Reference

Medicare glossary for Florida

Plain-language definitions of the Medicare words you'll see on notices, plan documents and enrollment forms, plus the Florida names that come up along the way: ACCESS Florida, AHCA and DCF, Statewide Medicaid Managed Care and its MMA and LTC programs, MEDS-AD, Medically Needy, FIDE and HIDE special needs plans, State Group Insurance and People First, the FRS Health Insurance Subsidy, and the rules that snowbirds and hurricane season bring.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 14, 2026

Jump to a letter: A · B · C · D · E · F · G · H · I · L · M · N · O · P · Q · S · T · U · V

ABN (Advance Beneficiary Notice of Noncoverage)

A form a doctor, lab or supplier with Original Medicare gives you before a service when they think Medicare may not pay for it. If you sign it and get the service, you may have to pay if Medicare denies the claim. You can still ask them to bill Medicare so you keep your right to appeal.

ACCESS Florida

The Florida Department of Children and Families' application system for Medicaid, the Medicare Savings Programs and other public assistance; Florida uses one application for all of them. You apply online through MyACCESS or get help from DCF's customer call center at (850) 300-4323 (Florida Relay 711). See Florida Medicaid and Medicare.

AEP (Annual Enrollment Period)

October 15 to December 7 each year, also called Open Enrollment. You can join, switch or drop a Medicare Advantage or Part D plan, and changes start January 1. For 2027 coverage it runs October 15 to December 7, 2026. State Group Insurance has its own open enrollment for its retirees, on different dates. See Medicare Open Enrollment in Florida.

AHCA (Agency for Health Care Administration)

The state agency that runs Florida Medicaid, including Statewide Medicaid Managed Care, PACE and the state's contracts with dual eligible special needs plans. Its Medicaid Helpline, 1-877-254-1055 (TDD 1-866-467-4970), takes questions and complaints about Medicaid plans and services. Eligibility is decided by DCF, not AHCA.

ANOC (Annual Notice of Change)

A notice your Medicare Advantage or Part D plan sends by September 30 explaining what changes next year: premiums, costs, drug list, network and benefits. If your plan is ending instead, you get a non-renewal letter; see plans ending in 2027.

Appeal

A formal request to change a coverage or payment decision by Medicare or your plan. There are five levels, and deadlines start from the date on your notice. See Medicare appeals in Florida.

Assignment

An agreement by a doctor or supplier to accept the Medicare-approved amount as full payment for a covered service. With assignment, you pay only your deductible and coinsurance. Florida law (s. 456.056) requires physicians to accept assignment for emergency care, and when your primary physician accepts assignment, consulting physicians must too unless you agree otherwise in writing beforehand.

Attained-age rating

A way of pricing Medigap so the premium rises automatically as you get older. Florida law prohibits attained-age premium structures on policy forms where more than half the policies go to people 65 or older (s. 627.410(6)(d)), and Florida Medigap policies are sold on an issue-age basis. Premiums can still go up for everyone in a plan, with OIR's approval.

Benefit period

How Part A measures hospital and skilled nursing facility use. It starts the day you're admitted as an inpatient and ends when you've been out of the hospital or skilled care for 60 days in a row. The Part A deductible applies to each benefit period ($1,736 in 2026; CMS publishes the 2027 amount each fall).

BFCC-QIO (Beneficiary and Family Centered Care Quality Improvement Organization)

The organization Medicare pays to handle fast appeals when a hospital stay or other covered care is ending, and complaints about quality of care. For Florida it is Acentra Health, 1-888-317-0751, TTY 711.

CARES (Comprehensive Assessment and Review for Long-Term Care Services)

The Florida Department of Elder Affairs program that decides whether a person medically needs a nursing-facility level of care for Medicaid long-term care. A CARES assessor visits in person before someone enters the LTC program; DCF decides financial eligibility separately (s. 409.979).

CHOICES rate comparison tool

The Office of Insurance Regulation's online tool that shows sample rates for Medicare supplement (Medigap) policies and other insurance sold in Florida. OIR says the rates are for illustration only; for a quote, contact an insurance agent or the insurance company. See OIR's CHOICES page.

