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Affordable Care Act Health Insurance in Florida

The Affordable Care Act (ACA), popularly known as Obamacare, was established by the United States government in 2010 to make human services (like health care) available and affordable to more people in the United States. The primary goal of ACA health insurance is to:

  • Ensure everyone has access to health insurance by providing subsidies to low-income earners

  • Expand the Medicaid program to provide coverage for adults with income below 138% of the Federal Poverty Level (FPL). Unfortunately, Florida is one of 12 states that has not expanded its Medicaid eligibility under the Affordable Care Act

  • Support all innovative medical care delivery methods designed to reduce medical costs

There is no official Florida health insurance marketplace in Florida where residents can purchase ACA insurance. Interested persons can get health insurance through a federally facilitated marketplace (FFM). ACA does not require individuals to purchase health insurance through the marketplace. Although buying health insurance from the marketplace makes you eligible for Advance Premium Tax Credit (APTC). Individuals can purchase ACA plans sold online through the health insurance marketplace or directly from a health insurance company or through an insurance agent. Floridians are currently taking advantage of ACA insurance as above 2.7 million of them signed up for individual health insurance during the 2022 open enrollment period.

A typical ACA insurance plan has two variants: individual or group. Individuals who lack employer-sponsored group policies can get individual health care plans, while employees can purchase group policies through their employer or organization. These two types of ACA plans are subdivided into:

  • Preferred Provider Organization (PPO)

  • Point-of-Service Plan (PPO)

  • Health Maintenance Organization (HMO)

  • Exclusive Provider Organization (EPO)

All ACA-compliant plans cover 10 essential health benefits (EHB), with no annual or lifetime coverage maximums. One distinctive feature of ACA insurance is that it has a guaranteed issue policy where no applicants can be denied coverage due to pre-existing conditions. In addition, ACA premiums are calculated based on age, tobacco use, location, plan category, and individual or family coverage. Factors like health, gender, and medical history do not affect premiums. Discuss with a Florida-licensed health insurance agent who can help you compare plans from several health insurers and find an affordable health insurance option that fits your particular set of needs. Also, you can discuss sensitive information with your agent relating to your health so they can help get an insurance plan that suits your needs.

What is Considered ACA Insurance?

All health insurance types that conform to the regulations outlined in the Affordable Care Act are considered ACA Insurance. All ACA-compliant plans must have the following minimum requirements:

  • They must cover all 10 essential health benefits (EHB):

    • Pediatric services, including oral and vision care, excluding adult dental and vision coverage

    • Ambulatory patient services (outpatient care you get without hospital admission)

    • Mental health and substance use disorder services, including behavioral health treatment

    • Hospitalization

    • Pregnancy, maternity, and newborn care (both prenatal and postnatal)

    • Laboratory services

    • Prescription drugs

    • Rehabilitative and habilitative services and devices

    • Preventive and wellness services and management of chronic disease

    • Emergency services

  • They must not have annual or lifetime coverage maximums

  • They must be guaranteed issue such that individuals cannot be denied coverage due to pre-existing conditions. Additionally, insurers cannot charge higher premiums due to pre-existing health conditions

What is the Purpose of ACA Insurance in Florida?

The major purpose of the ACA insurance in Florida is to make health coverage more affordable for residents. To achieve this, eligible individuals and families that purchase coverage through the health insurance marketplace are assisted in the following ways:

  • Advance Premium Tax Credit (APTC): Individuals who buy ACA insurance on the marketplace are given a reduction in their monthly premiums. The credit is usually determined by your income and sent directly to the insurer by the Internal Revenue Service (IRS). Individuals or families whose income is between 100% and 400% of the federal poverty level (FPL) and who do not qualify for other affordable coverage may be eligible for APTC. To be eligible for premium tax credit, you must meet a standard minimum values

  • The American Rescue Plan (ARP) Act: This was introduced in 2021 and will only last for two years. ARP act helps increase and expand eligibility for Affordable Care Act (ACA) premium subsidies for individuals enrolled in marketplace health plans. These subsidies extend to people with incomes over 400% of the federal poverty level (FPL) buying marketplace coverage. Additionally ARP act increases the amount of financial assistance given to lower income individuals who were already eligible under the ACA.

