Even if you feel relatively young and healthy, going without health insurance is extremely risky from a financial perspective. But today you have more options than ever before when it comes to affordable and effective health insurance. We understand that being a Florida resident can make it especially difficult to find the affordable and comprehensive health plan you need – but that doesn’t mean it’s impossible. This article is going to take a look at all of the options that are available to you as a sunshine state resident. Hopefully you will learn something new today that can help you find realistic health insurance options that fit your needs.
Major Medical Insurance in Florida
The vast majority of adults in America get their major medical insurance coverage from one of two sources: either a plan through their employer, or the Health Insurance Marketplace. If you’re reading this right now, odds are that you don’t have the option to get health insurance through your employer. So let’s take a closer look at “the Exchange”, as it is often referred to.
Like most states, the annual open enrollment period for the ACA federal Exchange starts on November 1st and typically ends on December 15th – although in 2019, it was extended to December 18th for people whose health insurance coverage would become effective in January of 2020. Most people just go to HealthCare.gov, fill out a simple application, and receive notice of their eligibility – as well as any subsidies they may qualify for – within a few days.
Whether you’re trying to choose between an ACA major medical policy, an employer-sponsored health plan, or one of the other insurance options available right now, it helps to know what you are in for with regard to a plan from the Exchange. Most of these plans are the preferred choice for two very important reasons: ACA major medical policies are guaranteed issue, and all of them are required to offer you the federally-mandated Essential Health Benefits. Let’s start by defining guaranteed issue for those who may not be familiar with it: if a company offers a guaranteed issue major medical policy through the Exchange, they are not allowed to deny you coverage for any reason. They’re also not allowed to raise your premiums based on things like pre-existing conditions. In fact, the only things which can legally alter your premium are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Then you have the 10 guaranteed Essential Health Benefits which must be included with ACA health policies. These 10 health benefits have been deemed the bare minimum form of coverage every health plan needs in order to qualify for sale on the ACA and to guarantee an adequate level of health and wellness. These 10 benefits include:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Not only are the ACA health insurance policies more comprehensive than most other insurance options today, but they are usually more affordable if you qualify for a federal subsidy. Unfortunately, that can be a challenge if you live in Florida. Florida is one of 13 states who still refuse to expand Medicaid eligibility to citizens making between 100% And 138% of the federal poverty level. If you fall within that income gap, you will neither be eligible for Medicaid nor will you qualify for federal assistance. This means you will have to pay for an ACA major medical health insurance policy completely out-of-pocket, or you will have to resort to one of the other health insurance options which will be discussed in this article.
The chart below shows what 138% of the federal poverty level looks like based on household size. It also has a column which shows the federal poverty level limit based on household size. Making 100% or below the federal poverty limit means you will likely qualify for Medicaid in the state of Florida. making 138% of the federal poverty limit or above means you will qualify for a federal subsidy. In between these two thresholds is the coverage gap where you will neither qualify for Medicaid nor will you qualify for a government subsidy. For more information about qualifying for Medicaid in the state of Florida you should visit the Access Florida Medicaid web portal at the Florida Department of Children and Families website.
|Annual Income (138% of FPL)
|Annual Income (100% of FPL)
Short Term Health Insurance in Florida
If you fall into the income gap we mentioned above, or if you don’t qualify for a federal subsidy for any other reason, then you may want to look around at your other options. Short-term health insurance is probably one of the most common and most affordable options for healthy people who don’t require much medical care. But it isn’t a perfect substitute for people who would benefit more from a comprehensive major medical plan offered through the ACA.
Here are some good things to know about short-term health insurance: for starters, your monthly premiums for these policies can cost up to 1/3 less than the monthly premium you would have to pay for an ACA health insurance plan without a subsidy. Most short-term health insurance plans don’t offer all of the Essential Health Benefits you would get with one of those plans, but many will attempt to come close and may even sell you additional coverage if you ask for it. Vision, dental, and indemnity insurance are popular additions to many short-term health insurance plans. Some customers also appreciate the fact that they don’t need to file an application through the federal government in order to qualify for short-term health insurance; you only need to file paperwork with the organization or company who offers to sell you a policy. Lastly, you have a good amount of consumer protection laws which make your purchase of a short-term health insurance plan that much safer for you, especially if you ever have to dispute a claim with your insurance provider.
Unfortunately, there are some very legitimate reasons why somebody might shirk away from a short-term health insurance plan. The most glaring of which is that you won’t get a guaranteed issue policy if you apply for short-term health insurance. If the company you are trying to purchase a plan from thinks that you have too many pre-existing conditions or doesn’t want to sell you coverage for a legally justifiable reason, they can choose to do so. They can also choose to charge you more based on your pre-existing conditions if they think it will make you more expensive to insure. Lastly, if you want a specific coverage benefit that they do not wish to provide – such as mental health counseling or substance abuse, for example – they don’t have to sell it to you. In fact, many of the benefits included in the Essential Health Benefits package of an ACA plan have never and will never be available through short-term health insurance. And it doesn’t look like that’s going to change anytime soon.