Choice counseling (Medicaid)

AHCA's service for choosing or changing a Statewide Medicaid Managed Care plan, at 1-877-711-3662. It helps with Medicaid plans; for Medicare plan choices, use 1-800-MEDICARE or Medicare.gov.

CMS (Centers for Medicare & Medicaid Services)

The federal agency that runs Medicare and works with states such as Florida on Medicaid. CMS sets the yearly Medicare amounts and approves Medicare Advantage and Part D plans.

Coinsurance

Your share of a covered cost, as a percentage. After the Part B deductible, you usually pay 20% of the Medicare-approved amount for doctor visits and outpatient care.

Coordination-only D-SNP

A D-SNP that covers your Medicare benefits and coordinates with your Medicaid without covering Medicaid benefits itself. Florida's contract lets these plans enroll only people whose Medicaid helps with Medicare costs (QMB, SLMB, QI or QDWI), not people with full Medicaid. CMS's 2027 data list 64 coordination-only D-SNPs in 66 Florida counties.

Copayment

A set dollar amount you pay for a covered service or drug, such as a doctor visit or a prescription. Amounts vary by plan.

Coverage determination

A decision by your Part D plan about whether it will cover a drug, and how much you pay. Asking for an exception, such as covering a drug that isn't on the plan's list, starts with a coverage determination.

Creditable coverage

Other drug coverage that is expected to pay at least as much as standard Part D, such as many employer, union, VA and TRICARE plans, the State Group Insurance secondary plans' drug coverage, and care from the Indian Health Service or a tribal health program. Having it lets you delay Part D without a late penalty. Your plan tells you each year whether its coverage is creditable.

D-SNP (Dual Eligible Special Needs Plan)

A Medicare Advantage plan only for people who have both Medicare and Medicaid. Each D-SNP in Florida must have a contract with AHCA. CMS's 2027 data list 127 D-SNPs from 14 parent companies, covering all 67 Florida counties, in three kinds: FIDE, HIDE and coordination-only. See dual eligible special needs plans in Florida.

DCF (Department of Children and Families)

The state agency that decides eligibility for Florida Medicaid (for people not on SSI), the Medicare Savings Programs and the financial side of Medicaid long-term care, through ACCESS Florida. Its customer call center is (850) 300-4323. DCF also runs the Florida Abuse Hotline, 1-800-962-2873, for reports of elder abuse, neglect or exploitation.

Declaration of Domicile

A sworn statement, filed with the clerk of the circuit court in your Florida county, that Florida is your permanent home (s. 222.17). It is voluntary and one of several ways to show residence. For Medicare plans, residence matters because you can join a Medicare Advantage or Part D plan only where you permanently live.

Deductible

What you pay before Medicare or your plan starts to pay. In 2026 the Part B deductible is $283 a year and the Part A deductible is $1,736 per benefit period; for 2027, Part D plans can have a deductible of up to $700.

DFS (Department of Financial Services)

The office of Florida's Chief Financial Officer. It licenses insurance agents (search them at DFS Licensee Search), takes consumer questions and complaints about insurers, agents and agencies at 1-877-693-5236, and investigates insurance fraud. DFS notes that CMS, not the state, has jurisdiction over Medicare plans. See how to check a Medicare agent's license in Florida.

Disaster Special Enrollment Period

A chance to make a Medicare Advantage or Part D change you missed because of an emergency or major disaster declared by a federal, state or local government, such as a hurricane. It applies only if you lived in the declared area (or rely on someone who does) and were eligible for another enrollment period that the disaster kept you from using; it isn't a new open season for everyone (42 CFR 422.62(b)(18) and 423.38(c)(23)). Call 1-800-MEDICARE to use it. See hurricanes and Medicare in Florida.

Dual eligible

A person who has both Medicare and Medicaid. In Florida, full dual eligibles must get their Medicaid through a Statewide Medicaid Managed Care MMA plan; partial dual eligibles get help only through a Medicare Savings Program. Medicare pays first, then Medicaid. See Florida Medicaid and Medicare.

EOB (Explanation of Benefits)

A statement from your Medicare Advantage or Part D plan showing services or drugs it paid for, what it paid and what you owe. It isn't a bill. Check it for charges you don't recognize.

