Frequently Asked Questions
Clear, plain-language answers to the most common questions about Medicare, ACA Marketplace plans, and working with an independent health insurance advisor in Florida.
Below you will find answers to the questions we hear most often from clients across Florida. These answers are written in plain language to help you understand your options quickly. For personalized guidance based on your specific situation, schedule a free consultation.
Medicare Questions
What is Medicare?
Medicare is the federal health insurance program for Americans aged 65 and older, and for certain younger people with disabilities or End-Stage Renal Disease. It is administered by the Centers for Medicare & Medicaid Services (CMS). Medicare has four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).
What are the different parts of Medicare?
Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor visits, outpatient care, preventive services, and medical supplies. Part C (Medicare Advantage) is an alternative to Original Medicare offered by private insurers that bundles Parts A, B, and usually D. Part D provides prescription drug coverage through standalone plans or as part of a Medicare Advantage plan.
When am I eligible for Medicare?
Most people become eligible for Medicare at age 65. You may also qualify before 65 if you receive Social Security Disability Insurance (SSDI) for 24 months or have been diagnosed with ALS or End-Stage Renal Disease. Your Initial Enrollment Period begins three months before your 65th birthday month and ends three months after.
What is the difference between Medicare Advantage and Medicare Supplement?
Medicare Advantage (Part C) replaces Original Medicare with a private plan that typically includes Part D drug coverage and extras like dental, vision, and hearing. You use the plan's provider network. Medicare Supplement (Medigap) works alongside Original Medicare to cover out-of-pocket costs like deductibles and coinsurance. With Medigap, you can see any Medicare-accepting provider nationwide but need a separate Part D plan for prescriptions.
What does Medicare cost?
Most people pay no premium for Part A if they or their spouse paid Medicare taxes for at least 10 years. The standard Part B premium for 2026 is income-based. Medicare Advantage plans often have $0 monthly premiums beyond your Part B premium. Medicare Supplement premiums vary by plan type, age, gender, tobacco use, and carrier. Part D premiums vary by plan and location. We provide a complete cost breakdown for every option in your zip code.
What is the Medicare Annual Enrollment Period?
The Annual Enrollment Period (AEP) runs from October 15 through December 7 each year. During AEP, you can switch Medicare Advantage plans, change Part D coverage, move from Original Medicare to Medicare Advantage, or switch back to Original Medicare. Changes made during AEP take effect January 1 of the following year.
Can I keep my doctor if I switch to Medicare Advantage?
It depends on the plan. Medicare Advantage plans have provider networks, and your doctor may or may not be in-network for a given plan. Before enrolling, you should verify that your preferred doctors, specialists, and hospitals are in the plan's network. With Original Medicare and a Medigap plan, you can see any doctor in the U.S. who accepts Medicare. We help you check provider networks before you enroll.
Do I need Medicare if I have employer coverage?
If your employer has 20 or more employees, your employer plan is typically primary and you can delay Medicare Part B without penalty. If your employer has fewer than 20 employees, Medicare becomes primary when you turn 65 and you should enroll. When you leave your employer plan, you get a Special Enrollment Period to sign up for Medicare without a late penalty. We help you navigate these coordination rules.
What is a Medicare Special Enrollment Period?
A Special Enrollment Period (SEP) allows you to enroll in or change your Medicare coverage outside of the standard enrollment windows. Common triggers include losing employer coverage, moving to a new county, qualifying for Medicaid, or being released from incarceration. Each SEP has specific rules and timeframes. We can help you determine if you qualify.
How does Medicare Part D prescription drug coverage work?
Part D plans cover prescription medications through a formulary (list of covered drugs) organized into tiers. Lower tiers generally have lower costs. Each plan has its own formulary, premiums, deductible, and copay structure. There is a coverage gap (donut hole) phase where you pay a higher share of drug costs until you reach catastrophic coverage. We compare every Part D plan against your specific medications to find the lowest total annual cost.
ACA Marketplace & Private Plan Questions
What is the ACA Marketplace?
The ACA Marketplace (also called the Health Insurance Marketplace or Obamacare) is a platform where individuals and families can shop for and enroll in health insurance plans. In Florida, the federal marketplace at HealthCare.gov is used. Plans are organized into Bronze, Silver, Gold, and Platinum tiers based on how costs are shared between you and the insurer. Premium tax credits (subsidies) may be available based on your income.
Am I eligible for ACA subsidies?
Eligibility for premium tax credits is based on your household income relative to the Federal Poverty Level (FPL). For 2026, individuals earning between approximately $15,060 and $60,240 may qualify. Family thresholds are higher based on household size. You must not be eligible for Medicare, Medicaid, or affordable employer coverage to qualify. We provide a free subsidy estimate as part of our consultation.
When can I enroll in an ACA plan?
The annual Open Enrollment Period runs from November 1 through January 15. Outside of this window, you can enroll during a Special Enrollment Period (SEP) triggered by qualifying life events such as losing employer coverage, getting married, having a baby, or moving to a new area. Medicaid and CHIP enrollment is available year-round.
What is the difference between on-exchange and off-exchange plans?
On-exchange plans are purchased through HealthCare.gov and are eligible for premium tax credits (subsidies). Off-exchange plans are purchased directly from insurance carriers and offer the same coverage but without subsidy eligibility. If you qualify for subsidies, on-exchange is almost always the better financial option.
Is an ACA plan better than COBRA?
In many cases, yes. COBRA allows you to continue your employer plan but at the full premium cost (employer share plus your share), which is often very expensive. ACA Marketplace plans frequently offer comparable or better coverage at a lower cost, especially if you qualify for premium tax credits. Losing employer coverage triggers a Special Enrollment Period for ACA plans. We help you compare your COBRA offer against every available Marketplace plan.
What carriers offer ACA plans in Tampa Bay?
Major carriers offering ACA plans in the Tampa Bay area include Florida Blue, Ambetter (Sunshine Health), Molina Healthcare, Oscar Health, and UnitedHealthcare. Plan availability and pricing vary by county and zip code. We compare every available option to find the best fit for your needs and budget.
About Integrity Health Solutions
Is there a cost to work with Integrity Health Solutions?
No. Our services are always free. We are compensated by insurance carriers through commissions built into plan premiums. You pay the same premium whether you enroll through us, through another broker, or directly with the carrier. There is never any cost, pressure, or obligation.
How is Integrity Health Solutions different from other agencies?
We are truly independent. Unlike captive agents who represent a single carrier, we compare plans from every major insurance company in your area — including Humana, Aetna, UnitedHealthcare, Cigna, Wellcare, Florida Blue, and more. Our recommendations are based solely on what is best for you.
What areas does Integrity Health Solutions serve?
We are licensed in Florida and Texas. Our office is based in St. Petersburg, Florida, and we have deep expertise in Pinellas, Hillsborough, Pasco, Manatee, and Sarasota counties. We serve clients statewide by phone and video, and offer in-person consultations in the Tampa Bay area.
How do I schedule a consultation?
You can schedule a free consultation by calling (727) 348-0589, emailing [email protected], or visiting our contact page at integrityhealth.solutions/contact. Consultations are available by phone, video, or in person in the Tampa Bay area.
Can you help me if I already have a Medicare or ACA plan?
Yes. We provide free annual reviews of existing Medicare coverage during the Annual Enrollment Period (October 15 – December 7) and help ACA plan holders review their options during Open Enrollment. If your health needs, medications, or financial situation have changed, we can help you determine if a different plan would save you money or provide better coverage.
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Frequently Asked Questions
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