FLORIDA HEALTH INSURANCE: FIND AFFORDABLE PLANS

If you live in Florida, you have a wide variety of options for affordable health insurance. You can enroll in your employer’s plan, sign up for Medicare or Medicaid ― if you qualify ― or even purchase an individual or family plan directly from a health insurance company. There are also off-market and non-Affordable Care Act (ACA) plans available.

This guide explains your Florida health insurance options in detail.

• Marketplace plans: You can buy a marketplace health insurance plan if you don’t have employer-sponsored coverage or your employer’s coverage doesn’t meet your needs.
• Open enrollment: The open enrollment period for health insurance coverage starting in 2023 in Florida’s runs October through December 7, 2022. If you miss open enrollment, you can’t buy a marketplace plan until the next year unless you qualify for a special enrollment period.
• Special enrollment: A special enrollment period allows you to sign up for health coverage outside of open enrollment. You may qualify for special enrollment if you have a qualifying life event (QLE) that caused you to lose coverage—for example, moving into a different zip code, losing your job, getting married, or having a child. You have 60 days from the time of the event to select a new plan.
• Health Insurance Marketplace: Florida uses the federal Health Insurance Marketplace. If you’re interested in getting an Advanced Premium Tax Credit to help cover your costs, it’s best to use the exchange to purchase a plan.
• Premium tax credit: You can purchase coverage directly from one of Florida’s health insurance companies if you don’t qualify for an Advanced Premium Tax Credit or don’t want to take the credit.
• Coverage types: Slightly more than 40% of Florida residents have employer-sponsored health coverage. Another 17.4% have Medicaid, 18% Medicare, and 9.5% non-group health plans. Approximately 13% of Florida residents have no health coverage.

Florida is one of 36 states that doesn’t have a separate state website for health insurance coverage. You’ll visit HealthCare.gov to start your enrollment and register an account. Once you have an account, you can apply for health insurance. The Health Insurance Marketplace checks your eligibility for Medicaid and uses the information you provide to determine if you qualify for an Advanced Premium Tax Credit. Make sure you have the full name, birth date, and Social Security number of every person in your family who needs coverage before you start the application process. The application includes several questions related to your income and family, including the following:

• Are you single or married?
• How many tax dependents will you claim on your current return?
• How much income will your household make this year?
• Do you want to see if you can get help paying for coverage?

After entering the required information, you’ll be able to view a list of available plans, including monthly premiums, annual deductibles, and coinsurance requirements. HealthCare.gov also has a tool that allows you to make side-by-side comparisons of up to three plans at a time. Once you pick a plan, you’ll be able to complete the enrollment process. The following insurance companies offer individual health insurance plans to Florida residents in the Marketplace:

• Ambetter from Sunshine Health
• Capital Health Plan
• Cigna Health and Life Insurance Company
• Florida Blue (Blue Cross Blue Shield of Florida)
• Florida Blue HMO (a BlueCross BlueShield FL company)
• Oscar Insurance Company of Florida

There are other options for off-market coverage, such as UnitedHealthcare, General, AAA, and Aspen.

There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:

• Medical needs
• Preferred plan type
• Premium affordability
• Individual vs. family deductibles

Insurance for individuals in Florida

When you’re looking for individual coverage, you have a little more flexibility. If you don’t have any chronic health problems, you may qualify for off-market or non-ACA plans. You may be able to reduce your annual out-of-pocket costs by choosing a plan with a low monthly premium and a high annual deductible. You have to pay the premium no matter how much you use your coverage. Still, you don’t pay anything toward the deductible until you receive medical services. The type of plan you choose is also an important consideration.

• Health maintenance organization (HMO) plans typically cost less than other health coverage types and have some restrictions that can affect your ability to access care. For example, you may have to ask for a referral if you want to see a specialist and your network is local.
• Preferred provider organizations (PPOs) don’t require referrals and usually offer nationwide coverage but tend to cost more than HMO plans. Most PPOs also have out-of-network benefits.
• Point-of-service (POS) plans combine the features of an HMO with the features of a PPO. You have to ask for a referral to see a specialist, but you can get care from out-of-network providers if you’re willing to pay a larger percentage of the cost.

Insurance for families in Florida

When you’re shopping for coverage for multiple people, you need to think about individual health needs and your potential out-of-pocket costs. You may be healthy, but perhaps your spouse has asthma, or one of your children has a disorder requiring ongoing care. In that case, you need to balance the monthly premium with the annual deductible and the copayment or coinsurance amount for each service. In some cases, it makes sense to purchase a more expensive plan that offers better coverage. If you choose a low-cost plan, you may have trouble paying the large deductible if one of your family members needs medical care.

Plan type is also an important consideration for families. If one of your family members needs ongoing medical care, you may find value in a PPO plan. A PPO gives you the freedom to see a specialist without asking for a referral. Before purchasing a plan, check the provider network to make sure it covers doctors and hospitals in a wide range of specialties.