ESRD (End-Stage Renal Disease)

Permanent kidney failure that requires dialysis or a transplant. People with ESRD can get Medicare at any age, and Florida law gives people under 65 with Medicare because of ESRD or a disability a 6-month Medigap open enrollment. Dialysis patients can get help in emergencies from Florida's ESRD Network (Network 7), 877-936-9260.

Estate recovery

Florida Medicaid's claim against the estate of a person who has died, for Medicaid paid after age 55 (s. 409.9101). It isn't enforced while a spouse, a child under 21, or a blind or disabled child survives, or against property exempt from creditors under Florida law, such as protected homestead, and hardship waivers exist. Help from a Medicare Savings Program alone isn't recovered under federal law.

Evidence of Coverage (EOC)

Your Medicare Advantage or Part D plan's full rulebook: what it covers, what you pay, how to appeal and your rights. Plans post it online and must send it on request.

Excess charge

An amount, up to 15% above the Medicare-approved amount, that a doctor who doesn't accept assignment can bill you under Original Medicare. Florida adds limits: physicians must accept assignment for emergency care, and consulting physicians must accept it when your primary physician does, unless you agree otherwise in writing first (s. 456.056). Medigap Plans F and G cover excess charges.

Extra Help

The federal program, also called the Low-Income Subsidy (LIS), that lowers Part D premiums, deductibles and copays for people with limited income and resources. People with full Florida Medicaid, a Medicare Savings Program or SSI get it automatically; others apply with Social Security. See Extra Help in Florida.

FIDE-SNP (Fully Integrated Dual Eligible Special Needs Plan)

A D-SNP run by one company that holds both a Medicare Advantage contract and a Medicaid managed care contract, so one plan covers your Medicare and Medicaid benefits. In Florida a FIDE-SNP also carries the member's Medicaid long-term care. CMS's 2027 data list 3 FIDE-SNPs, available in 42 Florida counties. See what is a FIDE-SNP?

Florida Medicaid

The joint federal and state program that pays for health care and long-term care for people with limited income and resources. AHCA runs it, and DCF decides eligibility (Social Security does for people on SSI). Florida hasn't expanded Medicaid to adults under 65 based on income alone. Most members get their care through Statewide Medicaid Managed Care. See Florida Medicaid and Medicare.

Formulary

A plan's list of covered drugs, usually in tiers. Each Part D and Medicare Advantage plan has its own, and it can change from year to year.

Free look period

The 30 days after you receive a Medigap policy when you can return it for a full refund of the premium you paid. Florida law requires the policy to display this no-loss cancellation clause prominently (s. 627.674(4)(d)).

FRS (Florida Retirement System)

Florida's main retirement system for public employees, with a Pension Plan and an Investment Plan. Retiring under it can make you eligible to keep State Group Insurance if you were covered when you retired, and it pays the Health Insurance Subsidy. The taxable part of an FRS pension counts toward IRMAA.

FRS Health Insurance Subsidy (HIS)

A monthly payment to retirees of Florida's state-administered retirement systems to help pay for health insurance, based on years of service (s. 112.363). You must certify that you have health insurance coverage, but it doesn't have to be the State's plan. The statute allows the subsidy to be reduced if funding falls short. See the FRS Health Insurance Subsidy and Medicare.

GEP (General Enrollment Period)

January 1 to March 31 each year, for people who missed their Initial Enrollment Period and don't qualify for a Special Enrollment Period. Coverage starts the month after you sign up, and late enrollment penalties may apply.

Guaranteed issue rights

Situations in which a Medigap company must sell you certain policies without health questions, such as when your Medicare Advantage plan leaves your area or ends, or you move out of its service area. Most federal windows last 63 days after the other coverage ends. Florida adds its own right: for 2 months after group health coverage ends, you can buy a Medigap policy without health questions (s. 627.6741(1)(a)2). See Medigap in Florida.

HIDE-SNP (Highly Integrated Dual Eligible Special Needs Plan)

A D-SNP that also covers some Medicaid benefits, including behavioral health services, under a contract with AHCA. CMS's 2027 data list 60 HIDE-SNPs, available in all 67 Florida counties.

HMO (Health Maintenance Organization)

A type of Medicare Advantage plan that generally covers care only from doctors and hospitals in its network, except emergencies and urgently needed care, and may require referrals to see specialists.