  • Cost Sharing Reduction: These are federal subsidies given to individuals and to their family members to help reduce their out-of-pocket costs on medical bills. To be eligible for this subsidy, you must:

    • Be enrolled in an ACA silver plan

    • Earn an income at or below 250% of the federal poverty level (FPL)

    • Meet ACA enrollment requirements

    • Be receiving the advance premium tax credit (APTC)

    Note: Those who belong to the Federally Recognized Indian Tribes will not qualify for a cost-sharing reduction if their income is below 300% of the federal poverty level.

What is ACA Insurance for?

ACA insurance in Florida provides comprehensive health coverage for individuals. In 2014, the ACA policy became a guaranteed issue to ensure everyone has access to health coverage, including those with pre-existing health conditions. Under this plan, you cannot be turned down or asked to pay higher premiums due to your health history. Women can pay similar premiums as men despite their longer life expectancy, and children can remain on their parent's policy until age 26. In addition, subsidies like advance premium tax credit and cost-sharing reduction are available to low-income earners to help reduce premium costs and out-of-pocket bills.

What are the Types of ACA Insurance?

In Florida, ACA insurance is divided into two types:

  • Group health plan: This type of ACA Insurance covers a specific group of people like employees of a company or members of an association, organization, or a particular profession

  • Individual: This type of insurance is not purchased through an employer or from a government-run program like Medicare, Medicaid, or Children's Health Insurance Program (CHIP). Individuals can purchase ACA insurance themselves through the Florida individual health marketplace or a licensed Florida health insurance agent

These two types of ACA Insurance are further subdivided into four:

  1. Preferred Provider Organization (PPO): PPO offers a provider network that insureds can use to meet their health care needs at a lower cost (lower deductible and less coinsurance). Using healthcare providers outside the PPO network may attract extra fees

  2. Point-Of-Service Plan (PPO): This plan typically comes with an out-of-network option in Florida. Members of this plan are at liberty to choose physicians within or outside the plan’s network to attend to their healthcare needs. However, selecting physicians outside the plan’s network means less coverage, higher deductibles, and coinsurance costs

  3. Health Maintenance Organization (HMO): HMO members are required to pay a monthly fee to access comprehensive medical services. Members are not permitted to use out-of-network medical providers except during emergencies

  4. Exclusive Provider Organization (EPO): Members are required to use hospitals and healthcare providers within the EPO plan network except if there is an emergency

Do you Need ACA Insurance in Florida?

Yes, you need ACA insurance in Florida, especially if you have pre-existing health conditions or an illness that requires constant doctor visits and medications. ACA insurance offers comprehensive health coverage that is guaranteed and beneficial to children, adults, and women. In addition, if you are a low-income earner in Florida, ACA insurance is your best option. This is because ACA insurance allows you to purchase health coverage based on your income level, and if you are eligible for subsidies, you will get ACA plans at a reduced cost.

Why Do you Need ACA Insurance?

You need ACA insurance because of its comprehensive health coverage that comes at an affordable rate. In addition, it is beneficial to have ACA insurance because:

  • It offers some preventive services like screenings, counseling, and immunizations for free

  • It provides health coverage for everyone regardless of their health status

  • It allows low-income earners to have access to health insurance and take advantage of federal subsidies available in the Marketplace

  • Women are charged similar amount for health insurance as men and are provided with guaranteed coverage for services essential to their health

  • It is impossible to run out of coverage because insurers cannot set a dollar limit on the coverage they provide for you

How Much ACA Insurance Do you Need?

How much ACA insurance you need in Florida largely depends on your health needs. You can ask yourself the following question as a guide to determining the right coverage that will suit your needs:

  • Do I have pre-existing medical conditions that require ongoing care?

  • How much monthly premium am I willing to pay, or am I eligible for a premium subsidy?

  • How much will I pay if I use healthcare providers or hospitals outside the ACA plan network?

  • Am I healthy, without a health history, but only need coverage for medical emergencies?

After thinking through your current and future medical needs, you will be able to determine how much ACA insurance you need. You can also seek the help of a Florida-licensed health insurance agent who can help you determine your needs and find an affordable ACA plan that will suit them.

