Medicare and Florida Medicaid: the programs that pay your premiums and your care

Some Floridians qualify for both Medicare and Medicaid — often called being “dual eligible.” When that happens, Medicare pays first, and Florida Medicaid may help with costs Medicare leaves behind, like premiums, deductibles and coinsurance, plus services Medicare does not cover at all, such as long-term care at home or in a nursing facility.

How Medicaid works for seniors in Florida

Florida Medicaid is administered by the Agency for Health Care Administration (AHCA), and eligibility is determined by the Department of Children and Families (DCF) — not by an insurance agency. Florida did not expand Medicaid, so for adults 65 and over eligibility is based on income and assets under the aged-and-disabled rules. You apply through ACCESS Florida at myaccessflorida.com, by phone, or at a DCF service center; SHINE counselors and the Area Agencies on Aging can help with the paperwork. Once eligible, most seniors receive their Medicaid benefits through a Statewide Medicaid Managed Care plan.

Programs that can lower your costs

• Medicare Savings Programs (MSPs) — QMB, SLMB and QI — pay the Part B premium ($202.90 in 2026) and, for QMB, Medicare’s deductibles, copays and coinsurance as well. Florida uses the federal income limits, which change each year. You apply through DCF, and you do not have to be on full Medicaid to qualify.
• Extra Help (Low-Income Subsidy) lowers what you pay for Part D premiums, deductibles and copays. If you qualify for an MSP or Medicaid you get Extra Help automatically; otherwise apply through Social Security.
• SMMC Long-Term Care pays for nursing-facility care and for in-home services that let people who would otherwise need a facility stay home. It has its own financial rules and a waiting list for home-based services; the Aging and Disability Resource Center in your region screens for it.
• Dual Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for people with both Medicare and Medicaid; they coordinate the two programs, usually at $0 plan premium, and often add extras. Florida requires D-SNPs to be aligned with a Medicaid managed-care plan from the same company, so a full-benefit dual eligible in a D-SNP can have one organization coordinating everything.

Free, unbiased state counseling on all of this is available from SHINE — Serving Health Insurance Needs of Elders, Florida’s State Health Insurance Assistance Program, run by the Department of Elder Affairs — at 1-800-963-5337. When you are ready to talk through the Medicare side, we are here at (702) 706-6564.

How we help

We help you understand whether a D-SNP is available and a good fit where you live, how a Medicare Savings Program and Extra Help could reduce your costs, and how to keep your Medicaid benefits working alongside Medicare. Eligibility decisions rest with DCF, AHCA and CMS; our job is to make the Medicare side clear.

ECOS Medicare Solutions is a private insurance agency and is not connected with or endorsed by Florida Medicaid, the Agency for Health Care Administration, the Department of Children and Families, or the federal Medicare program.