Your Comprehensive Guide to the Health Insurance Marketplace in Florida

Choosing a health insurance plan is a big decision and if you’ve never used the health insurance marketplace in Florida, you may not know where to start. We'll show you.

Choosing a health insurance plan is a big decision and if you’ve never used the health insurance marketplace in Florida, you may not know where to start. Between knowing what documents are required and comparing dozens of insurance plans, the process can feel overwhelming.

Fortunately, it doesn’t have to be stressful. This guide covers everything you need to know about the health insurance marketplace in Florida, specific plans, and how to navigate the marketplace so you can get coverage today.

Costs of Health Insurance Marketplace Florida-Specific Plans

Health Insurance Marketplace FL
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Like other states, the health insurance marketplace in Florida has four categories of insurance plans, which are based on how much coverage you want.

  • Bronze
  • Silver
  • Gold
  • Platinum

The Bronze category plans offer the lowest level of coverage, so you’ll pay more out of pocket for those. Platinum plans are the highest level of coverage, which means you’ll have significantly lower out-of-pocket costs for those.

However, health insurance plans have several cost components, including:

  • Deductibles: This is what you pay for medical services before your insurance company starts paying for services.
  • Coinsurance/copayments: Coinsurance is a percentage you pay for medical services, and copayments are flat fees you pay for medical services.
  • Out-of-pocket maximum: An out-of-pocket maximum is the most you will have to spend of your own money for any medical care.
  • Premiums: The monthly amount you owe each month to your insurance company is your premium.
  • Prescriptions: If your plan covers prescriptions, there may be separate deductibles and copayments for those services.

Each of these components factor into the overall cost of your healthcare. If you’re looking for more affordable insurance options though, the health insurance marketplace in Florida has different options depending on your income.

Income Limits for Health Insurance Marketplace Florida-Specific Plans

The health insurance marketplace was created to offer affordable health insurance to as many Americans as possible. One of the ways it does this is by providing premium tax credits for individuals and families that don’t meet certain income limits.

In addition to the tax credits, income limits help determine whether or not you and your family qualify for Medicaid or CHIP coverage.

Here’s what you need to know about income limits for health insurance marketplace Florida-specific plans:

  • Premium tax credits: If you are an individual, you may qualify for premium tax credits if you make between $12,490 and $49,960 yearly. A family of three may qualify for premium tax credits if their income is between $21,330 and $85,320.
  • CHIP coverage: If you are a family of three with children and you make around $42,000 per year, you may qualify for CHIP coverage. Larger families with higher income limits will qualify.
  • Medicaid expansion: In states that expanded Medicaid coverage, individuals may qualify for Medicaid if you make less than $17,236 in 2020. Florida did not expand Medicaid coverage, so those limits will vary based on your family size.

Even if you don’t qualify for financial assistance through the health insurance marketplace in Florida, you can still apply for and purchase coverage if you need it.

How to Navigate the Florida Health Insurance Marketplace

Navigating the Florida health insurance marketplace can feel like a challenge – the application requires a lot of information and there are dozens of plans to choose from. So, what do you do?

1. Fill Out an Application

Regardless of whether you’re trying to get financial assistance or not, the health insurance marketplace has a simple application that you need to fill. You’ll need to provide some basic information:

  • Personal information about yourself
  • Personal information about your spouse and/or dependents
  • Employment and income information
  • Basic health information

You are also required to provide your birthdates and Social Security Number, as well as a list of your doctors and current prescriptions. .

2. Review Available Insurance Plans

Once you’ve qualified for any premium tax credits, do a thorough review of available insurance plans. Here are some things to look out for:

  • Plan category
  • Individual and family deductibles
  • Emergency medical care costs
  • Monthly premiums

If you have an idea of how much you want your deductible to be and how much you can afford to pay for things like premiums and ER visits, start by reviewing plans that fit that criteria.

3. Compare Policies and Costs

Once you’ve had time to sort through the list of plan categories and deductibles, start using the built-in tool to compare your plan options. Here’s what you need to compare:

  • Doctor, clinic, and hospital coverage
  • Specialist copayments and requirements
  • Prescription coverage
  • Cost of routine healthcare
  • Plan exclusions

There is a tool in the marketplace that lets you choose which doctors, clinics, and hospitals you already use so you can choose a plan that they accept. There’s also a tool to get an idea of your annual healthcare costs.

How an Insurance Agent Can Help You Choose the Right Health Insurance Marketplace Florida Plan

You could spend a lot of time going through plans and comparing options, but that may not be the best way to go. An insurance agent or broker can help you fill out your application accurately, review all of the insurance plans, and choose the right plan for you and your family.

If you need help understanding your policy, an insurance agent or broker can walk you through your coverage options and exclusions.

Need help choosing the right health insurance marketplace Florida-specific plan? Contact the team at Fiorella Insurance Agency to get your application started today.

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