What ACA Insurance Coverage Do you Need?

The ACA coverage you need depends on your current and future medical needs. Generally, different metal levels help you determine how much you and your insurer will pay when a medical need arises. These levels are:

  • Bronze level: The insurer covers 60% of the medical cost while you cover 40%

  • Silver level: he insurer covers 70% of the medical cost while you cover 30%

  • Gold level: The insurer covers 80% of the medical cost while you cover 20%

  • Platinum level: The insurer covers 90% of the medical cost while you cover 10%

As you consider the amount of ACA coverage you need, ensure to decide if you want to pay higher premiums and have lower deductibles or higher deductibles and pay lower premiums. Speak to a Florida-licensed health insurance agent who can evaluate your health needs and help you determine the right amount of coverage to purchase.

Is ACA Insurance Required by Law in Florida?

No, ACA insurance is not required by law in Florida. When the ACA insurance was introduced in 2010, it was compulsory for all individuals, including Florida residents. Those who refused to get the policy were faced with tax penalties. However, ACA insurance is no longer mandatory since the removal of the tax penalty in 2019.

How Does ACA Insurance Work?

Most states have a health insurance marketplace where residents can purchase ACA insurance, but Florida does not have a state-run marketplace. Florida residents are required to purchase ACA insurance through a federally facilitated marketplace (FFM). There are two types of federal marketplaces available for Floridians:

  • Individual Marketplace

  • Small business health options program (SHOP)

It is not mandatory for Floridians to purchase an ACA policy through the FFM. However, purchasing ACA plans through the marketplace can enhance your eligibility for a premium subsidy. You can purchase your ACA plan directly from an insurer or through an insurance agent that is approved to sell Marketplace plans.

There is an annual open enrollment period for ACA coverage which is usually towards the end of the year (usually between November 1st and December 15th with a January 1st effective date). This is the period where you can purchase new coverage, renew existing one, or change your ACA plan or insurer. If you miss open enrollment, you have to wait until the following year to enroll unless you are eligible for a special enrollment period (SEP). SEP usually lasts for 60 days for individual plans and 30 days for small group health plans. To be eligible for SEP, you must be undergoing a significant life event like divorce, marriage, childbirth, or adoption. Individuals whose policies were terminated due to premium nonpayment cannot qualify for SEP.

Factors determining ACA insurance premiums include age, individual or family coverage, location, and tobacco use. Your pre-existing health conditions and gender does not affect your premium rates. After enrollment, you must pay your first month's premium for coverage to begin. This payment must be made to the insurer, not the Marketplace. When you pay, your insurer will send you a membership package that includes enrollment materials and a health insurance card as proof of your insurance. You are required to use the insurance card whenever you go for health care services, and the medical provider bills your insurer directly. You will pay lower copays and coinsurance when you get medical care from a healthcare provider within your plan's network. Your medical claims are usually handled based on the terms of your policy.

Talk to a knowledgeable Florida health insurance agent to discuss additional information and ask specific questions about how ACA health insurance pertains to your situation.

Subsidy Calculator for ACA

See how much of a subsidy you may qualify for if you purchase individual health insurance in Florida. ACA premium subsidy estimates are based on your household income.

Note: Florida Insurance Information Portal does not collect or store any personal information from individuals using this subsidy calculator, which is provided courtesy of the KFF - a national health issues non-profit organization:

What Does ACA Insurance Cover?

ACA insurance covers 10 essential health services that benefit children, adults, and women. These services include:

  • Prescription drug coverage

  • Inpatient hospital care

  • Ambulatory patient services (outpatient care)

  • Pediatric services

  • Emergency services

  • Rehabilitative and habilitative services and devices

  • Mental health services

  • Preventive and wellness services

  • Pregnancy and childbirth services

  • Laboratory services

What is ACA Insurance Good for?

ACA insurance is good for getting guaranteed issue comprehensive coverage at an affordable price. Essentially, it is good for:

  • Low-income earners who cannot afford health insurance

  • Individuals under 26 years (they can get coverage under their parent's ACA plan)

  • People who cannot get federal government health programs like Medicare

  • Individuals who do not have employer-sponsored insurance

  • Individuals with pre-existing health conditions like cancer, diabetes, and asthma

  • People with mental health and substance abuse disorders

Discuss with a Florida-licensed health insurance agent to know if ACA insurance is good for you based on your unique medical condition.

