Florida Health Insurance

Overview

If you live in Florida and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for Florida

If you are enrolling for an Obamacare subsidized insurance plan through Healthcare.gov or a broker, the official deadline to sign up for health coverage in 2014 was March 31st. If you signed up by March 31, you would be covered by May 1 and avoid paying a penalty for not being insured.

* Note that federal officials let you get qualified coverage after March 31 IF you started an application by March 31 and finish by April 15.

Do I Qualify for a Tax Break on Health Insurance?

Use the calculator below to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

What Plan Type is Right For Me?
How Many Need Coverage
Total Annual Income
 
 

You may qualify for Medicaid, a free, state-sponsored health insurance program. Call 800-318-2596 or go to the Health Insurance Marketplace website to find out if you can enroll in Medicaid.

You qualify for a subsidy (tax credit) that will save you money if you buy a plan on Florida's new insurance marketplace, called Health Insurance Marketplace. Plans should be offered there starting October 1, 2013. While your subsidy will cover part of the monthly premium for any of the marketplace's plans, a plan that's in the "silver tier" probably offers the best deal. That's because you also qualify for a second subsidy that increases the value of benefits you'd get from any silver plan.

You qualify for a subsidy (tax credit) that will save you money if you buy a health plan on Florida's new insurance marketplace, called Health Insurance Marketplace. Plans should be offered there starting October 1, 2013. Your subsidy will cover part of the monthly premium for any of the marketplace's plans, known as Qualified Health Plans.

You don't qualify for a subsidy. You can either buy a plan on the Health Insurance Marketplace website or click the button below to compare U.S. News-rated plans in your state's private insurance market. Plans on Health Insurance Marketplace will generally offer more health coverage than plans in the private market, but they also tend to cost more in monthly premiums. The Health Insurance Marketplace website should offer plans beginning October 1, 2013.

Any children in your household may be eligible for Medicaid. Call 800-318-2596 or go to the Health Insurance Marketplace website to find out if your children are Medicaid-eligible.

See Plans

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of Florida. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in Florida’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Do I Have To Buy Health Insurance?

You may have heard that everyone in Florida must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

Florida's Official Marketplace

Health Insurance Marketplace is Florida’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on Health Insurance Marketplace, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the Health Insurance Marketplace website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with eHealth.com, an online broker licensed to sell health insurance, to help you buy the health plan you want. The eHealth customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on Health Insurance Marketplace

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states will offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a Health Insurance Marketplace plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a Health Insurance Marketplace plan makes sense given your income on the State Overview tab, under the heading, "Do I Qualify For a Tax Break?"

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

158 plans are available in Seminole County in eastern Florida, the most of any county nationwide, reports Kaiser Health News. In Miami-Dade, nine insurers offer 137 plans. However, Florida Blue, an independent licensee of the Blue Cross and Blue Shield Association, sells 52 of them. 

However, because many of them are operating in only part of the state - and none is selling plans statewide - consumers in the majority of Florida's counties have no more than two insurers to choose from, according to the Orlando Sentinel. Residents of South Florida have more choice than those who live in the state's rural areas. Residents of Broward and Miami-Dade counties have nine insurers to chose from and residents of Palm Beach have eight. Residents in central Florida, living in Orange, Osceola and Lake counties have five insurers and those in Seminole and Volusia have six. In twenty-one rural counties, Blue Cross and Blue Shield is the only option for those purchasing exchange plans. 

Aetna. One of the largest U.S. insurance companies, Aetna has over 22 million medical members. Its network includes more than 1 million health care professionals and over 5, 300 hospitals nationwide. Floridians who buy an Aetna exchange plan may not have access to the entire network of doctors and hospitals. Aetna offers PPO exchange plans in Bronze through Gold tiers. 

Ambetter from Sunshine Health. Sunshine Health offers Ambetter to residents in the following three South Florida counties: Palm Beach, Broward and Dade. Sunshine Health provides healthcare options to low-income individuals in Florida, serving more than 216,000 members across the state, according to the Wall Street Journal. Sunshine Health is a subsidiary of Centene Corporation, a Fortune 500 company, which has been in business for more than 27 years. Its network includes ten hospitals: Coral Gables Hospital, Delray Beach Medical Center, Good Samaritan Medical Center, Hialeah Hospital, North Shore Medical Center, Florida Medical Center (Campus of North Shore), Palm Beach Gardens Medical Center, Palmetto General Hospital, St. Mary's Medical Center, and the West Boca Medical Center. Its network includes approximately 1,300 physicians. Sunshine Health offers Ambetter HMO exchange plans in Bronze through Gold tiers. 

Cigna Health and Life Insurance. Formed in 1982, the global health service company serves 75 million members worldwide. Floridians who buy a Cigna exchange plan may not have access to the entire network of doctors and hospitals. Cigna covers alternative treatments if they are deemed “medically necessary,” according to the Miami Herald, and also offers a discount program for those who wish to use them. Cigna offers PPO exchange plans in Bronze through Gold tiers. 

CoventryOne. CoventryOne is supported by Coventry Health Care, a subsidiary of Aetna, with over 5 million members in all 50 states. Locally, CoventryOne serves over 310,000 Floridians and 7,600 employers. CoventryOne offers HMO exchange plans in Catastrophic through Gold tiers. 

Florida Blue (Blue Cross and Blue Shield of Florida). Florida Blue is an independent licensee of the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, the District of Columbia and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. Floridians who buy a Blue Cross and Blue Shield exchange plan may not have access to the entire network of doctors and hospitals. Florida Blue offers EPO exchange plans in every tier. 

Florida Blue HMO. Florida Blue HMO is also an independent licensee of the Blue Cross and Blue Shield Association. Florida Blue HMO offers HMO exchange plans in Bronze through Platinum tiers. 

Florida Health Care Plans. FHCP is also an independent licensee of the Blue Cross and Blue Shield Association. FHCP offers HMO and PoS exchange plans in every tier. 

Health First Insurance. Established in 1995, this nonprofit provides health coverage options for those living in Florida's Brevard and Indian River counties. Health First is "central Florida's only fully integrated health system" and the "largest multi-specialty physician group in Brevard County," according to the company. Health First has four hospitals: Holmes Regional Medical Center, Palm Bay Hospital, Cape Canaveral Hospital and Viera Hospital. The company claims to specialize in outpatient and wellness services, offering four Pro-Health and Fitness Centers to members. Health First offers PPO exchange plans in Catastrophic through Gold tiers. 

Humana Medical Plan. Established in 1974 in Louisville, Ky., Humana is one of the largest U.S. health insurance companies with over 11.5 million members. Humana offers HMO exchange plans in every tier. 

Molina Healthcare of Florida. Established in 1980 in California, Molina Healthcare is a multi-state health care organization with a focus on providing government-sponsored health services to over 5 million Americans in 15 states, according to the company. Molina offers HMO exchange plans in Bronze through Gold tiers. 

Preferred Medical Plan. Established in 1972, Preferred Medical Plan is the "oldest licensed and independently owned HMO in Florida with the largest individual membership in South Florida," according to the company. The company serves more than 40,000 members in Medicaid and Medicare Advantage and is the oldest Medicaid managed care plan in Florida, according to Yahoo!. The company specializes in providing health care options to those living in Miami-Dade and Broward counties in South Florida. Preferred Medical Plan offers HMO exchange plans in Bronze through Gold tiers. 

Need More Help?

The Florida Office of the Insurance Consumer Advocate exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. The office can be reached at 850-413-3030 or emailed at InsuranceConsumerAdvocate@MyFloridaCFO.com. Residents can file an insurance complaint online.

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-05-01