What is Health Insurance in Florida in 2023?

Key Points

With an average cost of $325 per month, Florida health marketplace provides a mix of options, including both the ACA and Short Term health coverage. You can purchase additional coverage, such as hospital indemnity, dental, or vision insurance - as stand-alone or supplementary plans. All health insurance sales in Florida are regulated by the Office of Insurance Regulation.

Here are the most common health insurance companies in Florida:

Does Florida Require You to Have Health Insurance?

While there is no individual mandate that requires Florida’s residents to get private health insurance, businesses with 50 or more full-time employees are required by the federal law to offer health insurance benefits to all employees. The individual mandate penalty, which was assessed from uninsured individuals since the start of the Affordable Care Act in 2010 was eliminated in 2017, as part of the Tax Cuts and Jobs Act.

Does Florida Have Its Own Health Marketplace?

While Florida does not have its own state-based health insurance marketplace, residents can buy health insurance on the federally-run healthcare exchange.

How Much is Health Insurance in Florida?

On average private health insurance in Florida costs around $300-$500 for basic health coverage per person, while seniors on average spend $200-$300 per month. Persons applying with their families (spouses and/or children) may be able to get discounted rates. Florida is considered one of the states with the most expensive health insurance in the United States. Health insurance costs are determined by an individual’s lifestyle, age, gender, health status, underlying medical conditions, occupation, and smoking habits. In addition, the policy’s premiums, deductibles, copayments, and tax credits directly contribute to health insurance costs. The following is a breakdown of common health insurance packages in Florida:

• ACA: $400 - $600 per month for Silver/Gold plan. It costs less if you choose a Bronze plan, or the employer contributes towards the cost. Or it can cost up to $1,000 per month if you select the Platinum plan. The cheapest (full-price) individual Silver health plans cost $440-$499 per month (price differs based on the county). (Note: if your income falls between 100% and 400% of the Federal Poverty Level (FPL) - you qualify for discounted pricing on any Silver plan purchased on the marketplace.
• Short-term: $240 - $250 per month. It can be as low as $100 per month, depending on coverage. (Note: Short term health insurance cannot be purchased on the marketplace. Use and agent to shop)
• Hospital indemnity: typically $10 - $40 per month. (Note: Cannot be purchased on the marketplace. Use and agent to shop)
• Dental: costs $30 - $35 per month (Note: Sold on the marketplace)
• Vision: costs $15 - $20 per month (Note: Stand-alone vision plans are not available on the marketplace. Use an agent to shop)
• Medicare:
  • Original Medicare in 2023 costs $164.90 per month ($0 for Part A and $164.90 for Plan B - a decrease from $170.10 a year earlier),
  • Medigap supplemental plan typically costs $100-$130 per month, but with age it can go up to $200-$300 per month,
  • Medicare Advantage typically costs $0-$60 per month, plus the $164.90 for the Plan B.

What Are The Types of Health Insurance in Florida?

Below are the key points about the types of health insurance available to the residents of Florida: ACA, Short-term health, Medicare, Social Welfare Programs, and Supplemental health care options.

AFFORDABLE CARE ACT (ACA)

Affordable Care Act health insurance incorporates all types of health insurance policies which meet the minimum coverage requirements outlined in the federal law. To be ACA-compliant, a health insurance plan must accept anyone who applies (without discrimination) and offer the 10 Basic Essential Health Benefits, which include preventive, pregnancy, emergency, and drug coverage. ACA insurance can be purchased only during certain times of the year, based on qualifications:

• Open Enrollment (November - January) - when anyone can pick the plan for the upcoming year.
• Special Enrollment - if you qualify based on certain life events - you may be able to purchase ACA coverage outside the Open Enrollment:
  • Losing health coverage through the current provider,
  • Getting married,
  • Giving birth or adopting a new family member,
  • Experiencing a decline in income below a certain level.

By default, all of the following health insurance in Florida is ACA-compliant and cannot discriminate against the insured:

• Individual marketplace health plans (FL uses the Federal Healthcare marketplace)

• Employer-offered (employer-sponsored) health insurance

• Group health insurance

• Government-sponsored plans (Medicare, Medicaid, Veterans Affairs healthcare, etc.)

  FACT: Health insurance policies that are not ACA-compliant require more scrutiny of the terms by the consumer and the assisting agent.

