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Florida Health Insurance

The Affordable Care Act changed the way many Floridians can access health insurance in 2014. According to the Kaiser Family Foundation, Gov. Rick Scott announced in 2012 Florida would not create its own marketplace, and the state refused federal grant money to develop a state exchange. However, this does not prevent Floridians from visiting the federal marketplace, HealthCare.gov.

Florida proceeded with its own initiative called Florida Health Choices. Small businesses and some individuals can shop for coverage there, but according to the site’s FAQ, this marketplace does not comply with some provisions of the ACA. For example, the plans aren’t required to provide certain health benefits mandated by recent health reform. You can visit the site at MyFloridaChoices.org.

What is Florida’s health insurance exchange?

Florida residents are free to visit HealthCare.gov to use the federal marketplace for ACA-compliant insurance plans during open enrollment. After you sign up for an account, you will need to answer a few questions about your family income and size. In return, the website will let you know if you qualify for financial assistance and display a list of plans you can select.

Depending on your income and family size, you might qualify for an income tax credit, which comes in the form of a subsidy that can be applied immediately to the premiums of plans purchased on the marketplace. Alternatively, people with very low incomes or children in families with low to moderate incomes might qualify for Medicaid or the Children’s Health Insurance Program.

Do you qualify for a health insurance subsidy in Florida?

In January 2014, the Kaiser Family Foundation reported on how health reform will help some Floridians pay for health insurance. The ACA provides tax credits, or subsidies, for people with family incomes between 100 and 400 percent of the federal poverty level for 2013. This is between $23,550 and $94,200 for a family of four and between $11,490 and $45,960 for an individual.

Your eligibility for subsidies will typically be based on 2013 poverty level limits, and Medicaid and CHIP eligibility will typically be based on 2014 limits. To qualify, applicants cannot have access to employer-based insurance or other government health plans, regardless of income.

Florida residents with incomes higher than 400 percent of the poverty level can still purchase marketplace health insurance. People with incomes less than 100 percent of the poverty level generally won’t qualify for Medicaid in states that didn’t expand the program. Florida is one of 21 states that decided not to expand Medicaid coverage.

CHIP will cover the children of Florida families with incomes up to 215 percent of the poverty level in 2014, or about $51,280 for a family of four. In Florida, parents may qualify for coverage if their incomes are less than 35 percent of the poverty level, or about $8,350 for a family of four. Other adults are not eligible. According to a January 2014 Kaiser Family Foundation fact sheet, this creates a coverage gap in the state. About 20 percent of the state’s uninsured residents fall into the coverage gap. Undocumented immigrants make up an estimated 12 percent of the state’s uninsured, and they cannot qualify for premium subsidies.

Insurance companies participating in the marketplace

The following are a few of the health insurance companies that offer plans in the marketplace for Florida. Some of the plans are only offered in parts of the state.

CoventryOne
Ambetter from Sunshine Health
Cigna Health and Life Insurance
Blue Cross and Blue Shield of Florida
Humana Medical Plan

Florida health and coverage statistics

Florida population (2013): 19,552,860

Population 65 and older (2012): 18.2 percent
Life expectancy (2010): 79.4 years
Number of Medicaid beneficiaries (2012): 2,636,800
Number of Medicare beneficiaries (2012): 3,242,700
Estimated number of uninsured residents (2012): 3,940,700

Overall state health ranking: 33

Sources: Kaiser Family Foundation, U.S. Census Bureau, America’s Health Rankings 2014 report.