ICP (Institutional Care Program)

Florida Medicaid's program for nursing home care. Gross income can't be more than 300% of the SSI federal benefit rate; people with more can qualify by setting up a Qualified Income Trust. There is an asset limit and a 60-month look-back, and most of your income goes toward the cost of care. See Florida Medicaid long-term care.

IEP (Initial Enrollment Period)

Your first chance to sign up for Medicare: 7 months that start 3 months before the month you turn 65 and end 3 months after. See turning 65 in Florida.

Indian Health Service (IHS)

The federal agency that provides or pays for health care for members of federally recognized tribes. In Florida, the Seminole Tribe of Florida and the Miccosukee Tribe of Indians of Florida run their own health programs with IHS support, under the IHS Nashville Area. IHS and tribal care counts as creditable drug coverage. See the Seminole and Miccosukee Tribes and Medicare.

Inpatient

Formally admitted to a hospital on a doctor's order. Staying overnight doesn't make you an inpatient; ask whether you're admitted or under observation, because it changes what you pay.

IRMAA (Income-Related Monthly Adjustment Amount)

An extra amount added to Part B and Part D premiums if your income from two years earlier was above a limit. For 2026 premiums the first limit is $109,000 for an individual and $218,000 for a couple filing jointly; CMS publishes the 2027 brackets each fall. Florida has no state income tax, so only your federal return counts. See our IRMAA calculator.

Issue-age rating

Medigap pricing based on your age when you buy the policy, so your premium doesn't go up just because you get older. The Department of Financial Services says Florida Medigap policies must be sold this way. If you switch to a new insurer, it rates you at your age when you apply.

Late enrollment penalty

A lasting addition to your premium if you sign up for Part B or Part D late without other qualifying coverage. The Part B penalty is 10% for each full 12-month period you could have had Part B but didn't. See our penalty calculator.

Look-back period

The 60 months before you apply for Medicaid long-term care, such as nursing home care, during which DCF reviews gifts and other transfers of assets for less than their value (ESS Policy Manual 1640.0608). A transfer in that window can delay coverage.

Long-term care ombudsman

An advocate for people who live in nursing homes, assisted living facilities and other long-term care settings. Florida's Long-Term Care Ombudsman Program, part of the Department of Elder Affairs, investigates residents' complaints; call 1-888-831-0404.

LTC program (SMMC Long-Term Care)

The part of Statewide Medicaid Managed Care that pays for long-term care, such as nursing facility care and home and community-based services, for Medicaid members 65 and older (or 18 and older with a disability) who need a nursing-facility level of care. Home and community-based services have a statewide waiting list ordered by a priority score. See Florida Medicaid long-term care.

MA OEP (Medicare Advantage Open Enrollment Period)

January 1 to March 31 each year. If you're in a Medicare Advantage plan, you can switch to another one or go back to Original Medicare (and join a Part D plan) once during this period.

MA-PD (Medicare Advantage plan with drug coverage)

A Medicare Advantage plan that includes Part D. The State of Florida offers group MA-PD plans to retirees in State Group Insurance who have Parts A and B; joining is optional, open year-round, and done through People First, which needs your Medicare card first.

Medicaid Fraud Control Unit

The Florida Attorney General's unit that investigates fraud by Medicaid providers and abuse or neglect of patients in facilities. Report at 1-866-966-7226. For Medicare fraud, call 1-800-HHS-TIPS or 1-800-MEDICARE. See Medicare fraud in Florida.

Medically Needy (Share of Cost)

A Florida Medicaid program for people whose income is too high for other Medicaid groups. Each month, the amount by which your income is over the Medically Needy income level is your "share of cost"; once your medical bills that month reach it, Medicaid can pay for the rest of the month. It has its own asset limit.

Medicare Advantage (Part C)

A plan from a private company approved by Medicare that covers Part A and Part B services, usually with Part D drug coverage. 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. For 2027, CMS data show 297 Medicare Advantage plans open to everyone in Florida, and 3,051,948 Floridians were in Medicare Advantage plans in July 2026. See Medicare Advantage in Florida.