SHORT TERM HEALTH

Short-term health insurance is a temporary (non ACA-compliant) coverage, which can discriminate against the insured based on their health and pre-existing conditions. While some of the ACA’s essential health benefits, such as Preventive care, can be added to select short-term plans, most short term health insurance is primarily meant for emergencies only and typically has a high deductible. To help with covering the deductible in case of an emergency, a hospital indemnity plan is typically purchased as a supplement.

Short term health insurance is not sold on the health marketplace and typically requires you to speak to an agent. Unlike ACA coverage, which can be purchased only during certain times of the year or when offered, short term health insurance can be purchased year-round.

Short term health insurance can be right for Florida residents who are:

• Changing jobs or waiting for health insurance benefits to begin at their new job
• No longer enjoying employer-sponsored coverage
• Unable to apply for the Affordable Care Act (ACA) because they missed Open Enrollment and do not qualify for Special Enrollment
• Waiting for ACA compliant plans to start
• Searching for coverage that can bridge them to Medicare
• Turning 26 and no longer eligible to be part of their parent's insurance
• Healthy and below 65 years old

Florida Short-term Limited Duration Health Insurance can be purchased for a maximum consecutive term of 36 months (3 years). Note that there is no guaranteed renewal for Short-term plans. Therefore, individuals whose health worsens during the policy may be unable to renew their insurance, or their health condition may be excluded from their policy when they renew it. Always check your Short-term Limited Duration Health Insurance plan details to learn more about exclusions or coverage of pre-existing conditions.

NOTE: If your short-term insurance provider drops the coverage due to pre-existing or newly developed conditions, ACA insurance is the only one that can cover you.

Short-term plans benefit individuals who do not need regular medical care, like frequent doctor visits or expensive prescriptions. Note that this plan may make you ineligible for any guaranteed issue individual health plans in Florida.

MEDICARE

Medicare in Florida is a government-sponsored program that provides low cost health insurance to residents aged 65 or older, who have worked and paid Medicare taxes for at least 10 years. Once qualified, Floridians can sign up for Medicare 3 months before their 65th birthday. However, a resident may be eligible to get it before age 65 if they have a disability, ALS (Lou Gehrig’s disease), or End-Stage Renal Disease (ESRD).

FREE OR LOW COST HEALTH INSURANCE

Low income Florida residents and their children can qualify for low-cost and even free health insurance through programs such as Florida State Medicaid and Florida KidCare (see Public Health section below).

SUPPLEMENTAL HEALTH

Additional or stand-alone health insurance options are also called supplemental health insurance. They help cover healthcare costs like copayments, coinsurance, deductibles, and services typically not covered by basic health insurance plans. The common types of supplemental health insurance in Florida are:

• Vision insurance
• Dental insurance
• Hospital indemnity insurance
• Accident insurance
• Disability insurance
• Long-term care insurance (LTC)
• Medicare supplemental plans
• Accidental death and dismemberment insurance (AD&D)

Critical Illness health insurance plans are also available for specific conditions like cancer, stroke, or kidney failure. Some additional or stand-alone health insurance policies may cover food, medicine, transportation, and other expenses related to an illness or injury.

Does Florida Offer Public Health Insurance?

Yes, Florida offers public health insurance to the qualifying residents: Medicare, Medicaid, and Children’s health insurance program (read more).

Does Health Insurance Cover Medical Cannabis in Florida?

No. Currently, over 800,000 Florida residents qualify for medical cannabis, and their health insurance doesn't cover the cost. This is because the federal government classifies cannabis as a Schedule 1 drug, in line with heroin, ecstasy, and LSD.

To have health insurance or Health Savings Account (HSA) cover it, cannabis needs to be made legal. This can happen in two ways: either by decriminalizing it or by changing its classification from Schedule 1 to a lower Schedule 5 or 6 (as advocated by the Americans for Safe Access).

How to Choose Health Insurance Plan in Florida

A person looking to get a health policy may ask what health insurance should I get? Before choosing a health insurance plan in Florida, you should consider which plans meet your needs, budget, duration, and eligibility.

• ACA plans cover all pre-existing conditions and all essential benefits, such as an annual physical and immunizations. Coverage is renewed every year. Your income may qualify you for discounts and subsidies. Out-of-pocket costs vary based on the type of plan.
• When you turn 65, you switch to Medicare or Medicare Advantage, to continue receiving ACA coverage.
• Short-Term health insurance
• If your income qualifies, you may receive free or low-cost health insurance coverage through Medicaid.