What Does ACA Insurance Typically Include?

ACA insurance typically includes 10 essential health benefits (EHB), including prescription drugs, doctors’ services, mental health services, inpatient and outpatient hospital care, and pregnancy and childbirth. Additionally, ACA insurance covers birth control and breastfeeding by providing contraceptive methods, breastfeeding equipment, and counseling for all women, including pregnant and nursing mothers.

ACA insurance also includes free preventive services such as screenings, counseling, immunization, and supplements that adults, women, and children can enjoy. Discuss with a Florida-licensed health insurance agent to know what your ACA plans cover in specific detail.

Who is Covered by ACA Insurance?

ACA insurance in Florida covers different categories of people, including:

  • Dependents: Children can stay under their parent's ACA plan and benefit from numerous preventive services like screenings, assessment, counseling, immunizations, and supplements

  • Self-employed individuals: Can get individual health insurance directly from the individual marketplace or through an agent

  • Females: Women no longer need to worry about higher premiums because of longer life expectancy under ACA insurance. They can also enjoy preventive care services including screenings, assessment, counseling, immunizations, and supplements with no cost-sharing

  • Pregnant women: maternity and newborn care are essential benefits under ACA insurance. The medical care during pregnancy, childbirth, and after the baby is born is duly covered

  • Employees: Most employers offer group health plans to their employees and can even extend the coverage to their immediate relatives. Employers with one to 50 full-time employees in Florida qualify for small group health plans. In contrast, employers or associations with 51 or more employees qualify for large group health plans

  • Couples: Married individuals have access to family health plans under ACA insurance at discounted rates. Couples can choose to be on the same or different ACA health plan, depending on their preference

  • Young adults: They can remain under their parent’s plan till age 26

  • Adults: ACA insurance provides preventive care services for adults, including screening, counseling, immunization, and fall prevention for adults 65 years and over residing in a community setting

  • Low-income earners: These individuals can benefit from subsidies that lower their premiums and out-of-pocket expenses

  • People with disabilities: ACA provides coverage for people with disabilities such that they cannot be denied coverage because of their condition. This also extends to a parent who have a child with disability

  • People with mental health and substance abuse disorder: Individuals with bipolar disorder, schizophrenia, eating disorder, stimulant use disorder, and marijuana disorder can also benefit from ACA insurance plans. The ACA plan can cover behavioral health treatment (including counseling and psychotherapy) and prescribed drugs for such persons

What Types of Items Does ACA Insurance Cover?

ACA insurance covers 10 essential health benefits (EHB), including preventive and wellness services for children, adults, and women. For example, your insurance policy will cover you if you suffer from a heart attack or severe head injury that requires you to visit the emergency room (ER). Also, your insurer will not make you pay more in copayments or coinsurance if you get emergency care from an out-of-network hospital. If you have to be admitted to the hospital for treatment as a result of surgical procedures, your insurance will cover it.

ACA plan also covers laboratory services like X-rays, CT scans, MRIs, blood and fluid tests, pathology, and pregnancy tests. Any injury, surgery, disease, or illness that requires rehabilitative and habilitative services is also covered under ACA insurance. For instance, if you had brain surgery and speech therapy is needed, your plan will cover it and all the prescription drugs.

ACA insurance covers pregnancy, maternity, and neonatal care (before and after birth). For example, pregnant tobacco users can get tobacco intervention and counseling, under this plan. Your ACA plan covers all preventive services for preconception and prenatal care and well-baby check-ups and offers comprehensive lactation support, breastfeeding equipment, counseling and screenings.

Furthermore, ACA insurance covers mental health and substance abuse disorders. For instance, if you have bipolar disorder, your ACA plan will cover outpatient treatment, inpatient care, rehab services, psychotherapy, and prescription drugs.

What is Not Covered by ACA Insurance in Florida?