The Health Insurance Marketplace classifies plans into four tiers named after metals: Bronze, Silver, Gold, and Platinum. Each plan is assigned to a tier based on its monthly premium, annual deductible, and required coinsurance amounts. Although low-premium plans are attractive, it’s important to select a plan based on the total cost of coverage:

• Bronze plans have the lowest monthly premiums. In exchange for a low premium, you’ll have a high annual deductible. You’ll also have to pay 40% coinsurance every time you receive medical services. A Bronze plan is typically the best option if you don’t have any chronic health conditions and want coverage for emergencies. In 2023, the most affordable Bronze plan in Florida costs $353 per month.
• Silver plans have higher premiums than Bronze plans but also have lower deductibles and coinsurance requirements. A Silver plan can be cheaper than a Bronze plan if you qualify cost-sharing available to enrollees with incomes below a certain threshold. Cost-sharing is only available with a Silver plan. Silver plan members pay 30% coinsurance for each service. In 2023, the most affordable Silver plan in Florida costs $468 per month.
• Gold and Platinum plans have the highest monthly premiums but also have lower deductibles and insurance requirements. With a Gold plan, you’ll pay 20% of the cost of each service you receive, and the coinsurance requirement dips to 10% if you have a Platinum plan. These plans are ideal if someone in your family has a chronic condition that requires regular medical care. In 2023, the most affordable Gold plan in Florida costs $459 per month.

Florida has two programs that provide health coverage for low-income residents: Medicaid and KidCare. Medicaid is a joint effort between Florida and the federal government. KidCare connects Florida children with a plan based on age, household income, and household size.

Medicaid in Florida

Medicaid is available to Florida residents who have low income and qualify as any of the following:

• At least 65 years old
• Pregnant
• Blind
• Age 18 and younger

You may also qualify for Medicaid if you have a disability or live with someone who has a disability. Most Medicaid beneficiaries use Statewide Medicaid Managed Care, which covers doctor visits, hospital stays, and other medically necessary services.

Medicaid is only available to low-income Florida residents. To qualify for Medicaid coverage, you must not earn more than the maximum annual income for your household size. If you live alone, the maximum annual income is $18,075. The income limit increases to $24,353 for a household of two and $30,630 for three.

In addition to the commonly used Managed Medical Assistance program, Florida has a long-term care option for residents who are at least 18 and need a nursing home level of care. Covered services may come from staff in a nursing facility or assisted living center. To apply for Florida Medicaid, visit the Member Portal. Once you create an account, you can apply and check on your eligibility.

KidCare in Florida

KidCare aims to connect Florida children with health care. KidCare matches Florida children with Medicaid, Florida Healthy Kids, MediKids, or the Children’s Medical Services (CMS) Health Plan using information about household size, income, age, and special medical needs.

• The CMS Health Plan covers minors with special medical needs from birth through age 18
• MediKids provides coverage for children between the ages of 1 and 4
• The Healthy Kids program offers health insurance for children between the ages of 5 and 18

To apply for health coverage on behalf of a child in your family, visit the Florida KidCare website.

Florida has several Medicare options available to older adults and people with disabilities:

• The most basic option is Original Medicare, which consists of Part A (inpatient care) and Part B (preventive care and outpatient medical services). Original Medicare doesn’t cover prescriptions, but supplemental plans are available to help reduce your out-of-pocket expenses. These supplemental prescription plans are known as Medicare Part D. The Medicare Part A deductible for inpatient hospital stays is $1,600 in 2023. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• Florida also has the Medicare Advantage program, which gives eligible residents access to various Medicare plans sold by private insurers. Many of these plans include prescription coverage and may also cover things like gym memberships and transportation to medical appointments, giving you more coverage than Original Medicare. As of 2023, there are 17 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.
• Medicare Advantage program, which gives eligible residents access to various Medicare plans sold by private insurers. Many of these plans include prescription coverage and may also cover things like gym memberships and transportation to medical appointments, giving you more coverage than Original Medicare.

Eligibility

To enroll in Original Medicare or Medicare Advantage, you must meet certain eligibility requirements. First, you must be a United States.S. citizen or permanent resident. You must also be at least 65 years old or have a disability that causes you to receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may also qualify for Medicare at a younger age if you have end-stage renal disease (ESRD).

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

Serving Health Insurance Needs of Elders (SHINE) is Florida’s State Health Insurance Assistance Program. If you have questions about your Medicare options or need help enrolling in Original Medicare or Medicare Advantage, call SHINE at (800) 963-5337 to speak with a counselor.

Florida allows insurers to sell short-term health plans, also referred to as temporary health insurance. Plans are designed to cover short gaps in coverage, such as time in between jobs or if you missed open enrollment.

In Florida, insurance companies can sell short-term plans with an initial coverage term of no more than 12 months and extend them up to 36 months. Short-term health plans don’t have to follow the protections included in the ACA and may not cover pregnancy, preventive care, or preexisting conditions.

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