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FRS retirees and Medicare

What Florida state retirees pay for health coverage

Publicado Por Vista Insurance Services 9 min de lectura

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If you retired from the State of Florida and kept State Group Insurance, you generally pay the whole premium. Florida law bars a state contribution for retirees, with narrow line-of-duty exceptions in ss. 112.19 and 112.191 that can cover an officer or firefighter catastrophically injured in the line of duty, and certain survivors. For 2026, that means $813.46 a month for single Standard HMO/PPO coverage before Medicare and $430.18 for single Self-Insured HMO/PPO coverage in the Medicare I tier, plus the Part B premium (2026 premium table). If you're an eligible retired FRS member, the Health Insurance Subsidy, from $45 to $225 a month, helps you pay it.

Table of contents

What does the state charge a retiree before Medicare?

Florida law sets the rule on cost:

"No state contribution for the cost of any part of the premium shall be made for retirees, surviving spouses, or eligible former employees for any type of coverage under the state group insurance program." (Florida Statutes 110.123(4)(e), 2026)

The same paragraph makes a line-of-duty exception, subject to the conditions in ss. 112.19 and 112.191. For most retirees, the state table's early retiree row shows a zero employer share. Here are the 2026 monthly rates before Medicare:

2026 monthly premium (state table) Standard HMO/PPO High-deductible (HDHP)
Early retiree, single $813.46 $736.80
Early retiree, family $1,831.08 $1,632.05
COBRA (non-Medicare), single $994.86 $916.66
COBRA (non-Medicare), family $2,239.39 $2,036.38

When you first retire, you can continue through COBRA for up to 18 months or elect retiree coverage. COBRA enrollees pay the entire premium plus a 2 percent administrative fee. One thing to know before you decide: if you don't continue health coverage at retirement, you can't elect it later as a retiree.

What does the state plan cost once you have Medicare?

When you become eligible for Medicare, you're moved to a Medicare coverage tier. From then on, the state's secondary plan pays second when Medicare pays, and first for most prescription drugs and for covered services Medicare doesn't pay for. Here are the 2026 rates for the state's Self-Insured HMO/PPO plan, tier by tier:

2026 monthly premium, Self-Insured HMO/PPO (state table) Standard High-deductible (HDHP)
Medicare I: a single policy for you $430.18 $324.26
Medicare II: a family policy, at least one of you eligible for Medicare $1,243.63 $1,061.06
Medicare III: you and one dependent, both eligible for Medicare $860.35 $648.52

Other plans on the same table, the state's Medicare Advantage plans with drug coverage (MA-PD) from Capital Health Plan and Humana, are priced separately.

Those Medicare rates don't include the Medicare Part B premium, which is $202.90 a month in 2026, or higher depending on your income (2026 Part B premium). So if you're one person in the Self-Insured Medicare I Standard plan and pay the standard Part B amount, you pay $633.08 a month in 2026 ($430.18 to the state and $202.90 to Medicare) before any subsidy.

The state plan pays second even if you never enroll in Medicare. That's why MyBenefits warns that a retiree without Part B will have significant out-of-pocket expenses, paying the portion, about 80 percent, that Medicare would have paid. In general, retiree coverage that pays second may require Part B before it pays. For the enrollment steps in order, see Medicare for FRS retirees.

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How much does the Health Insurance Subsidy take off?

The Health Insurance Subsidy (HIS) is a monthly payment that helps retired members of a state-administered retirement system pay for health insurance. Since July 1, 2023, Florida Statutes 112.363 sets it at $7.50 a month for each year of creditable service at retirement, at least $45 and at most $225. If you're a Pension Plan retiree, it's paid as part of your monthly retirement benefit check (MyFRS). With 25 years of service, it would cover $187.50 of that $633.08 Medicare I example, leaving $445.58 a month.

