Medicare Open Enrollment When Your Parent Lives in a Florida Nursing Home or Assisted Living
Most Medicare open enrollment advice assumes your parent lives at home and picks a plan once a year. If your parent lives in a Florida nursing home or assisted living facility, the rules are different. Nursing home residents get more flexibility than almost anyone else on Medicare. Assisted living residents mostly do not. With several insurers cutting Florida Medicare Advantage plans for 2027, this fall's choice affects which doctors, pharmacies and rehab facilities your parent can use. Here is what applies before open enrollment closes on December 7, 2026.
Nursing home residents can change plans in any month
Federal rules give people who live in a nursing home an ongoing enrollment window. According to Medicare, the chance to join, switch, or drop coverage lasts as long as your parent lives in the facility and for two full months after the month they move out. A change generally takes effect on the first day of the following month.
The federal definition of "institutionalized" covers people who live, or are expected to live, 90 days or longer in a skilled nursing facility, a nursing facility, a long-term care hospital, a rehabilitation hospital, a psychiatric hospital, a swing-bed hospital, or a facility for people with intellectual and developmental disabilities.
In practice, December 7 is not a hard deadline for a long-stay nursing home resident. If their plan is leaving, or the facility drops out of its network, you can still fix it in January or later. That is a reason to choose carefully rather than rush.
It is not a reason to ignore the mail, though. If your parent's Medicare Advantage plan is not renewing for 2027 and you do nothing, they return to Original Medicare on January 1 without a drug plan. For someone on several medications, even a short gap causes real problems. If a non-renewal letter arrived, pick replacement coverage now.
Assisted living works differently
Assisted living is not on the federal list of qualifying institutions. An assisted living resident generally follows the same calendar as someone living at home:
- Open enrollment runs October 15 through December 7, 2026, with changes effective January 1.
- If your parent is in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period from January 1 through March 31 allows one switch to another Advantage plan or a return to Original Medicare.
- Other special enrollment periods still apply, such as a plan non-renewal, a move to a new service area, or having Medicaid or Extra Help.
For an assisted living resident, December 7 is a real deadline. If the facility's visiting doctors, its pharmacy or the nearby hospital are leaving your parent's plan, act now.
If your parent has Medicaid too
Many long-stay nursing home residents in Florida qualify for both Medicare and Medicaid. In Florida, Medicaid pays for long-term nursing home care through the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, and some assisted living residents receive Medicaid help through the same program.
Since 2025, people with both Medicare and Medicaid, and people who get Extra Help with drug costs, can make certain changes once a month. They can leave a Medicare Advantage plan for Original Medicare with a standalone Part D plan, or switch drug plans. A separate monthly option lets people with full Medicaid join an integrated dual eligible plan aligned with their Medicaid plan. Neither option allows a move into an ordinary Medicare Advantage plan, but nursing home residents have their own monthly window for that.
Institutional Special Needs Plans
One option many families have never heard of is an Institutional Special Needs Plan, or I-SNP. These are Medicare Advantage plans limited to people who need, or are expected to need, long-term facility care for 90 days or more. They contract with specific nursing homes, and many place a nurse practitioner or care team inside those facilities to handle routine medical issues on site.
The key question with an I-SNP is simple: does it contract with your parent's facility? If your parent later moves to a different nursing home, the plan may not follow them. Federal rules also allow I-SNPs to enroll people living outside a nursing home who need an institutional level of care, as long as an independent party performs the assessment. If your parent is in assisted living, ask whether any I-SNP in your county enrolls residents of that building.
What Medicare pays for in a facility, and what it doesn't
Medicare does not pay for long-term custodial care, meaning help with bathing, dressing, meals and supervision, in a nursing home or in assisted living. It does pay for doctor visits, therapy, hospital care and prescriptions, which is why the plan choice still matters.
For short-term rehab, Original Medicare covers skilled nursing facility care after a hospital inpatient stay of at least three days in a row. Time spent under observation or in the emergency room does not count. Coverage is limited to 100 days per benefit period. In 2026, your parent pays nothing for days 1 through 20 after the $1,736 Part A deductible, then $217 a day for days 21 through 100. Medicare has not yet published the 2027 amounts.
Medicare Advantage plans may waive the three-day hospital stay requirement, but they may charge copayments during the first 20 days and often require prior authorization before a rehab stay.
Five questions to answer before you choose a plan
- Is your parent's facility in the plan's network for 2027? Ask the facility's business office which plans it accepts next year, then confirm with the plan.
- Do your parent's doctors, including any physicians or nurse practitioners who visit the facility, accept the plan?
- Does the pharmacy that serves the facility work with the plan, and are your parent's current medications on the 2027 drug list?
- If your parent ends up in the hospital, which skilled nursing facilities are in network for rehab, and does the plan waive the three-day stay rule?
- Does your parent qualify for Medicaid or Extra Help? Either one opens the monthly change options described above.
When a plan change becomes a facility decision
Sometimes the plan question becomes a facility question. If the plans that fit your parent's needs do not work with their current nursing home, or you were already weighing a move, compare facilities before you commit. You can search every licensed provider in the Florida nursing home and assisted living directory, line up inspection results and staffing side by side by picking a city and ticking two to four facilities to compare, or start with the Florida nursing homes that hold a CMS 5-star rating.
If you are still sorting out whether your parent's plan is affected, our guide to which Florida counties are losing Medicare Advantage plans for 2027 covers where the cuts are landing.
The bottom line
If your parent lives in a nursing home, they can change Medicare coverage in any month, so take the time to choose a plan that works with their facility, doctors and pharmacy. Just make sure a non-renewal does not leave them without drug coverage on January 1. If your parent lives in assisted living, treat December 7 as a firm deadline unless they have Medicaid or Extra Help.
For free, unbiased help comparing plans, call Florida's SHINE program at 1-800-963-5337. SHINE counselors are trained volunteers who do not sell insurance.
Sources: Medicare.gov, Special Enrollment Periods; Medicare.gov, Skilled Nursing Facility Care; Medicare.gov, Long-Term Care; Centers for Medicare & Medicaid Services, CY 2027 Medicare Parts C and D Enrollment and Disenrollment Guidance; Code of Federal Regulations, 42 CFR 422.2, definition of Institutionalized; Centers for Medicare & Medicaid Services, Institutional Special Needs Plans (I-SNPs); Justice in Aging, Important Changes in 2025 to Special Enrollment Periods for Low-Income Medicare Enrollees; SHIP Technical Assistance Center, Florida SHINE program listing.