Income-Related Adjustments (IRMAA)
For Florida residents with higher incomes, Medicare premiums for Part B and Part D are subject to an income-related monthly adjustment amount (IRMAA). This surcharge is based on the modified adjusted gross income (MAGI) from your tax return two years prior. Details on 2025 IRMAA thresholds and monthly premiums can be found on the {Link: NCOA website https://www.ncoa.org/article/what-you-will-pay-in-out-of-pocket-medicare-costs-in-2025/}.
Out-of-Pocket Maximums for 2025
The concept of a maximum out-of-pocket (MOOP) limit is important for controlling healthcare costs, but it varies by the type of plan you have. Original Medicare (Parts A & B) has no annual out-of-pocket maximum. Medicare Advantage (Part C) plans have a yearly MOOP for in-network medical services, capped at $9,350 federally in 2025, though plans can offer lower limits. Starting in 2025, there is a $2,000 annual out-of-pocket cap for covered prescription drug costs for Medicare Part D. After meeting this, costs for covered drugs are $0 for the rest of the year. For more information on 2025 costs, visit the {Link: NCOA website https://www.ncoa.org/article/what-you-will-pay-in-out-of-pocket-medicare-costs-in-2025/}.
Florida's Medicare Savings Programs (MSPs)
Florida residents with limited income and resources may receive help with Medicare costs through state and federal programs administered by Florida's Medicaid office. Eligibility is based on household size, income, and assets for programs like the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI). The 2025 income and asset limits for Florida MSPs can be found on the {Link: NCOA website https://www.ncoa.org/article/what-you-will-pay-in-out-of-pocket-medicare-costs-in-2025/}.
Comparison of Medicare Options and Limits
| Feature | Original Medicare (Parts A & B) | Medicare Advantage (Part C) | Medicare Supplement (Medigap) |
|---|---|---|---|
| Out-of-Pocket Maximum | None | Federally capped ($9,350 in-network 2025); plans can set lower limits. | Varies; Plans K and L have MOOP limits ($7,220 and $3,610 in 2025). |
| Prescription Drug Limit | No coverage; requires separate Part D. | Part D often included; $2,000 annual out-of-pocket cap starting in 2025. | No coverage; requires separate Part D. |
| Network Restrictions | No network for providers accepting assignment. | Typically uses a network; out-of-network costs higher or not covered. | No network restrictions; used with Original Medicare. |
| Higher-Income Surcharges | IRMAA applies for Part B. | IRMAA applies for Part B and Part D. | IRMAA applies for Part B and Part D (paid directly to Medicare). |
| Florida Availability | Standard across the U.S.. | Offered by private insurers; availability varies by county. | Available from multiple private insurers; Plans A-N offered. |
Conclusion
While there is no single “limit” to Medicare in Florida, costs are influenced by income, plan choice, and health needs. Higher earners pay IRMAA surcharges for Parts B and D based on a two-year look-back at income. Original Medicare lacks an out-of-pocket maximum, unlike Medicare Advantage plans. A significant change for 2025 is the $2,000 annual cap on Part D prescription drug costs. Florida’s Medicare Savings Programs offer financial aid for those with lower incomes to help cover expenses. Understanding these structures is crucial for managing Medicare costs in Florida.
