What you are choosing between
Keep State Group Insurance: once you have Medicare, you either stay in a State Group Insurance health plan (the nationwide PPO, or an HMO in its service area), which pays after Medicare and includes the State's drug coverage, or join one of the State's optional group Medicare Advantage and Prescription Drug (MA-PD) plans. See Florida state retirees and Medicare.
Buy individual coverage: an individual Medicare Advantage plan (most include drug coverage), or Original Medicare with a Medigap policy and a Part D plan. For 2027, CMS data show 297 Medicare Advantage plans open to everyone in Florida and 11 standalone Part D plans. The number in your county ranges from 7 in Monroe County to 52 in Hillsborough County.
Side by side
| Question | State Group Insurance (secondary plan or State MA-PD) | Individual Medicare plans |
|---|---|---|
| Who pays first | Secondary plan: Original Medicare, then the State plan. State MA-PD: the plan, in place of Original Medicare. | Medicare Advantage: the plan. Medigap: Original Medicare, then Medigap. |
| Doctors and hospitals | Secondary plan: a nationwide PPO, or an HMO in its service area; check its provider rules. MA-PD: the plan's HMO or PPO network. | Medicare Advantage: the plan's network, sold by county. Medigap: any provider in the U.S. who accepts Medicare. |
| Drug coverage | Secondary plan: the State's drug coverage, creditable for Part D. MA-PD: Part D included. | Usually included in Medicare Advantage; with Medigap, a separate Part D plan. |
| Part B | Secondary plan pays as if you had Part B, so you need it. MA-PD requires Parts A and B. | Parts A and B required for Medicare Advantage and Medigap. |
| Premium | Set by the State for your tier (Medicare I, II or III); see MyBenefits. | Set by each company; you also keep paying Part B. |
| Spouse | Covered as a dependent on family coverage; for an MA-PD, everyone on the policy must have Medicare. | Each person buys his or her own plan or policy. |
| When you can change | MA-PD: year-round. Other changes: State Open Enrollment or a qualifying status change. | Medicare's enrollment periods, such as Oct. 15 to Dec. 7, or a Special Enrollment Period; Medigap any time, but health questions may apply. |
| Going back | Not possible once a retiree cancels. | You can change individual plans in later Medicare enrollment periods. |
For 2027, Part D coverage, including the Part D in a group MA-PD, has a yearly out-of-pocket cap of $2,400 for covered drugs. Medicare Advantage plans may offer extra benefits such as dental, vision, hearing or fitness. Extra benefits vary by plan and county, may have limits and costs, and not every plan offers them. Check a plan's Summary of Benefits or Evidence of Coverage.
What leaving State Group Insurance means
It's permanent. The Florida Department of Management Services (DMS) says a retiree who cancels State Group Insurance, or lets it end for nonpayment, "may not re-enroll at a later date as a retiree." DMS also says that if you buy Part C, Part D or Medigap coverage on the private market, you should cancel the State plan.
- Dependents: a spouse or child covered on your State family coverage loses it too, so plan their coverage before you cancel.
- One plan at a time: Medicare lets you be in only one Medicare Advantage or Part D plan at a time, so an individual plan can't sit alongside a State MA-PD. Ask People First how any outside plan would affect your State coverage.
- The FRS Health Insurance Subsidy doesn't depend on State coverage; you certify whatever coverage you have, and Medicare counts. See the HIS and Medicare.
Medigap timing in Florida
Florida has no Medigap birthday rule or yearly right to switch plans. Outside your 6-month Medigap open enrollment, which starts the first month you're both 65 and enrolled in Part B, a company can ask health questions unless you have a guaranteed-issue right. Florida law (Fla. Stat. 627.6741) gives a 2-month window to buy Medigap without health questions after coverage under a group health insurance policy ends, and federal rules give a 63-day right when employer or retiree coverage that pays after Medicare is ending. Whether either applies can depend on the kind of coverage and why it ends, so ask the Medigap company and get approval in writing before you cancel State coverage. More: Medigap after employer coverage ends and when you can buy Medigap in Florida.
How to compare
- Get your State numbers. Find your monthly State premium for your Medicare tier on MyBenefits or from People First (866-663-4735).
- Add up the year. State premium for you and any dependents versus the individual plan's premium, plus likely copays, coinsurance and drug costs. Your Part B premium is the same either way.
- Check doctors and drugs. Look up your providers and prescriptions in the State plan's documents and in any individual plan you're considering.
- Think about your spouse and travel. State family coverage moves with your choice; individual plans cover one person each, and Medicare Advantage networks are local.
- Time it. Don't cancel State coverage until the new coverage is approved and has a start date, and remember you can't come back.
To compare individual plans from the companies they work with, you can request a call from a licensed insurance agent. You can also see individual plans in your ZIP code.
Sources
- Florida DMS, MyBenefits — Retirees
- Florida DMS, MyBenefits — Medicare Advantage and Prescription Drug (MA-PD)
- Florida DMS, MyBenefits — Retirees FAQ
- Florida Statutes 112.363, Retiree health insurance subsidy
- FRS Division of Retirement — Form HIS-1 and instructions
- Florida Statutes 627.6741, Medicare supplement policies
- Medicare.gov — Compare Original Medicare and Medicare Advantage
- Florida Administrative Code Chapter 69O-156, Medicare supplement (guaranteed-issue rights in 69O-156.0095)
- CMS — Medicare Advantage and Part D contract and enrollment data
Frequently asked questions
State Group Insurance or an individual Medicare plan: which is right for me?
It depends on your State premium, whether you cover a spouse, your doctors, your drugs and where you live or travel. Because a retiree who cancels State coverage can't re-enroll, treat leaving as a permanent decision and get the new coverage approved first.
Can I keep the secondary State plan and add a Medigap policy or a Part D plan?
The State says members of its secondary plan should not enroll in a separate Part D plan, and that retirees who buy Part C, Part D or Medigap coverage on the private market should cancel the State plan. Ask People First before buying anything.
Does the FRS Health Insurance Subsidy still apply if I leave State Group Insurance?
Yes, if you otherwise qualify. Florida Statutes 112.363 says State group coverage isn't required, and the FRS Pension Plan HIS form accepts Medicare Part A and/or Part B as qualifying coverage.
How many individual Medicare plans are there in Florida for 2027?
CMS data show 297 Medicare Advantage plans open to everyone from 22 companies across Florida, plus 11 standalone Part D plans. What's sold varies by county.
Medicare in your Florida county
Plans, local agents and help, county by county: Miami-Dade · Broward · Palm Beach · Hillsborough · Orange · Duval · Pinellas · Lee · Polk · Pasco · Brevard · Volusia · Seminole · Sarasota · Osceola · Manatee · Lake · Marion · Collier · St. Lucie · All 67 counties →