Medicare Prescription Payment Plan

An option in every Part D plan that spreads your out-of-pocket drug costs into monthly payments over the year instead of paying at the pharmacy. It doesn't lower your total cost. The 2027 Part D out-of-pocket cap is $2,400; see our drug cap estimator.

Medigap (Medicare Supplement Insurance)

A policy from a private company that helps pay costs Original Medicare leaves to you, such as deductibles and coinsurance. Plans are standardized by letter. In Florida they are governed by Chapter 627, Part VIII of the Florida Statutes and Chapter 69O-156 of the Florida Administrative Code, and OIR approves policy forms and rates. Florida has no birthday rule or yearly switching right. See Medigap in Florida.

Medigap open enrollment period

The 6 months that start the first month you're 65 or older and enrolled in Part B. During it, companies must sell you any Medigap policy they offer, regardless of your health. Florida also gives people under 65 with Medicare because of a disability or ESRD a 6-month window starting with Part B; premiums are usually higher before 65, and you get a new open enrollment at 65.

MEDS-AD

Florida Medicaid's coverage group for aged and disabled people with income up to 88% of the federal poverty level. It doesn't cover people who receive Medicare unless they are also getting nursing home, hospice or home and community-based services, so most low-income Floridians on Medicare get help through a Medicare Savings Program, SSI or Medically Needy instead. See what is MEDS-AD?

MMA (Managed Medical Assistance)

The part of Statewide Medicaid Managed Care that covers medical care. Florida law requires Medicaid recipients, including people who also have Medicare, to get their Medicaid through it, and the state's contract says an MMA plan can't make a full dual eligible change from their Medicare primary care doctor.

MOOP (maximum out-of-pocket limit)

The most you pay in a year for covered Part A and Part B services in a Medicare Advantage plan. For 2027, Medicare allows in-network limits of up to $9,850; each plan sets its own limit at or below that. Original Medicare has no yearly limit unless you add Medigap.

MSN (Medicare Summary Notice)

The statement Original Medicare mails every four months if you had services, also available in your Medicare.gov account. It lists claims, what Medicare paid and what you may owe, and explains how to appeal.

MSP (Medicare Savings Program)

The state programs that help pay Medicare premiums and cost sharing. Florida offers QMB, SLMB and QI1 through DCF, with income limits at 100%, 120% and 135% of the federal poverty level and an asset limit. See Medicare Savings Programs in Florida and our savings programs screener.

Network

The doctors, hospitals, pharmacies and other providers a plan contracts with. Most Medicare Advantage plans use networks; Original Medicare and Medigap work with any provider nationwide that accepts Medicare.

Observation status

Hospital care as an outpatient while doctors decide whether to admit you. Part B covers it, so you may pay coinsurance for each service, and observation days don't count toward the 3 inpatient days needed for skilled nursing facility coverage. The hospital must give you a Medicare Outpatient Observation Notice after 24 hours.

OIR (Office of Insurance Regulation)

The Florida agency that licenses and regulates insurance companies. It approves Medigap policy forms and must approve Medigap rates before an insurer uses them, and rate increases must apply to a whole class of policyholders, not one person's health. Complaints about agents go to DFS.

Opt-out provider

A doctor or other practitioner who has formally opted out of Medicare for at least two years. Medicare pays nothing for their services except in emergencies, and you pay under a private contract. CMS's September 2026 opt-out list includes about 2,900 Florida clinicians. See finding doctors who accept Medicare in Florida.

Original Medicare

Part A (hospital) and Part B (medical) run by the federal government. You can see any provider in the country that accepts Medicare, which is why many snowbirds keep it. Many people add a Medigap policy and a Part D plan.

PACE (Program of All-Inclusive Care for the Elderly)

A program for people 55 and older who need a nursing-home level of care but can live safely at home, run by local PACE organizations that provide and coordinate all their care. AHCA's September 2026 report lists 12 PACE organizations operating in Florida, in about two dozen counties, with more applications pending; not every county has PACE.

Part A (hospital insurance)

Covers inpatient hospital care, skilled nursing facility care after a qualifying stay, hospice and some home health care. Most people pay no Part A premium because they or a spouse paid Medicare taxes for about 10 years. See Medicare Part A.

