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If you live in Florida, you have a wide variety of options for 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-ACA plans available.
This guide explains your Florida health insurance options in detail.
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:
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:
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 for multiple people. These considerations include:
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.
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.
|Average premiums in Florida||2018||2019||2020||2021|
|Most affordable bronze plan||$313||$345||$338||$339|
|Most affordable silver plan||$450||$461||$454||$447|
|Most affordable gold plan||$479||$502||$501||$489|
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 is available to Florida residents who have low income and qualify as any of the following:
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 $17,131. The income limit increases to $23,169 for a household of two and $29,207 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 aims to connect Florida children with health care. KidCare matches Florida children with Medicaid, Florida Healthy Kids, MediKids, or the Children’s Medical Services 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.
|Eligibility and Enrollment|
|Eligibility||To enroll in Original Medicare or Medicare Advantage, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability that causes you to receive SSDI benefits for at least 24 months. You may also qualify for Medicare at a younger age if you have end-stage renal disease.|
|Enrollment||Three months before you turn 65, you’ll become eligible for an initial enrollment period. During the IEP, you’ll have an opportunity to sign up for Medicare. If you started receiving Medicare before the age of 65, you could make changes to your coverage at this time.
Medicare has an open enrollment period from October 15 to December 7 each year. During open enrollment, you can sign up for Medicare or switch your Medicare Advantage or Medicare Part D plan to meet your needs better.
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 1-800-963-5337 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 Affordable Care Act and may not cover pregnancy, preventive care, or preexisting conditions.
Florida doesn’t have any state laws requiring residents to have health insurance coverage. The Affordable Care Act still mandates that all U.S. residents have health insurance. Still, there’s no longer a tax penalty for failing to maintain a minimum level of coverage.
No, you don’t have to use the Health Insurance Marketplace for health coverage. But you’ll need to enroll using the marketplace if you want to receive an Advanced Premium Tax Credit to reduce your out-of-pocket costs.
Florida residents may qualify to participate in alternative health insurance plans that cost less than coverage purchased from an insurance company. For example, cost-sharing programs are available to pool member funds to pay health claims.
It’s up to you to purchase health insurance. Still, flexible spending accounts and health savings accounts are not a substitute for insurance coverage. Unless you can save enough to cover significant out-of-pocket expenses, it’s best to have health insurance in addition to an FSA or HSA.
In most cases, short-term disability payments cover household expenses if you’re unable to work due to disability. You’ll still need health insurance to cover any medical expenses arising from your injuries. Additionally, your short-term disability payments may not be enough to cover the cost of a lengthy hospitalization or cutting-edge treatments.
Long-term disability coverage replaces your income if you’re out of work for a long time due to an injury or illness. Like short-term disability, long-term disability can cover housing, food, and other household expenses while you’re unable to work. It’s not a substitute for health insurance. The payments aren’t likely to be high enough to cover most medical services. If at all possible, you should have health insurance even if you already have LTD coverage.
KidCare covers medical screenings, preventive care, immunizations, and medical treatment for various injuries and illnesses. The program matches Florida children with an appropriate health insurance program.