Ratings, costs and honest tradeoffs

Medicare Advantage Plans Rated and Cost-Compared in Florida

Every fall, carriers roll out new Medicare Advantage plans for Florida counties, and every plan looks attractive in its own brochure. My job is to put the ratings and the real costs side by side for your doctors and your prescriptions. I am Lourdes Hernandez, and I serve Palm Beach and Broward counties in English and Spanish.

How Medicare Advantage Plans Are Rated: The 5-Star System

Medicare scores every Advantage plan from 1 to 5 stars each year, using measures that include customer service, complaint rates, member experience, how well plans manage chronic conditions, screening tests and drug safety. The ratings are public on Medicare.gov, and a plan with 4 or more stars is performing well by Medicare's own yardstick. One rule worth knowing: a plan that reaches 5 stars in your county comes with a special enrollment period, so you can join it outside the normal windows once per year.

I check ratings for every plan I quote, but I also tell clients what the stars cannot do. A rating averages the experience of thousands of members across Florida. It cannot tell you whether your cardiologist in Boca Raton is in the network, whether your medication sits in a low tier, or whether the plan's prior authorization rules will slow down the scan your doctor ordered. Stars are one input in the decision, not the verdict, and I treat them that way when we compare plans together.

How Much Does Medicare Advantage Plans Cost in Florida?

The honest answer is that costs vary by county, by carrier and by the specific plan, so I will not quote you a number that could be wrong tomorrow. What I can do is show you the full set of numbers that matter. The monthly premium is the entry fee, and many Florida plans advertise a premium of zero. After that come the copays for doctor visits, the deductible, the coinsurance on bigger services, and the drug tier costs for each medication you take.

The number I focus on most is the maximum out-of-pocket, the annual cap on what the plan can charge you for covered care in network. Two plans with identical premiums can have very different caps, and in a heavy care year that cap is what separates a manageable bill from a frightening one. Plans also differ on what happens out of network, and in an HMO there may be no out-of-network coverage at all except emergencies. When we compare plans for your household, I put all of these lines in the same table so nothing hides.

What $0-Premium Plans Really Cost You in Palm Beach & Broward Counties

Zero-premium plans are everywhere in Palm Beach County and Broward County, and I want to be clear that many of them are solid, legitimate options. The premium is real money saved. What the brochure does not show is where the plan recovers it: higher copays at specialists, tighter networks, prior authorizations, a drug tier list that places your medication higher, or a maximum out-of-pocket that sits toward the ceiling of what plans are allowed to charge.

Here is how I walk a client through it in Delray Beach or Coral Springs. We list the care you actually used last year: the visits, the tests, the therapies, the prescriptions. We price that same year of care under each plan being considered, including the zero-premium one. Sometimes the zero-premium plan wins and the tradeoffs are ones you never feel. Sometimes a plan with a modest monthly premium is cheaper by the end of the year because your copays land lower. Neither answer is wrong; the goal is to decide with the arithmetic in front of you instead of the headline.

The other honest note: plan options and premiums genuinely differ between counties. A neighbor in Fort Lauderdale may be looking at a different carrier list than you are in West Palm Beach, so never assume what a friend was offered applies to you.

Do Medicare Advantage Plans Cover Hospice Care?

Yes, and here is the detail worth understanding. Every Medicare Advantage plan must cover hospice care, but the hospice benefit itself runs through Original Medicare. When a person on an Advantage plan elects hospice, they return to Original Medicare for that care and its related services, and the Advantage plan typically continues to cover the rest of their care that is unrelated to the terminal illness. In practice, the hospice team coordinates with the plan, and your Medicare card is what the hospice provider bills.

I raise this because families in Fort Lauderdale and Sunrise sometimes hear in an Advantage sales pitch that hospice is "included," which is technically true of all plans and says nothing about the quality of that specific plan's coordination. When someone in your family is facing a serious illness, what matters is whether the plan's care management works smoothly with the hospice agency, and that is a question I help clients ask directly rather than assume from a brochure.

How to Compare Ratings and Costs Side by Side

When I sit down with a client, the comparison always runs in the same order. First, networks: are your doctors, hospitals and pharmacies in each plan, checked against the current list rather than last year's. Second, prescriptions: each medication against each plan's formulary and tier, because a single drug can change the ranking of every plan on the page. Third, the money: premium, deductible, copays for the visits you actually make, and the maximum out-of-pocket. Fourth, extras: dental, vision, hearing, fitness and transportation, counted only if you would genuinely use them.

Fifth, the timing rules. Your Initial Enrollment Period is the 7 months around your 65th birthday, three months before, the month of, and three months after. Medicare Open Enrollment runs October 15 through December 7 each year, when anyone can join, switch or leave a plan for the coming year. If you are already in an Advantage plan, the January 1 through March 31 window lets you switch to a different plan or go back to Original Medicare, one change. Special situations, like moving out of your plan's service area, open their own windows.

For a plain explanation of when each window opens and what you can do inside it, see my guide on open enrollment for Medicare Advantage plans. And if you are weighing Advantage against a supplement instead, the tradeoffs are laid out on my page about how Medicare Supplement plans work.

One more thing families ask me about eventually is final expenses, because Advantage plans do not cover burial costs. I wrote a straightforward comparison of burial insurance versus life insurance for FL, NJ and NC for exactly that conversation. If you would rather talk through your own plan options live, call me at (551) 223-3854 or book a plan review. There is no charge, and no pressure to change anything.