Short-term health insurance is the most ideal and most affordable for people who are in relatively good health and don’t need much – if any – medical care at all. Which may leave some people wondering: why purchase a health plan you don’t plan on using? The answer is that the financial consequences of not doing so could be dire. Yes, most short-term health insurance plans start with a substantial deductible (usually around $5,000 or more) which you must pay out-of-pocket before you get reimbursed for your medical costs. But what if something devastating happens, like a serious car accident? Or a cancer diagnosis? That $5,000 will pale in comparison to your total medical costs. Purchasing this form of health insurance is a good way to protect yourself from suddenly getting saddled with tens or hundreds of thousands of dollars in unexpected medical bills. One more thing to keep in mind is that short-term health insurance will only guarantee you the premiums you’re paying for a maximum of 36 months. After that, your insurance company must put you through underwriting again. Any health changes you have undergone in this time will likely make your premiums more expensive if you decide to purchase more short-term health insurance.
Christian Health Plans/Health Share Plans in Florida
Technically, you are no longer legally required to purchase health insurance – but it is still a good idea based on reasons we have discussed already. When the ACA legislation first passed, there was a legal requirement to purchase coverage known as the individual mandate. As of the beginning of 2019, that law was no more, except for states which chose to implement their own individual mandate. Florida is not one of those states.
Back when the individual mandate was the law of the land, however, Christian health plans experienced a surge in demand. This is because they qualified as replacement coverage due to the religious exemption in the law. People were most likely to purchase a Christian health plan if it was more affordable than anything they found on the ACA and/or if they preferred such a plan to what was otherwise available on the Exchange. In practice, Christian health plans have a lot in common with short-term health insurance, such as:
- No guaranteed issue
- Unlimited out-of-pocket costs
- Lifetime and annual benefit caps
- No guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
However, there are still very substantial differences between the two. Because of the religious nature of these organizations, there is very little federal oversight or regulation of these plans; this means that there are fewer consumer protection laws for customers like you. With short-term health insurance, you can legally dispute a claim if you feel you have a justifiable reason to do so. With a Christian health plan, you cannot. If a Christian health organization decides not to pay out on a claim or deny you medical benefits, they are legally free to do so without any consequences whatsoever. Also, because of the religious nature, most of these organizations will impose “participation guidelines” which you must adhere to in order to receive coverage. You will be expected to declare a specific faith, abstain from biblically unhealthy habits like smoking and drinking, and follow a biblically driven lifestyle in general. You’ll also be using different terminology with a Christian health plan. You won’t be paying monthly premium; you’ll call it a “monthly shared amount” instead. And you won’t be paying co-pays, coinsurance, or deductibles; those expenses are generally referred to as “personal responsibility amounts” or “unshared amounts”.
Fixed Indemnity Plans in Florida
Fixed indemnity plans aren’t usually sold as a replacement or an alternative to major medical insurance. But recent changes in the ACA laws have resulted in a surge in popularity for indemnity plans. Many of these plans are still sold alongside other forms of coverage, whether that’s short-term health insurance or a formal ACA health plan. They pay out on claims in a fixed way: usually per day, per week, per month, per visit, or per event. And whatever claims get paid out rarely cover all of your medical expenses. But it can certainly help you stay above water if you do have substantial medical expenses.
The majority of fixed indemnity plans come with things like annual benefit and lifetime caps, just like short-term health insurance or a Christian health plan. They also are subject to medical underwriting, meaning that you can be rejected for coverage or charged more based on your current health status. Yet despite all of this, these supplemental policies are still very popular when combined with other forms of coverage in order to get comprehensive medical benefits and keep your total medical costs down.
Discount Cards in Florida
Medical discount cards are a good way to help lower your out-of-pocket medical expenses if you don’t have a very comprehensive health plan. The most popular medical discount cards usually cover prescriptions, although some may offer additional services like discounts on vision or dental care. Some may even go as far as to offer discounts for doctor visits or other such care. They work similarly to something like AAA or the AARP. You pay a monthly or an annual fee, you get issued a card in the mail, and you present that card at participating organizations in order to receive financial discounts at the register.
Keep in mind, though, that this is not a replacement for major medical insurance. Most of the basic medical care you need might not be eligible for discounts through such programs. There are no claims to file and they will not reimburse you later for your medical expenses; either you get a discount at the register, or you have to pay 100% out-of-pocket. Finally, be on the lookout for scams. There are legitimate organizations out there when it comes to medical discount cards – but there are also companies who exaggerate or flat out lie about the discount you may be eligible to receive, or where you may be able to get them. So do your homework and double-check the claims they make before you decide to subscribe to a medical discount card program.