Private Health Insurance and Publicly Sponsored Programs For Florida Health Insurance Coverage

 

Small businesses

(1-50 employees)

U.S. Uninsured Help Line

800-234-1317

Group Health

Florida Association of Health Underwriters www.fahu.org

Up to $5M lifetime maximum, assorted deductibles

If uninsured for previous 1-6 months, a waiting period for coverage of pre-existing conditions may apply

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE Company size 1-50 employees Two employees must work for

at least 6 months out of the year, and work 20 hours per week for coverage

 

Individuals recently covered by an employer
COBRA and  Mini-COBRA

And then

HIPAA

Health Insurance Portability and Accountability Act

866-4-USA-DOL www.dol.gov

Cobra Subsidy: 9 months of partially subsidized COBRA premium

COBRA /Mini-COBRA coverage is available for up to 18 months depending on qualifying events

COBRA benefts are the same as what you had in your group coverage

After COBRA expires, HIPAA individual plan conversion benefts are based on the program selected, no expiration

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE Cobra Subsidy: If you were involuntarily terminated between Sept 1, 2008 and Dec 31, 2009, you are eligible for a COBRA subsidy from the Federal Government. If you become eligible for other insurance, you will no longer be eligible for the subsidy. If you turned down COBRA from Sept 1, 2008 to Feb 17, 2009, you are eligible for the subsidy. Must have an income at or below $125,000 for individuals or $250,000 for couples.

 

Individuals and Families in Florida
U.S. Uninsured Help Line

800-234-1317

Individual Plans

Florida Association of Health Underwriters www.fahu.org

Assorted plans depending on medical needs

There is a 24-month look-back and exclusionary period limit for pre-existing conditions in traditional individual market health insurance products in Florida

Pre-existing conditions may not be considered for  HIPAA-eligible population

Limits on pre-existing health conditions may apply

Eligibility is subject to medical underwriting

If you are denied coverage for a medical condition, you may be eligible for FCHA, see next column

Individuals with pre-existing,

severe or chronic medical conditions

 

Cover Florida

877-872-6580 www.coverforidahealthcare.

com

Six carriers have designed 27 creative health insurance products. Each carrier ofers at least two beneft options – one with catastrophic and hospital coverage, and one without. Benefts include preventive services, screenings, ofce visits, as well as ofce surgery, urgent care, hospital coverage, emergency care, prescription drugs, durable medical equipment, and diabetic supplies.

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE Ages 19 to 64 who have been

without health insurance for at least six months – even if there are pre-existing health conditions. May also qualify if you lost your job that provided employer-sponsored health benefit, lost of benefits under COBRA; death of, or divorce from, a spouse who has provided employer-sponsored health benefit.

Low-income individuals & families
Medicaid

850-488-3560 Medicaid Options Help Line

888-367-6554 www.fdhc.state.f.us/Medicaid

Among some of the services: ambulatory surgical center birth center services, child health check up chiropractic care, durable medical equipment and supplies, federally qualifed health centers, home health hospital inpatient/outpatient care, laboratory, licensed midwives, physician, podiatry prescriptions, rural health clinics, therapy, X-rays

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE Pregnant Women: 185% FPL Children (Ages 0-1): 200% FPL

Children (ages 1-5): 133% FPL Children (ages 6-19): 100% FPL

Aged, Blind and Disabled: 90% FPL Supplemental Security Income Recipients: 74% FPL

 

Children

Florida KidCare

 

MediKids, Healthy Kids, Children’s Medical Services  and Medicaid 888-540-5437 877-316-8748 TTD www.foridakidcare.org

Comprehensive health insurance coverage

Benefts vary based on the segment of the program in which a child participates— MediKids, Healthy Kids, or the Children’s Medical Services (CMS) Network for children with special health care needs

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE Under age 19 and uninsured Have an income at or below

200% of the FPL Be a U.S. citizen or qualifed

non-citizen Cannot be eligible for Medicaid Not be the dependent of a state

 

Women In Florida
Breast and Cervical Cancer Prevention

 

800-227-2345 www.doh.state.f.us/Family/bcc

(Pregnant women see Medicaid)

Breast and cervical cancer screening exams (mammograms, pap smears and clinical breast exams) are provided to diagnostic exams are provided as necessary case management is provided to all clients

Outreach, public education and professional education is provided

Treatment for eligible women may be paid by Medicaid

GUARANTEED COVERAGE Uninsured and underinsured

women 50 to 64 years of age, at or below 200% of FPL

 

Seniors and Disabled
Medicare

800-952-5253 800-MEDICARE www.medicare.gov

Medicare Prescription Drug Program

800-633-4227

Medicare ofers two standard plans, A: Hospital Insurance and B: Medical Insurance, as well as several supplemental and advantage plans 

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE Disabled or age 65 and older

or people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

 

Trade Dislocated Workers (TAA recipients)

Health Coverage  Tax Credit

866-628-HCTC www.irs.gov (key word HCTC)

Will cover 80% of your COBRA premium if employer contributes less than 50% (or spouses’ employer)

Will cover individual insurance in which you were enrolled for last 30 days before TAA benefts

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE Must be receiving TAA (Trade

Adjustment Assistance) Must not have access to

employer plan that pays 50% of coverage cost

Age 55 and older

20% of the insurance premium

 

Veterans

 

VA Medical  Benefts Package

877-222-8387 www.va.gov

Comprehensive preventive and primary care, outpatient and inpatient services

Pre-Existing Health  Conditions Covered

GUARANTEED COVERAGE ”Veteran status” = active duty

in the U.S. military, naval, or air service and a discharge or release from active military service under other than dishonorable conditions

$0 and share of cost and co-pays depending on income level

 

Other Programs In Florida

Women-InfantChildren (WIC)

800-342-3556 http://www.doh.state.f.us/ family/wic/

Partnership for Prescription Assistance

888-4PPA-NOW (888-477-2669) www.pparx.org

Florida Alzheimer Disease Initiative

850-414-2000

Florida AIDS Insurance Continuation Program

305-592-1452 http://www.doh.state.f.us/ disease_ctrl/aids/care/aicp.html

NOTE: Government programs look at each family’s circumstance to determine eligibility.

Income and assets tests may be required to determine eligibility for publicly sponsored programs.

Guaranteed Coverage means you cannot be turned down due to your health conditions.

Programs and plan availability, eligibility requirements, costs, and coverages are subject to change.

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Financial aid and free or low-cost benefits

Government Benefits Finder 800-FED-INFO www.benefits.gov

(Search tool for grants, loans and other benefits)

Catalog of Federal  Domestic Assistance www.cfda.gov

(Search tool for grants, loans and other benefits)

Finding local health care options

Bureau of Primary Health Care 888-ASK-HRSA www.ask.hrsa.gov/pc 

(Search tool by zip code)

Self Help Clearing House www.mentalhelp.net/selfhelp

(Search tool for people sharing information on hundreds of diseases, health conditions and other health care related situations)

Laws and regulations

Florida Office of  Insurance Regulation  800-342-2762 www.floir.com

(General information on all types of insurance)

Department of Health and Human Services www.hhs.gov

(Various health care search tools)

Florida Health and  Human Services www.dcf.state.fl.us/ess www.doh.state.fl.us

(State program information)

Employee Benefits  Security Administration www.dol.gov/ebsa

( Official information and rules from the  U.S. Department of Labor)

Help with this Matrix or finding a broker or agent

Florida Association of Health Underwriters www.fahu.org

(State organization of insurance brokers)