 — 47 fewer plans (121 exited; 74 new).
National Medicare Advantage market reshuffles
A reported 1,148 new plans and 1,229 departures nationally for 2027.
CMS releases the 2027 Medicare Advantage landscape
CMS says Medicare Advantage and prescription drug premiums are expected to remain stable nationally in 2027.
Hialeah reaches $2.4M settlement over disputed hospital utility bills
The City of Hialeah settled $2.4 million in disputed water and sewer charges with Healthcare Systems of America, the operator of Hialeah Hospital and Palmetto General Hospital, after the ownership change. About $561,000 tied to Steward remains outstanding.
Florida PunditJudge approves sale of 7 Steward hospitals to Healthcare Systems of America
A bankruptcy judge approved the sale of seven Steward hospitals to Healthcare Systems of America, including four in Miami-Dade: Coral Gables Hospital, Hialeah Hospital, North Shore Medical Center, and Palmetto General Hospital. Steward had filed Chapter 11 in May 2024.
Becker's Hospital ReviewHealthcare Systems of America named interim manager of five Florida Steward hospitals
A bankruptcy court named Healthcare Systems of America interim manager of Coral Gables, Florida Medical Center, Hialeah, North Shore, and Palmetto General hospitals while Steward's bankruptcy sale moved forward.
Becker's Hospital ReviewFeed items in English; sources linked.
Fraud Watch
Scammers and dishonest providers steal billions from Medicare and Medicaid every year. Here’s the latest fraud cases — know the schemes so you can spot them.
Medicare fraud
Official enforcement sourcesFlorida lab vice president and marketer convicted in $15 million Medicare testing scheme
A federal jury found them guilty after Medicare was billed for unwanted and unnecessary tests added to COVID-19 testing.
HHS-OIGTwo Florida men sentenced in $34.8 million Medicare brace scheme
They used seven medical-equipment companies to bill Medicare for unneeded braces, including braces beneficiaries did not request. The sentences were 33 and 24 months.
U.S. Department of JusticeThe Villages Health System agrees to $541.5 million settlement
The Florida provider group agreed to resolve allegations that unsupported diagnosis codes increased Medicare Advantage payments.
HHS-OIGMedicaid fraud
Official enforcement sourcesArizona clinic owner sentenced to 14 years in $69 million Medicaid scheme
The clinic billed for addiction treatment that was not provided, paid kickbacks, falsified records, and targeted Native American patients in a higher-payment program.
U.S. Department of JusticeIowa attorney sent to prison in Medicaid eligibility fraud scheme
Prosecutors said he used sham luxury-car transactions to help older clients appear eligible for Medicaid-funded nursing home care.
U.S. Department of JusticeFlorida Attorney General announces arrests in Medicaid transportation case
Two people were charged over alleged false gas-reimbursement claims for medical transportation trips that did not happen.
Florida Attorney General · Medicaid Fraud Control UnitThis is a dated snapshot. Cases may have changed since publication. Charges and allegations are not convictions unless the item says so.
Trusted help and official sources
Use these links to verify plan details or get unbiased help.
Medicare Plan FinderCompare official plan details and estimated costs.
Florida SHINE counselingFree, unbiased Medicare counseling in Florida.
CMS landscape downloadsOfficial source files used for this snapshot.
KFF Medicare dataIndependent analysis and national Medicare context.
Florida AHCAFlorida health care facility and agency information.
Find other Medicare-certified facilities
Use Medicare Care Compare to search nursing homes, hospices, and home health agencies. These listings describe Medicare-certified providers, not participation in a specific HMO network.
Doctor counts are not published by CMS
Per-plan doctor counts are not available in this dataset, and provider directories can be inaccurate. Use the plan’s current directory and call the provider to confirm network status.
Choose your providers
Build a simple care team list from the providers, plan, and medications you choose.
No account, personal name, or date of birth is requested.
Choose your providers
Add or remove providers and medications anytime. Each change updates this page's link.
HMO Plan
Search 2027 HMO plans by plan or organization name.