Here are some of the conditions, from the statute and MyFRS:

  1. Vested. Most retirees must meet the Pension Plan vesting requirement for their class, which is 6 years of FRS service credit if you enrolled before July 1, 2011, or 8 years if on or after; disability retirees have a different test.
  2. Retired. A Pension Plan member must have left every FRS employer and begun drawing benefits. Investment Plan members have their own test, which MyFRS explains.
  3. Certified coverage. Your health coverage must be certified in writing to the Department of Management Services; you need not be in your former employer's group plan.
  4. Not in an optional program. Participants in the Senior Management Service Optional Annuity Program and the State University System Optional Retirement Program do not receive it.
  5. Applied for. You apply to the Division of Retirement with proof of coverage. If your certification arrives 7 or more months after benefits begin, back pay covers at most 6 months.

DROP and pension money questions

Health premiums are one thing; your DROP account, its payout and your pension are another. For those, contact the Division of Retirement and the MyFRS Financial Guidance Line, 1-866-446-9377 (TRS 711).

How is the premium set, and where do you see yours?

Under Florida Statutes 110.123(5), the Department of Management Services sets the program's benefits and required contributions, with prior approval by the Legislature. The plan year runs January 1 through December 31, and the 2026 table took effect in December 2025 for January 2026 coverage. The state has already posted its 2027 table, effective December 2026 for January 2027 coverage.

You can find your own amount on your People First benefits statement (the Insurance Benefits tile, then the Insurance Benefits Statement icon), on the MyBenefits premium tables, and in your mailed benefit materials. The state asks you to always read those mailings for premium increases and plan changes.

What changes if you buy private Medicare coverage instead?

You may buy Part C, Part D or Medigap plans on the private market. If you do, MyBenefits says you should cancel your state group health plan, and once you cancel, you can't enroll again. So weigh that step carefully. Here's how the state describes each private option:

Part D works differently. Florida Blue administers the state's nationwide PPO secondary plan, and Aetna and UnitedHealthcare its HMO secondary plans. If you're in one of those secondary plans, rather than an MA-PD plan, the state's 2026 creditable coverage notice says that if you join a Medicare drug plan and keep the state plan, you and your eligible dependents stay eligible for its health and drug benefits; if you drop the state plan, you drop its hospital, medical and drug coverage. MyBenefits also says not to add a separate Part D plan if you're in a secondary plan, because the state's drug coverage is creditable.

What do county, city and school board retirees pay?

If you retired from a county, city or school board, your premium comes from your former employer's plan, not the state table. Florida Statutes 112.0801 requires a county, municipality, special district, community college or district school board that offers group insurance to let certain retirees stay in the plan, with the same health coverage as active employees "at a premium cost of no more than the premium cost applicable to active employees." The cost may be paid by the employer or by the retirees. The statute defines who counts as a retiree, so ask your former employer's benefits office whether you qualify and what it costs.

If you're weighing the state plan against private Medicare coverage and want to go over the Medicare side of your own numbers, ask me: Ask Jeannie to reach out.

No ofrecemos todos los planes disponibles en su área. Actualmente representamos 14 organizaciones que ofrecen 52 productos en su área. Comuníquese con Medicare.gov o llame al 1-800-MEDICARE para obtener información sobre todas sus opciones.

1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, las 24 horas del día, los 7 días de la semana

Frequently asked questions

Does the state pay any part of a retiree's health insurance premium?

Generally no. Florida Statutes 110.123(4)(e) bars a state contribution toward the premium for retirees, surviving spouses and eligible former employees, with narrow line-of-duty exceptions in ss. 112.19 and 112.191 that can cover an officer or firefighter catastrophically injured in the line of duty, and certain survivors. The state's 2026 premium table shows the employer share in its early retiree row as zero.

Can my state health premium come out of my FRS pension check?

Yes, if you receive a monthly retirement benefit from the Division of Retirement: your premium may be deducted from it. You can pay electronically through your bank instead, but then you'll need to tell your bank each time the premium changes.

Does the state's Medicare premium include Part B?

No. The state's 2026 Medicare rates don't include the Part B premium, which you pay to Medicare on top, and that amount can be higher depending on your income.

Sources

About the author

Vista Insurance Services is a Florida fictitious name registered to Vista Consultants LLC, a Florida insurance agency (agency license L135539) with Jeannie Pond as agent in charge. Jeannie Pond is a Licensed Insurance Agent, NPN 8940178, licensed since 2009.

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