Part B (medical insurance)

Covers doctor visits, outpatient care, preventive services, durable medical equipment and some drugs given in a doctor's office. Most people pay the standard monthly premium, $202.90 in 2026. See Medicare Part B.

Part D (drug coverage)

Prescription drug coverage from private plans, either a standalone drug plan or built into a Medicare Advantage plan. In 2027, your yearly out-of-pocket cost for covered drugs is capped at $2,400, and the old gap in coverage between phases no longer exists. Florida has 11 standalone drug plans for 2027. See Medicare Part D in Florida.

Part D and Medicare Advantage regions

The areas CMS uses to organize regional plans. Florida is a region by itself for both: Medicare Advantage Region 09 and Part D (PDP) Region 11. A standalone Part D plan sold in Florida covers the whole state.

People First

The State of Florida's human resources and benefits service center, where state employees and retirees enroll in and change State Group Insurance coverage. Retirees who want a State group MA-PD plan send their Medicare card to People First. Its service center is 866-663-4735 (TTY 866-221-0268).

Permanent residence

Where you live as your primary home. You can join a Medicare Advantage or Part D plan only if you permanently reside in its service area. If you have more than one home, a plan can ask for proof such as voter registration, driver's license, tax records or utility bills, and in a dispute it follows the law of your state. A seasonal stay isn't a change of permanent residence. See snowbirds and Medicare.

PPO (Preferred Provider Organization)

A type of Medicare Advantage plan with a network, where you can also see out-of-network providers, usually at a higher cost.

Prior authorization

Approval you or your provider must get from a plan before a service or drug is covered. Medicare Advantage and Part D plans use it for some services and drugs.

QI1 (Qualifying Individual)

A Medicare Savings Program that pays the Part B premium for people with income over 120% and up to 135% of the federal poverty level who don't qualify for another Medicaid group (except Medically Needy). DCF notes that its funding is limited to a yearly federal allocation.

QMB (Qualified Medicare Beneficiary)

A Medicare Savings Program for people with income up to 100% of the federal poverty level. Florida Medicaid pays Medicare premiums, deductibles and coinsurance, and providers may not bill you for Medicare cost sharing. In Florida, QMB has no retroactive coverage. See what is QMB in Florida?

Qualified Income Trust (Miller trust)

An irrevocable trust holding only the person's income, which lets someone with income above the institutional limit qualify for nursing home Medicaid, home and community-based services or PACE in Florida. Enough income goes into the trust each month to bring countable income under the limit, and the state is repaid from what remains at death, up to the Medicaid it paid (ESS Policy Manual 1840.0110).

Senior Medicare Patrol (SMP)

A federally funded program in every state that helps people with Medicare prevent, detect and report fraud, errors and abuse. You can reach it through the national SMP Resource Center at 1-877-808-2468. See Medicare fraud in Florida.

SEP (Special Enrollment Period)

A time outside the usual periods when you can sign up or change plans because of a life event, such as a permanent move, losing employer coverage, or your plan ending. CMS data show at least 302,773 Floridians in Medicare Advantage plans that won't continue in 2027; if yours doesn't renew, you have until February 28, 2027 to choose new coverage. See plans ending in 2027 and Medicare enrollment periods.

Service area

The counties where a Medicare Advantage plan is offered and where you must live to join it. If you move out of the service area permanently, you can switch plans with a Special Enrollment Period. If you're away for more than 6 months, the plan must generally disenroll you unless it offers a visitor or traveler benefit.

SLMB (Special Low-Income Medicare Beneficiary)

A Medicare Savings Program that pays the Part B premium for people with income between 100% and 120% of the federal poverty level and assets within the limit. DCF decides eligibility through ACCESS Florida.

SMMC (Statewide Medicaid Managed Care)

The way most Florida Medicaid members get their care: through private health plans under contract with AHCA. It has three parts: Managed Medical Assistance (MMA), Long-Term Care (LTC) and Dental. The current contracts, SMMC 3.0, started February 1, 2025, across nine regions.

SNF (Skilled Nursing Facility)

A facility that gives skilled nursing or rehabilitation care. Part A covers up to 100 days per benefit period after a qualifying inpatient hospital stay of at least 3 days, with coinsurance from day 21. Long-term custodial care in a nursing home isn't covered by Medicare.

