The Sunshine State is one of the best places to get financial assistance on Obamacare health insurance sold through the Marketplace.
Florida Health Insurance Overview
If you’re looking for individual or family health insurance in Florida under the Affordable Care Act also known as Obamacare, you’ll probably have a good chance of getting government subsidies to lower your costs. You can also get low-cost or free Florida health insurance through public programs like Medicaid and the Children’s Health Insurance Program (CHIP).
Health insurance through Medicare is also a big deal in Florida. So if you’re at least 65 years old (or disabled), Medicare may be a cheaper option for you.
You can review the sections below to learn different aspects of buying health insurance in Florida, such as how to enroll, average health insurance costs, and income requirements to qualify for subsidies.
Florida and the Affordable Care Act
As of 2019, Florida is among the 18 states that have sued the federal government to challenge the Affordable Care Act (Obamacare) as unconstitutional. The lawsuit was filed by Texas in 2018 and is known as Texas v United States.1
The Sunshine State is no stranger to challenging the ACA. As early as March 23, 2010, the day the ACA was signed into law, Florida filed a lawsuit against the federal government challenging the validity of Medicaid expansion and the individual mandate.2
Although there are attempts to repeal the ACA, or at least some parts of it, open enrollment for 2020 Obamacare plans won’t be affected. So you can still sign up for Florida health insurance, apply for subsidies to lower your monthly costs, or get coverage through Medicaid if eligible.
What You Need to Know
Florida’s 2021 Open Enrollment Period runs from November 1, 2020 to December 15, 2020. Coverage takes effect on January 1, 2021.
You may qualify for subsidies and federal help paying for monthly premiums. It depends on how much you make. You also have to apply for an Obamacare plan.
Other public and private options exist outside of Obamacare. Low- to moderate-income families can apply for Medicaid while those between jobs or waiting on Medicare eligibility can consider short-term health insurance.
Florida Health Insurance Enrollment in the Marketplace
Florida uses the federal exchange at Healthcare.gov for Obamacare open enrollment that takes place from November 1 to December 15 each year. Despite the state’s opposition to the federal healthcare law, Florida has had the highest number of sign-ups for individual Obamacare plans since 2014.3
Florida saw enrollments climb to almost 1.8 million for the 2019 plan year, up from about 1.7 million in 2018.3 For 2020 coverage, Florida is already leading the country with more than 463,000 enrollments before the December 15 deadline.
The vast majority of Floridians who enroll in Marketplace coverage are under age 65, which shouldn’t be a surprise given that the 65-and- older age group are better suited for Florida Medicare plans. As of 2019, total ACA enrollment for the under-65 market in Florida is nearly 1.75 million compared to about 31,000 for those 65 and older.4
Medicare Enrollment in Florida
Most people know Medicare as government health insurance for people 65 and older. But people under 65 with a disability or chronic illness can also get Medicare.
With the Sunshine State being a top retirement destination, it may be no surprise to know that Florida has the second highest number of Medicare enrollees of any state. As of 2018, approximately 4.5 million Floridians are enrolled in Medicare.
Among Florida’s Medicare enrollees, nearly 2.6 million get benefits directly through the federal government’s Original Medicare program. Another 1.9 million get coverage through private Medicare Advantage plans, which offer benefits not included with Original Medicare such as prescription drug coverage. Since 2018, a separate 1.5 million Florida residents (approximately) are enrolled in standalone Medicare Prescription Drug Plans.5
As of 2019, Aetna, Anthem, Florida Blue, Humana, and UnitedHealthcare are the largest Medicare Advantage providers in Florida by number of enrollees.6
Word of Advice
Review all your options. See what makes sense for your needs and your budget.
Health Insurance Companies in Florida
You have access to 2021 individual and family health insurance from nine companies that sell plans both on and off the exchange. You can also buy these plans if you’re a self- employed entrepreneur with no employees.
Cigna left the Florida Health Insurance Marketplace to sell plans off the exchange starting in the 2016 open enrollment period (OEP)7 but has returned to the Florida exchange for the 2020 plan year. Bright Health Insurance Company joins Cigna for the 2020 OEP.
