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How to Choose a Health Benefit Plan in Florida

There are various health insurance plans in Florida, and each plan is designed to fulfill unique needs and is also targeted at specific individuals. Follow these steps to learn how to choose the health insurance that suits your needs:

Find out what your available health insurance options are:

There are multiple health insurance options available in Florida, but depending on the period that you decide to buy a health policy, your options may be limited. For instance, if you miss the annual open enrollment period to get ACA-compliant coverage (that runs between November 1 and January 15), your only available option to buy health insurance will be to get temporary coverage, while you wait for the next open enrollment. You can get short-term insurance also if you are changing jobs and waiting for health insurance benefits to start at your new job.

Determine the type of health coverage you need:

Consider your available plans and choose the one that fulfills your needs the best.

  • If you are purchasing the plan during the open enrollment period, you can pick among any ACA-compliant plan, based on the type of coverage you are expecting to need during the coverage year. If you expect lots of medical appointments and possible surgeries, you may want to get a plan where you pay more per month, but in the end more of your bills will get paid. If you visit the doctor only for the annual checkups, a cheaper health plan (High Deductible Health Plan - HDHP), which requires you to pay more out-of-pocket if used, may be a better fit.

Generally, there are four categories of ACA health insurance plans in Florida. These are Bronze, Silver, Gold, and Platinum. Each category shows how you and your health insurance provider share your health coverage costs.

Plan Category The insurance company pays You pay
Bronze 60% 40%
Silver 70% 30%
Gold 80% 20%
Platinum 90% 10%

Note that the less you pay in deductibles and other out-of-pocket costs, the higher your premiums will be. For example, platinum plans are usually more expensive than bronze plans, but it is a good option if you require a lot of care and are willing to pay a high monthly premium. A platinum plan will cover nearly all your medical expenses.

  • If you are considering short term health insurance (in or out of the open enrollment period), you can find coverages that cost several times less than the full cost of ACA insurance. Though, in return for the lower cost you are not getting anywhere close to the amount of coverage of any ACA-compliant plan. Some short-term policies are designed to achieve the lowest cost and provide limited coverage, primarily for emergencies only. In contrast, others cost a bit more but may offer extra options, including preventive visits and prescription coverage. Make sure to read the plan's full details and understand what you are getting. Ask a knowledgeable insurance agent to help you compare the plans.

Seniors looking for Medicare coverage can pick the plan based on the expected usage needs:

  • Original Medicare - covers doctors visits and some preventive care,
  • Original Medicare with Medigap - where Medigap is added to take care of the drug prescription costs,
  • Medicare Advantage - a private insurer alternative, which combines the features of Original Medicare and Medigap. </li>

Determine the needed options:

Besides the main health insurance policy, you may need to pick add-ons based on your specific needs, such as: Dental, Vision, or Short-term Disability insurance. Buying coverages as a bundle is a good way to save money.

Short term health insurance is typically purchased along with a supplemental hospital indemnity plan, which helps cover the high deductible of the plan in case of a medical emergency.

If you plan to purchase Medigap, try getting it within six months of turning 65. If you wait for too long to get this supplementary coverage, develop a condition and try to apply, you may be denied coverage based on this newly developed “now pre-existing” condition. (speak with an agent for more details)

Decide where to get your health plan:

Your earnings often determine the type of insurance you can get. Private health insurance is generally more expensive, and persons who do not qualify for government-sponsored plans can easily opt for it. Individuals can shop for ACA health plans through the federal Marketplace. In addition, Florida companies with over 50 employees are required by law to provide employer-sponsored health insurance. The employer can purchase coverage from an insurance company or choose to self insure. Employees in such organizations can take advantage of this coverage. Short term health insurance is also available to residents seeking temporary coverage because they are temporarily out of paid employment or they missed the open enrollment period.

To get short term insurance, speak with a licensed agent who can align your needs with the best plan and explain how the plan works if you need to use it. Since all short-term is not under ACA, they are different and must be carefully reviewed. (NOTE: 36 months is the longest consecutive term you can have a short term policy from the same insurer).

Seniors can get health insurance through Original Medicare, OM + Medigap, or Medicare Advantage. Original Medicare is applied for through the Social Security Administration, while Medigap and Medicare Advantage are purchased from private insurers through agents.

Compare health insurance quotes:

After deciding on the type of health insurance you want and where you want it, shop around for quotes from multiple health insurance companies. While the Florida Office of Insurance Regulation regulates insurance rates, comparing plans and their quotes is still important. However, do not focus only on their prices but also their benefits, network providers, exclusions, and terms and conditions. Also, compare the out-of-pocket costs associated with each plan before deciding, including the plan’s deductible, copayments, and coinsurance. Sometimes, plans that have low premiums may have hidden high out-of-pocket costs. Note that the rates are fixed for government-sponsored plans, but not everyone qualifies.

(read more about public health insurance options in Florida)

The important factors contributing to health insurance cost and coverage are lifestyle, age, gender, underlying medical conditions, health status, occupation, and smoking habits. A Florida-licensed health insurance agent may provide better guidance on how to choose health insurance that suits your needs.