The Health Insurance Marketplace in Florida
A product of the Affordable Care Act, the Obamacare health plans are on sale and have changed the scope of insurance. The Marketplace is an online shopping center for your health insurance needs (comparable to ECHealthInsurance.com even before the exchanges were developed) operated by the federal government in 30 states, including Florida. A marriage between health insurers, the Department of Health and Human Services and the Internal Revenue Service, the exchange offers individual and family coverage at a reduced rate to those who qualify with tax credits. As the federal government now regulates health plans, costs cannot get too high, and each plan must feature the same types of benefits. With these criteria, health plans are competing for your business, and you benefit by paying less than private coverage in certain circumstances.
Exchanges are also open to small business owners who want to insure their workers through the Small Business Health Options Program (SHOP). They may also qualify for tax credits to assist with costs if their business is small enough. With numerous local businesses and start-ups throughout the state, this program may prove helpful for such employers and their full-time employees.
Targeting Floridians who could not previously afford or obtain coverage on the private market, the exchange is especially designed for the middle-income population. While access to private individual plans is open to anyone including those with pre-existing conditions, and premiums cannot be adjusted for health status or gender, you may find coverage is still too costly. This is where the exchange comes in. If you earn up to 400 percent of the poverty line, you may be eligible for tax credits to lower your premium rates and make coverage more reasonable.
Who Qualifies for the Exchange
Anyone can apply for a plan on the exchange, but it’s best suited for Floridians who don’t get insurance through their employer. If you are offered a health plan with at least 60 percent coverage at work, you will not be eligible for a subsidy, and therefore might as well purchase coverage on the private market. If your job offers less substantial coverage or none at all, and you earn less than 400 percent of federal poverty, you’ll want to consider these plans.
The lower your income, the more you’ll benefit from tax credits. If you earn on the higher end, a slight increase in pay could disqualify you from financial assistance, however. And if your income is below the poverty line, you will not be eligible for assistance, as Florida should have expanded Medicaid in order to accommodate what is now the gap between cutoffs for Medicaid and exchanges.This unfortunately leaves many Floridians uninsured and unable to obtain coverage despite increased access to it under the ACA.
The income groups below indicate the guidelines for subsidies on the Florida exchange.
Tax Credit Income Guidelines
100 to 250% FPL
Financial assistance for premiums AND cost sharing
100 to 400% FPL
Financial assistance for premiums only
Coverage and Plan Choices
On the exchange in every state, the law requires each participating health plan to offer four different coverage levels, ranging from 60 to 90 percent of your medical costs after deductible. With the included benefits and coverage, these plans are considered comprehensive, and should pay for a variety of regular and necessary medical services. Plans are sold by private insurers, mainly Florida Blue, which serves the entire state. Company availability varies by county, with ten total carriers to choose from. Based on where you live, you could have anywhere from one to nine carrier options.
- Aetna Life Insurance Company
- Cigna Health and Life Insurance Company
- Coventry Health Care of Florida, Inc.
- Florida Blue (Blue Cross Blue Shield of Florida)
- Florida Health Care Plan, Inc.
- Health First Health Plans
- Health First Insurance Company
- Health Options, Inc.
- Humana Medical Plan, Inc.
- Molina Healthcare Of Florida, Inc.
All insurers offer the same four tiers of coverage. This includes Bronze, Silver, Gold and Platinum plans, in order of coverage level from low to high ranging from 60 to 90 percent. As with traditional health plans on the private market, these include premiums, deductibles, coinsurance and copays. Cost sharing, such as deductibles, copays and coinsurance, may be reduced with subsidies for covered services if your income is low enough.
You can select a plan based on what you can afford per month and how much you prefer to pay for health care, or whatever balance of cost sharing and premium rates falls in your price range. For younger Floridians, catastrophic coverage is available on the exchange. This covers just a few essentials for an affordable rate while helping residents up to age 30 avoid the penalty tax.
Below is a basic breakdown of the coverage found on the Florida Health Insurance Exchange.
Bronze Plan: 60%
Health plan pays 60% after deductible, you pay 40%.
Largest amount of cost sharing, lowest premium.
Advantage: Lowest monthly rate, acceptable for healthy people.
Disadvantage: Higher out-of-pocket when you receive care.
Silver Plan: 70%
Health plan pays 70% after deductible, you pay 30%.
Best value for most customers — balance of lower premiums and moderate cost sharing.
Advantage: Lower rates, greatest savings with tax credits.
Disadvantage: Still paying a decent amount out-of-pocket for medical services at 30%, but not bad.
Gold Plan: 80%
Health plan pays 80% after deductible, you pay 20%.
Moderate premiums and lower cost sharing: ideal if it fits your budget.
Advantage: Lower medical costs, tax credits apply and will discount your premiums.
Disadvantage: Higher premiums and a smaller discount applied with subsidies.
Platinum Plan: 90%
Health plan pays 90% after deductible, you pay 10%.
Optimal for those who plan to use their coverage, very low cost sharing for a higher premium.
Advantage: Least costly out-of-pocket, tax credits are applicable to lower premium rates.
Disadvantage: Higher premiums may be too costly for some customers even with rate reductions.
Covered Services: The Essential Health Benefits
Another requirement of the exchange is that all insurers include ten categories of “essential health benefits” (EHBs) in their policies. Regardless of whether you buy a Bronze or a Platinum plan, the same types of care are covered by your plan. Plans sold on the private market are also required to include EHBs in their comprehensive plans, but again, they are not discounted for certain income levels, and not every category is guaranteed to be covered unless you buy from the exchange. Therefore, if you’re planning to have a baby or seek mental health counseling in the near future, the exchange is a better option. The following categories provide a broad umbrella of what may be covered by your plan. Specifics are still up to each insurer, but they must include some level of coverage.
- Office visits
- Maternity and newborn care
- Prescription drugs
- Prevention, wellness and chronic disease management
- Rehabilitation and habilitation for injuries
- Mental health and substance abuse treatment, including behavioral health care
- Pediatric care
- Emergency services
- Laboratory services
How to Apply
For more information on the carriers serving your county and how to apply for coverage on the Florida Marketplace, call a licensed agent at 888 803 5917. We can help you apply, find out if you are eligible for tax credits, and get you covered. HealthCare.gov is the federal online portal for coverage, where you can also find more information about your state’s exchange.
Earn more than 400 percent of FPL? Compare your health insurance options from multiple companies with a free, instant health insurance quote.
Compare Florida Marketplace Plans
Use the tool below to find which carriers serve your county and how much health plans cost, including an estimate of the premium tax credit for which you may be eligible. Call an East Coast Health Insurance agent to find out more about these plans and apply for an individual policy.
*The above disclaimer pertains to the creator of this comparison tool, not Every Choice Health Insurance, a licensed broker of insurance products.