There are no specific outlines of what ACA insurance excludes. Insurance providers are only mandated to cover the 10 essential health benefits included in the ACA plan. Hence, there can be different restrictions on coverage for similar plans. Generally, ACA insurance does not cover cosmetic surgery, dental and vision care for adults, infertility issues, abortion, male contraception, and long-term care. Additionally, ACA insurance does not include other coverage plans like:

  • Grandfathered plans

  • Medical discount plans

  • Grandmothered plans

  • Short-term limited-duration medical insurance

  • Critical-illness policies

  • Accident supplements

  • Some limited-benefit policies

  • Fixed-dollar indemnity plans

Ensure you understand what a plan covers and excludes before purchasing it. You can talk to the insurer directly, an insurance agent, or read the exclusion section of the policy for more information on what your intended plan excludes. Also, your insurance agent can help you get other coverages that will include services not covered under ACA plans.

What Does ACA Insurance Typically Exclude?

ACA insurance exclusion varies by insurer. Hence, it is the health insurance company that determines what to include or exclude on a particular ACA plan and ensures all the 10 essential health benefits under ACA are covered. Generally, ACA insurance excludes the following:

  • Cosmetic surgery: ACA insurance does not cover cosmetic surgery, but some plans cover plastic surgery if it is medically needed. For example, it may cover a woman who gives birth to a baby with defects

  • Dental and vision care: ACA insurance does not provide coverage for teeth and eyes care for adults

  • Male contraception: Although ACA insurance provides coverage for birth control for women, male contraception like vasectomy and condoms are not covered

  • Infertility issues: Insurers are not required to cover infertility treatments like surgical procedures and assisted conception. For example, intrauterine insemination (IUI) and in vitro fertilization (IVF) are not covered under ACA plans

  • Long-term care: This is not covered under ACA insurance. Individuals who need long-term care should purchase long-term insurance as an add-on to their ACA plan

  • Others: In Florida, ACA excludes acupuncture, abortion, weight-loss surgery, private-duty nursing, bariatric surgery, hearing aids, routine foot care, orthodontia for adults, and infusion therapy. You might have to get other coverages to cover for these medical services.

Check with your Florida-licensed health insurance agent for specific details on what your ACA policy excludes.

What is an Example of ACA Insurance?

A typical example of ACA insurance in Florida is when an individual who does not have access to employer-sponsored insurance purchases health coverage on the individual marketplace. Premiums and deductibles are calculated based on the individual's income level.

Another example is when an individual gets group health coverage through an employer or organization. All group members pay a similar amount for premiums, deductibles, coinsurance, and copays.

What is the Most Common Use of ACA Insurance?

The most common use of ACA insurance in Florida is the provision of guaranteed issue comprehensive health insurance coverage to all eligible individuals. This means that health insurers will sell health insurance policies to anyone who applies, regardless of pre-existing health conditions. Hence, people battling health issues do not need to be afraid of denial or higher premiums due to their health status.

ACA insurance is also used as a safety net for low-income earners to cater for medical emergencies or high medical expenses that may arise in the future. Low-income earners can take advantage of federal subsidies like advance premium tax credits and cost-sharing reductions to help pay for premiums and reduce deductibles, copayments, coinsurance, and total out-of-pocket spending. The reductions can help low-income earners who expect to spend more on medical care target a higher-priced metal level with the lowest deductible.

Employers use ACA group plans as a hiring strategy to set their business apart from their competitors. They use it to gain employees’ loyalty and retain their best workers for the long term. Additionally, employers use ACA group plans as an incentive to enhance productivity. Health insurance packages for employees make them healthier such that they take fewer sick leave and are hardly absent from work due to health issues.

Talk to a Florida-licensed health insurance agent who can assess your needs and compare plans from multiple insurers. They will guide you in choosing the best plan that suits your needs.

What is the Difference Between ACA Insurance and Short-Term Limited-Duration Insurance?