Hospital
Search the selected county's hospital directory.
Pharmacy
Choose a listed pharmacy or type another name.
Home Care
Search the selected county's home health directory.
Doctor
No physician directory is included. Add the name exactly as you type it.
Medical Equipment (DME)
Search the selected county's medical equipment directory.
Medications
This list is for reference only — talk to your doctor or pharmacist about your medications.
My Care Team List
Your provider and medication selections, with related company news, newest first.
Top 10 diseases
Most common chronic conditions among Medicare beneficiaries
Figures are for Medicare fee-for-service beneficiaries (including some under-65 people with disabilities), are based on claims, and use 2021—the latest ranked year published.
Medicaid in Florida
Understand senior programs, dual eligibility, and the 2026 limits to verify before applying.
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Reach Florida families looking for Medicaid help
Healthcare organizations can share a simple, useful message with people learning about Medicaid.
Advertising information is coming soon. Please check back.
Have both Medicare and Medicaid?
If you qualify for both, you're called dual-eligible. Medicaid can pay your Medicare premiums, deductibles, and copays — and you may join a special D-SNP plan built for people with both.
In Florida, 17% of Medicare beneficiaries are dual-eligible: 8% receive full Medicaid benefits and 9% receive partial assistance. Source: KFF, 2026 ↗
Programs for seniors
Regular Medicaid — Aged & Disabled
Full Medicaid for 65+ or disabled. 2026: $1,171/month individual ($5,000 assets); $1,588/month couple ($6,000 assets).
Nursing Home / Long-Term Care Medicaid
Covers nursing home or home-based long-term care. 2026: $2,982/month individual ($2,000 assets). Over the limit? A Qualified Income (Miller) Trust can help you qualify.
Medically Needy (Share of Cost)
No hard income limit. You pay a monthly 'share of cost' (like a deductible); Medicaid covers the rest once it's met.
Medicare Savings Programs
QMB pays your Part A & B premiums, deductibles, and coinsurance (2026: $1,330/month individual). SLMB/QI help with the Part B premium.
Important Medicaid details
Four things to understand before you choose a plan, spend down, or apply for long-term-care help.
Share of Cost
Over the income limit? You may still qualify.
Florida’s medically needy program lets you “spend down.” When your medical bills reach your set share of cost for the month, Medicaid covers eligible care for the rest of that month.
- It starts over each month.
- You must have medical bills that meet the amount.
- You must apply through ACCESS Florida.
Dual plan types
Special plans for people with both Medicare and Medicaid.
- D-SNP: a Medicare Advantage plan for people with both programs; it coordinates the two coverages.
- FIDE-SNP: fully integrated; one company runs both Medicare and Medicaid for the simplest experience.
- HIDE-SNP: highly integrated; the coverage is coordinated but less fully combined.
If you have both cards, ask whether your plan is one of these. They coordinate more benefits than a regular Medicare Advantage plan.
Estate recovery and the 5-year look-back
Two things to know before applying for long-term-care Medicaid.
Estate recovery After you pass away, Florida may seek repayment from your estate for long-term-care Medicaid it paid. Your home may be affected.
5-year look-back Giving away money or property during the five years before applying can make you ineligible for months.
Do not transfer assets without legal advice. Talk with a Florida elder-law attorney before applying. This is a warning, not legal advice.Applying for Florida Medicaid in 3 steps
- Apply at myflorida.com/accessflorida or call 1-866-762-2237.
- Have ready: ID, Social Security number, proof of income, proof of Florida residency, and information about your assets.
- Watch for mail from DCF and respond quickly. Deadlines are short.
SHINE counselors can help you apply for free: 1-800-963-5337.
2026: Medicaid Planning Assistance ↗ · Florida SHINE ↗
2026 limits:
Limits shown are 2026 figures and change yearly — always confirm with DCF or a SHINE counselor.
Florida Medicaid plan directory
Choose your county to see the Medicaid managed-care plans that serve it.
MMA health plans
MMA is your regular Medicaid health plan for doctor visits, hospital care, and prescriptions.