Below are Florida health insurance companies offering 2021 ACA plans in the individual market:
- Blue Cross and Blue Shield of Florida
- Bright Health Insurance Company of Florida
- Celtic Insurance Company
- Cigna Health And Life Insurance Company
- Florida Health Care Plan
- Health First Commercial Plans
- Health Options
- Molina Healthcare of Florida
- Oscar Insurance Company of Florida
Florida Health Insurance Costs
For 2021, the state approved a 3.1% increase on the average unsubsidized premium, or a rise of $18 per month.8
Meanwhile, Florida residents who enrolled in 2019 Marketplace coverage paid an average premium of $605 per month before premium tax credits (called subsidies) and $100 per month after tax credits. Those already receiving subsidies saved $543 on average, which brought their monthly premium down to an average rate of $66. We talk more about subsidies and how to qualify in the section below.
Check a 2020 subsidy chart and calculator to see which subsidies you might qualify for.
Obamacare Coverage and Subsidies for Low-Income Floridians
If your income is between 100 and 400% of the federal poverty level (FPL), you qualify for Obamacare subsidies to get low-cost coverage through Florida’s Health Insurance Marketplace. This means that for 2019, you must earn between $12,140 and $48,560 for a single-member household and $25,100 and $100,400 for a family of four.
Florida is one of the best states to get financial assistance for individual and family health plans under the Affordable Care Act or Obamacare. As of February 2019, 95% of Florida Marketplace enrollees receive subsidies that lower their monthly premiums. Another 66% receive cost-sharing reductions that help reduce out-of-pocket expenses, such as copays and prescription drug costs.9
Keep in mind that subsidies are only available on metal-tiered plans sold through the Marketplace, which are bronze, silver, gold, and platinum. And only silver plans qualify for cost-sharing reductions.
Florida Medicaid for Low-Income Families, Children, Pregnant Women, the Aged, and Disabled
About 3.4 million people in Florida are enrolled in Medicaid, which offers free or low-cost health insurance for those who qualify. This is despite the fact that Florida has not expanded its Medicaid program that would have allowed low-income individuals who earn up to 138% of the federal poverty level to qualify.10
If Florida had expanded Medicaid, 850,000 more residents who are uninsured would have access to affordable health insurance, according to an October 2019 press release from Miami-Dade County. The lack of Medicaid expansion in Florida typically affects able-bodied adults under 65 who are not pregnant and don’t have children.
- Parents and caretaker relatives of children
- Former foster care youths up to age 26 (regardless of income)
- Pregnant women
- Non-citizens with medical emergencies
- Elderly (65 and older) and disabled adults who don’t currently receive Social Security Income (SSI)
Florida CHIP for Low-Income Children and Pregnant Women
Florida has nearly 240,000 residents who enrolled in the Children’s Health Insurance Program (CHIP).10 Florida CHIP is available to children ages 1 to 19 who live in households that make no more than 210% of the FPL and pregnant women who earn up to 191% of the FPL as of 2019.12
Generally, you and each eligible child in your household qualify for CHIP if you earn too much to get Medicaid. Each household member who’s applying usually must be a U.S. citizen or legal Florida resident. You can enroll in CHIP year-round by completing an application online with Florida KidCare.
Below are the income limits to qualify for CHIP in Florida:
- 1 Person: $24,980
- 2 People: $33,820
- 3 People: $42,660
- 4 People: $51,500
- 5 People: $60,340
- 6 People: $69,180
- 7 People: $78,020
- 8 People: $86,860
If your family has more than eight people, add $8,840 for each additional person.
Florida Short-Term Health Insurance: If You’re In Between Jobs or In a Coverage Gap
If you need coverage for a limited time, short-term health insurance may be right for you. This can happen if you’re changing jobs, waiting for coverage to begin at a new job, or you missed the annual open enrollment and don’t qualify for a Special Enrolment Period to buy an Obamacare plan.
Below are some highlights of short-term health insurance:
- Offers initial coverage limits up to 364 days with renewals for up to 36 months
- Can enroll year-round and get coverage as soon as the next day
- Offers limited coverage for services, such as emergency care, doctor’s visits, and specialist care
- An alternative to Obamacare — plans don’t have to follow federal rules for things like covering pre-existing conditions and including essential health benefits
- Can be denied coverage based on health status
- Usually cheaper than Obamacare — can get a plan for less than $100
- Plans are not eligible for federal subsidies
Whether you’re applying for coverage for yourself or a family of four, make sure to review all your options. Examine what makes sense for your needs and budget.