The differences between ACA insurance and short-term limited-duration insurance include:

  • Coverage: ACA insurance has a more comprehensive coverage than Short-term limited-duration coverage. While a standard ACA includes a minimum of 10 essential health benefits (EHB), short-term limited-duration insurance only covers four, which are doctor visits and outpatient care, emergency services, hospitalization, and laboratory services/tests. It does not provide coverage or provides limited coverage for the remaining six essential health benefits (EHB)

  • Guaranteed issue: Under ACA, you will be offered enrollment if you're eligible regardless of your health status. In contrast, short-term limited-duration insurance is not a guaranteed issue policy, and your application can be denied due to your health status

  • Pre-existing conditions: In the ACA plan, expenses relating to the pre-existing condition are covered, but this does not apply to short-term limited-duration insurance

  • Limited duration: In the ACA plan, as long as you pay your premiums, your plans are active, but short-term insurance lasts for less than a year and can only be renewed for 3 years

  • Year-round availability: You can only apply for ACA plans during the open enrollment period, which is usually towards the end of the year. If you miss open enrollment, you might have to wait till the following year to apply unless you qualify for a special enrollment period (SEP). You must have a qualifying event to be eligible for SEP. However, short-term limited-duration insurance is available all year round such that you can apply for it at any time

  • Network: ACA plans have network providers that differ in size and location. Using out-of-network providers attracts extra costs. However, short-term insurance does not have network restrictions. You can receive medical services from any doctor and hospital of your choice

  • Premiums: You will pay higher premiums for ACA plans because you will get comprehensive coverage than short-term insurance

Do I Need ACA Insurance if I Have Short-Term Limited-Duration Insurance?

Yes, you need ACA insurance if you have Short-term limited-duration insurance because your policy coverage is temporary. For example, Florida's short-term limited-duration insurance lasts for less than 12 months with a limited renewal opportunity of up to three years. Additionally, short-term coverage is not a guaranteed issue such that you can be denied coverage if you have a pre-existing medical condition. Speak to Florida-licensed health insurance to guide you while trying to choose the best health insurance that will suit your specific condition.

Do I Need Dental and Vision Insurance if I Have ACA Insurance?

Yes, you need dental and vision insurance if you have ACA insurance because your ACA policy will not include such coverage if you are over 19 years old. Hence, it is good to add a stand-alone dental and vision insurance to your ACA policy to cover your teeth and eyes expenses.

If you already have ACA insurance, you can talk to your existing health insurance agent about getting dental and vision insurance. If you do not currently have an insurance agent, you can find a knowledgeable one on the Marketplace to recommend the best dental and vision insurance that will suit your needs.

Who Can Get ACA Insurance?

Anyone in Florida can get ACA insurance, including children, adults, and women. Individuals at all income levels can get ACA insurance. People with household income between 100% and 400% of the federal poverty level (FPL) can qualify for subsidies to reduce their premiums and out-of-pocket expenses. In addition, people with pre-existing health conditions, pregnant women, and individuals with mental health and substance abuse disorders can get ACA insurance. Discuss with a Florida-licensed health insurance agent to know if you are eligible for ACA insurance in Florida.

Who Qualifies for ACA Insurance?

Legal residents living in Florida qualify for ACA insurance. You may be eligible for an ACA insurance coverage if:

  • You are residing in the United States

  • You are a U.S. citizen or national (or be lawfully present))

  • You are not incarcerated

  • You do not have Medicare coverage

Who Needs ACA Insurance?

Everyone living in Florida needs ACA insurance, especially those with pre-existing health conditions and who have been previously rejected by insurers.

Who Should Get ACA Insurance?

You should get ACA insurance in Florida if:

  • You need comprehensive health coverage that will cover your medical expenses

  • You have a pre-existing health condition

  • You need regular medical services

  • You do not qualify for employer-sponsored health insurance

  • You are not eligible for coverage under any government programs like Medicare, Medicaid, or Children's Health Insurance Program (CHIP)

  • You have no active health insurance coverage

  • You are pregnant or a nursing mother

  • You have mental health or substance abuse disorder

  • You are a low-income earner with household income between 100% and 400% of the federal poverty level (FPL)

Contact a Florida health insurance agent to know if you should get ACA insurance. A knowledgeable agent will help you determine your eligibility status and the right amount of coverage that would suit your current and future medical needs.

What are the Benefits of ACA Insurance?

ACA insurance is beneficial because individuals at all income levels can have access to healthcare. Insurers can not charge higher premiums or deny coverage for people with pre-existing health conditions. Numerous free preventive services like screenings, counseling, immunization, supplements, and medications are available to adults, women, and children without cost-sharing.