Long-Term Care (LTC) plans
LTC helps with nursing home care, a home health aide, and assisted-living support.
If a plan website does not open, call member services.
Choose a county to see its Medicaid plans.
SMMC 3.0 contracts effective February 1, 2025 · snapshot checked October 11, 2026. Official Florida Medicaid managed care site ↗
For patients & seniors — especially dual-eligible 65+
Where Medicaid supplements Medicare.
$1,171/mo
Eligibility & Renewal Success
The key question for seniors: do you stay covered year after year? Know your program's income and asset limits, and keep your information current with DCF so renewal succeeds.
MEDS-AD individual income limit · 2026 · Check limits ↗
Check locally
Provider Access
What share of primary care doctors, specialists, dentists, and nursing homes near you accept Medicaid — and can you get an appointment within 30 days? Always check your MMA plan's provider directory.
$202.90/mo
Out-of-Pocket Cost Protection
For dual-eligibles, Medicaid can pay the Medicare Part B premium ($202.90/month in 2026), deductibles, and copays. For a QMB beneficiary that's over $2,400 a year in premium savings alone.
Part B premium covered by QMB · 2026 · Florida SHINE ↗
100 days
Long-Term Care Coverage Breadth
Medicare covers skilled nursing up to 100 days (with cost-sharing after day 20) — then stops. Medicaid covers what Medicare doesn't: nursing home stays beyond 100 days, home health aide hours, personal care, adult day care, dental, vision, hearing, and rides to appointments.
Where Medicare skilled-nursing coverage stops
Ask now
Wait Times & Care Experience
Some Florida waiver programs have waits stretching years — ask the Alliance for Aging about current timelines for the program you need. For plan quality, check CAHPS patient-experience scores on Medicare.gov.
3 outcomes
Health Outcomes That Matter
Three outcomes worth watching: avoidable hospital stays, avoiding nursing home placement when home care would do, and the share of seniors receiving care at home or in the community versus in an institution.
No county-level measure is shown; ask your plan or care manager.
No Miami-Dade provider-acceptance percentage, appointment wait time, waiver wait time, or CAHPS score is claimed here. Check current figures with your plan, provider, or local aging-services counselor.
Medicaid news
Verified updates relevant to Florida Medicaid members and families.
Medicaid events
Free local and online events tagged for Medicaid, dual eligibility, or general senior health.
Updated weekly
Every event listed is free
Check the organizer's page before attending because schedules, locations, and registration requirements can change.
Recurring series
Get Medicaid help
Apply through Florida ACCESS or speak with a free counselor before choosing a managed-care plan.
How to apply
Apply online through Florida's ACCESS portal (MyACCESS). DCF decides eligibility; AHCA runs the program.
Choice Counseling (free help choosing a plan)1-877-711-3662Mon–Thu 8am–8pm; Fri 8am–7pm
Paper application by phone1-850-300-4323
SHINE counselors give free, unbiased Medicare/Medicaid help.
Florida SHINE ↗2026 limits:
Limits shown are 2026 figures and change yearly — always confirm with DCF or a SHINE counselor.
Pharmacy directory
Search for a pharmacy in the selected county.
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Put your pharmacy in front of local seniors
Pharmacies can use this space to share services, locations, or helpful information with older adults nearby.
Advertising information is coming soon. Please check back.
Hours aren't in our data — call ahead to confirm a pharmacy is open, especially late at night.
Retail pharmacies are local places where you pick up medicine. Mail-order pharmacy options send covered medicine to your home; check your plan to see which service it uses and what it costs.
Most costly medications in Medicare Part D
The medicines with the highest total spending nationwide in 2024.
Important: These are gross costs paid by Medicare, plans, and members before manufacturer rebates. CMS cannot publish the rebate amounts.
Source: CMS Medicare Part D Spending by Drug, 2024.
Directory data: Centers for Medicare & Medicaid Services national provider registry, September 2026. Call the pharmacy and your plan to confirm current details and network status.