Snowbird

A common name for someone who spends winters in Florida and the rest of the year somewhere else. Original Medicare and Medigap work with providers anywhere in the U.S. that accept Medicare. A Medicare Advantage or Part D plan is tied to one permanent residence, and an MA plan must generally disenroll you after more than 6 months away. See snowbirds and Medicare.

SNP (Special Needs Plan)

A Medicare Advantage plan limited to people with certain chronic conditions (C-SNP), people who live in an institution such as a nursing home (I-SNP), or people with Medicare and Medicaid (D-SNP). CMS data show 245 special needs plans in Florida for 2027. See special needs plans in Florida.

Special Needs Registry

Florida's registry, kept by the Division of Emergency Management with county emergency management agencies, of people who would need help during an evacuation or in a shelter because of a physical, mental, cognitive or sensory disability (s. 252.355). Registering doesn't guarantee a special needs shelter space. See the Florida Special Needs Registry.

State Group Insurance

The State of Florida's health insurance program for state employees and retirees, run by the Division of State Group Insurance in the Department of Management Services. Retirees on Medicare can keep a PPO or HMO plan that pays secondary to Medicare, as if they had Part B even if they don't, or join one of the State's group MA-PD plans. A retiree who cancels can't re-enroll later. See Florida state retirees and Medicare.

Strike Force (Medicare Fraud Strike Force)

Teams of federal prosecutors and agents that target health care fraud. The first one started in Miami in March 2007, and teams now work in Miami, Tampa and Orlando, among other areas. See Medicare fraud in Florida.

TPMO (Third-Party Marketing Organization)

A company or agent, other than the plan itself, that sells or markets Medicare Advantage or Part D plans for the plans it contracts with. Benefits Life, the publisher of this site, is one. TPMOs must tell you they don't offer every plan in your area.

TRICARE For Life

Coverage for military retirees and their families who have Medicare Part A and Part B. Medicare pays first, then TRICARE For Life, and you must keep Part B to keep it. Care at military hospitals and clinics, such as Naval Hospital Jacksonville and Eglin's 96th Medical Group, is on a space-available basis. See military, veterans and TRICARE in Florida.

Urgently needed care

Care for a sudden illness or injury that isn't an emergency but needs prompt attention. Medicare Advantage plans must cover it even out of network when you're temporarily outside the plan's service area, such as on a trip out of state.

Visitor or traveler benefit

An optional Medicare Advantage feature that lets a member who is away from the service area, but still in the U.S., stay enrolled for more than 6 months and up to 12 months, with in-area cost sharing. Plans may limit it to certain areas and providers, and many plans don't offer it, so ask before you rely on it (42 CFR 422.74(d)(4)(iii)). See Medicare Advantage out of the area for 6 months.

Sources

Frequently asked questions

What does Florida call the Medicare Savings Programs?

Florida uses the federal names: QMB (Qualified Medicare Beneficiary), SLMB (Special Low-Income Medicare Beneficiary) and QI1 (Qualifying Individual). They pay the Part B premium and, with QMB, Medicare deductibles and coinsurance. The Department of Children and Families decides eligibility, with income limits at 100%, 120% and 135% of the federal poverty level and an asset limit. You apply through ACCESS Florida.

What is the difference between AHCA and DCF?

The Agency for Health Care Administration (AHCA) runs the Florida Medicaid program, including Statewide Medicaid Managed Care and the state's contracts with dual eligible special needs plans. The Department of Children and Families (DCF) decides who is eligible for Medicaid and the Medicare Savings Programs, through ACCESS Florida.

Who regulates Medigap and insurance agents in Florida?

The Office of Insurance Regulation (OIR) approves Medigap policy forms and must approve rates before insurers use them. The Department of Financial Services (DFS) licenses insurance agents and takes consumer complaints at 1-877-693-5236. Medicare Advantage and Part D plans are federal, so complaints about them go to 1-800-MEDICARE.

Where can I look up a Medicare term that isn't on this page?

Medicare.gov has a full glossary, and 1-800-MEDICARE can explain any term on a Medicare notice. A licensed insurance agent who works with Benefits Life can also help you read plan documents at no cost to you; you can request a call from a licensed insurance agent.

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