Why is ACA Insurance Good?

ACA Insurance is good in Florida because of the following:

  • Emergency services provided by out-of-network providers do not attract extra fees

  • Dependents are covered under their parent's policy until age 26

  • There are certain preventive care services that members will enjoy with no cost-sharing

  • Members can appeal denied claims

  • It is easier to compare apples to apples because insurers have a standard summary of benefits

  • People with pre-existing health conditions can not be denied coverage or charged higher premiums

  • The cost of prescription drugs is less

  • The available subsidies that come with ACA plans make them less expensive for qualified persons

  • Women do not need to pay higher premiums than men for a similar policy

Why is ACA Insurance Bad?

ACA Insurance has the following disadvantages:

  • People cannot enroll at any time in the year; they have to wait for an open enrollment period. However, if you miss open enrollment, you have to wait till the following year, except if you qualify for the special enrollment period

  • Individuals who are not eligible for subsidies may pay more for healthcare services

  • Shopping for coverage without the help of a health insurance agent can be complicated due to limited enrollment periods, website challenges, and more coverage options

  • Individuals have fewer insurance options when choosing healthcare providers

  • Florida is part of the states that have refused to expand Medicaid, making the program available to fewer people. This could be why we have over 4 million uninsured adults in Florida without access to low-cost health insurance

If you have any questions regarding your ACA plan, contact a Florida-licensed health insurance agent to help clarify any issues you might be having.

Is ACA Insurance Worth it?

Yes, ACA insurance is worth it because it provides access to comprehensive healthcare at an affordable rate and offers guaranteed issue coverage to all individuals regardless of their health status. It also offers premium subsidies or cost-sharing reductions to eligible applicants and provides preventive care and emergency services to all individuals.

Contact a Florida-licensed health insurance agent to know how ACA insurance can benefit you and meet your needs.

What Happens if you Don’t Have ACA Insurance?

In Florida, ACA insurance is not mandatory. Hence there are no legal implications or tax penalties to not having it. Individuals without ACA-compliant health insurance should be ready to pay out of their pockets for medical expenses. Such individuals would miss out on the financial assistance available to most marketplace enrollees.

Individuals without ACA insurance should consider getting non-ACA-compliant plans like Limited Benefits and Short-term Limited-Duration Health Insurance to protect them from expensive medical bills for healthcare services. Unlike ACA-compliant plans which provide traditional major medical coverage, these alternative health insurance plans only provide temporary or limited coverage. Individuals with pre-existing medication conditions or who need regular medical services cannot benefit from alternative health plans.

Why is ACA Insurance Important?

ACA insurance is important because it gives everyone access to health care regardless of their health and financial status. Women no longer need to pay more for medical services under ACA insurance. In addition, some preventive services like screenings, assessments, counseling, and immunizations are offered to children, adults and women without cost-sharing. Speak to a Florida-licensed health insurance agent to help you determine if ACA insurance is an important policy to consider based on your current health demands.

What Happens When your ACA Insurance Lapses?

ACA insurance lapse occurs when you fail to pay your premiums as and when due. Insurers are at liberty to end coverage when this happens, but they usually give insureds a grace period to pay the premiums. This grace period is usually 90 days if you:

  • Purchased your ACA plan from the Marketplace

  • Are eligible for subsidies like advance premium tax credit

  • Have paid premiums for at least one whole month during the benefit year

Your insurer can terminate your health coverage at the end of the grace period if you have not paid your premiums. However, you have the right to appeal such a decision if you believe your coverage was wrongly terminated. Some consequences you may have to bear if you lose your coverage due to nonpayment are:

  • You might not qualify for a Special Enrollment Period

  • You might not be eligible for an automatic re-enrollment for the following year if you did not participate in the open enrollment of the year your policy lapsed

You can opt for a new ACA plan if your policy is terminated. When you apply and qualify to enroll in a Marketplace plan, you may be able to enroll in the same plan you lost if it is still available. However, you may be required to pay all the premiums owed to your insurer before completing your enrollment. Even if you choose a new plan or go with your previous plan, you would have to pay your first month's premium to the insurer to complete your enrollment.