Changing your Medicaid plan in Florida is fairly simple and can be done to better suit your needs. To get started, check your eligibility through the Florida Medicaid website or by calling the customer service number. Once you’re enrolled, you can shop for plans during the annual open enrollment period, which typically runs from November 1st to January 31st. During this time, you can compare plans, benefits, and costs to find the one that works best for you. You can make the switch by contacting your local Medicaid office, calling the customer service number, or doing it online through the Florida Medicaid website. Be sure to have your Member ID number and other personal information handy when you make the switch. The change will usually take effect the first day of the following month.
Eligibility Requirements for Switching Medicaid Plans
Eligibility requirements are set forth by the state of Florida and are reviewed during the application process, and are as follows:
- Being a Florida resident
- Being a U.S. citizen, a qualified alien, or a lawful permanent resident
- Meeting financial and asset requirements
- Meeting income requirements
- Being pregnant
- Being disabled
- Being 65 years of age or older
- Being blind
- Needing nursing home care
- Having a child under the age of 19
In addition to the above requirements, there are special eligibility requirements for certain groups of people, such as Native Americans and veterans. You can find more information about these requirements on the Florida Medicaid website.
| Eligibility Requirement | Who Qualifies |
|---|---|
| Florida residency | Must live in Florida |
| U.S. citizenship or lawful permanent residency | Must be a U.S. citizen, a qualified alien, or a lawful permanent resident |
| Financial and asset requirements | Must meet certain income and asset limits |
| Pregnancy | Must be pregnant |
| Disability | Must be disabled |
| Age 65 or older | Must be 65 years of age or older |
| Blindness | Must be blind |
| Nursing home care | Must need nursing home care |
| Child under age 19 | Must have a child under the age of 19 |
Types of Medicaid Plans Available in Florida
There are three main types of Medicaid plans available in Florida: Managed Medical Assistance (MMA), Long-Term Care (LTC), and Children’s Medical Services (CMS). Each type of plan provides different benefits and services.
- Managed Medical Assistance (MMA)
MMA plans are provided by private health insurance companies that contract with the state of Florida. MMA plans offer a wide range of benefits, including doctor visits, hospital care, prescription drugs, and mental health services.
- Long-Term Care (LTC)
LTC plans provide coverage for long-term care services, such as nursing home care, assisted living, and home health care. LTC plans are available to people who are 65 years of age or older, or who have a disability.
- Children’s Medical Services (CMS)
CMS plans provide coverage for children who are under the age of 19 and who have a disability. CMS plans cover a wide range of services, including doctor visits, hospital care, prescription drugs, and therapy.
| Type of Medicaid Plan | Who is Eligible | Benefits and Services |
|---|---|---|
| Managed Medical Assistance (MMA) | Adults and children who meet income and eligibility requirements | Doctor visits, hospital care, prescription drugs, mental health services |
| Long-Term Care (LTC) | People who are 65 years of age or older, or who have a disability | Nursing home care, assisted living, home health care |
| Children’s Medical Services (CMS) | Children who are under the age of 19 and who have a disability | Doctor visits, hospital care, prescription drugs, therapy |
Steps for Switching Medicaid Plans in Florida
Switching Medicaid plans in Florida is a straightforward process that can be completed in a few simple steps. Here’s a step-by-step guide to help you make the switch smoothly:
- Research Available Plans: Start by researching the Medicaid plans available in your area. You can use the Florida Medicaid website or consult with a Medicaid eligibility specialist to gather information about the different plans and their benefits.
- Determine Eligibility: Ensure that you meet the eligibility criteria for the Medicaid plan you want to switch to. The eligibility requirements may vary depending on the plan, so it’s important to check the specific criteria.
- Choose a New Plan: Once you have identified the plan that best meets your needs and eligibility, contact the plan’s customer service number or visit their website to initiate the enrollment process.
- Complete the Application: Fill out the Medicaid application form with accurate information. Be prepared to provide personal details, income information, and any necessary documentation.
- Submit the Application: Submit the completed application to the Florida Medicaid office or the managed care plan you’re enrolling with. You can submit the application online, by mail, or in person.
- Wait for Approval: The Medicaid office or managed care plan will review your application and determine your eligibility. The approval process can take several weeks, so it’s important to submit your application as early as possible.
- Notify Your Current Plan: Once your new plan is approved, you should notify your current Medicaid plan of your decision to switch. This will ensure a smooth transition and prevent any disruptions in your coverage.
- Receive New Plan Materials: After your enrollment is complete, you will receive a welcome packet from your new Medicaid plan. This packet will include your member ID card, a list of covered benefits, and information about accessing care.
- Start Using Your New Plan: Once you receive your new Medicaid plan materials, you can start using your benefits immediately. Make sure to carry your member ID card with you whenever you seek medical care.
Pro tip: To make the switching process easier, consider contacting a Medicaid eligibility specialist or enrollment counselor for assistance. They can answer your questions, help you with the application process, and ensure a smooth transition to your new plan.
Additional Information:
- You can switch Medicaid plans in Florida during the annual open enrollment period, which typically runs from November 1 to January 31 each year.
- If you experience a qualifying life event, such as a change in income, address, or family size, you may be eligible for a special enrollment period and can switch plans outside of the open enrollment period.
- To learn more about Medicaid plans and switching plans in Florida, visit the Florida Medicaid website or contact the Medicaid customer service line.
| Plan Name | Website | Customer Service Number |
|---|---|---|
| Aetna Better Health of Florida | https://www.aetnabetterhealth.com/florida | 1-888-786-5527 |
| Ambetter from Sunshine State Health | https://www.ambetterfromsunshine.com | 1-877-212-6680 |
| CarePlus Health Plans | https://www.careplushealthplans.com | 1-800-791-0542 |
| Florida Blue Medicaid | https://www.floridabluemedicaid.com | 1-800-832-1844 |
| Health Options | https://www.healthoptions.net | 1-800-683-7581 |
| Humana Medicaid | https://www.humana.com/medicaid | 1-800-454-5177 |
| Sunshine Health | https://www.sunshinehealth.com | 1-800-209-9901 |
| UnitedHealthcare Community Plan of Florida | https://www.uhccommunityplan.com/florida | 1-877-842-3181 |
Timeline for Processing Medicaid Plan Switches
When you submit a Medicaid plan switch request, the processing time can vary depending on various factors. Here’s a general timeline to provide an idea of what to expect:
- Within 30 Days: If you request a switch during the annual open enrollment period (typically from November 1 to January 31), your request should be processed and your new plan should be effective on the first day of the new coverage year (January 1).
- Within 60 Days: If you request a switch outside of the open enrollment period, the processing time may take up to 60 days from the date you submit your request.
- Expedited Processing: If you qualify for expedited processing due to certain circumstances, such as a change in income, loss of coverage, or moving to a new county, your request may be processed more quickly, usually within 10 business days.
Keep in mind that these timelines are approximate and may vary based on individual circumstances and the workload of the Medicaid office. It’s recommended to submit your switch request well in advance to ensure a smooth transition to your new plan.
| Within 30 Days | Within 60 Days | Expedited Processing | |
|---|---|---|---|
| Processing Time | Annual open enrollment period (November 1 – January 31) | Outside of open enrollment period | Qualifying circumstances (change in income, loss of coverage, moving to a new county) |
| Effective Date | First day of new coverage year (January 1) | Up to 60 days from request submission | Typically within 10 business days |