Read more about: Choosing between health insurance plans in Florida

How to Get Health Insurance in Florida

You can get health insurance in Florida from the federal health insurance marketplace, through a broker/agent, an online brokerage, directly from the health insurance company, and through your or your spouse's employer. The health marketplace sells only ACA insurance and dental plans. Short term and supplemental plans are purchased through agents.

NOTE: Make sure to always read and understand the terms of the policy before binding the coverage. Seek the help of a Florida-licensed professional insurance agent for advice and to help you get better terms (a knowledgeable agent is able to negotiate some aspects of the coverage directly with the insurer).

Florida health insurance can be purchased:

• Online through shopping websites
• Through a licensed Florida Health Insurance agent in person, online, or over the phone (Make sure that your agent is well versed in the type of health insurance you want to get, so you are not limited in your options)
• Through employers (over 90 percent of Florida’s large employers offer health insurance, while less than 40 percent of small business do)
• Through membership associations, unions, or churches
• From the federal government's Health Insurance marketplace
• Directly from a Florida approved health insurance carrier
• Through State-funded programs for low-income residents, including Florida Medicaid and Florida Children's Health Insurance Program (CHIP)
• As part of parents' Health Insurance plan (this applies to individuals below 26 years old)
• Through student plans offered by universities or colleges
• Through Medicare.gov - for seniors who choose Original Medicare
• Through private senior care insurance companies that offer Medicare Advantage plans as an alternative to Original Medicare and Medigap.

Read about the “Steps of Applying for Health Insurance”

What is Health Insurance Deductible in Florida?

A health insurance deductible is the amount an insured in Florida must pay out of pocket to cover medical expenses before their insurance plan starts providing coverage. Florida deductibles differ based on the type and plan of health insurance:

For ACA health insurance, deductible is a part of the expenses that count towards the federally set Maximum Out of Pocket (MOOP) amount. In 2023, MOOP is $9,100 for an individual and $18,200 for a family (an increase from $8,700/$17,400 in 2022), which means that no ACA health plan in Florida can have a deductible higher than $9,100.

Short term health insurance in Florida does not have to follow ACA rules, and the deductible is typically between $5,000 to $15,000 per year.

Medicare plans can have deductibles as low as $0 per year, but the plans that offer higher deductibles have restrictions on how high they can get:

• 2023 Medicare Part A (hospitalization) deductible is $1,600 (an increase of $44 from 2022).
• 2023 Medicare Part B deductible is $226 (compared to $233 in 2022).
• 2023 Medicare Drug deductible is capped at a maximum of $505

What Is Copay in Health Insurance?

Copay, also known as a copayment, is the flat fee you pay to your medical service provider for a covered medical service every time you receive the service. For most plans, you pay a copay each time you visit your doctor or fill a prescription. For ACA insurance, copay is part of the overall annual Maximum out-of-Pocket limit. For short term health insurance here is no limit, and copay is defined by the policy.

Coinsurance vs Copay

Coinsurance is a percentage of your medical expenses shared between you and your insurance provider after you have paid your deductible. For instance, suppose your medical bill is $3,500, your coinsurance is 20%, and your deductible is $500; after you pay your deductible, what is left will be $3,000. You will then pay your 20% coinsurance of the $3,000, which is $600, while your insurer covers the remaining 80%, which is $2,400. Note that if your coinsurance percentage is high, your share of the medical bills will also be high. The main difference between coinsurance and copay is that copay is a fixed fee you pay every time you visit your doctor or fill a prescription, while coinsurance is a percentage of the total cost of covered services.

What is Open Enrollment for Health Insurance in Florida?

An open enrollment period is a specific yearly period during which you can sign up for ACA health insurance and cancel or change your current health plan. A person looking to get ACA health insurance in Florida may ask when is open enrollment for health insurance 2023 in Florida? The open enrollment period in Florida typically runs from November 1 through December 15, the same as the federal open enrollment. After this period, you may have to wait until the next open enrollment period to register or make any changes to your plan, except if you qualify for a special enrollment period triggered by a qualifying event. You qualify for SEP if you had to deal with certain life events, like losing health coverage, relocation, marriage, childbirth/adoption, or adopting a child, or your household income is a specified percentage below the FPL.

If you are left without health insurance coverage in between eligible enrollment periods, as a Florida resident you are able to purchase short-term health insurance as a temporary solution. Speak with your health insurance agent for more details about affordable health insurance options.