Types of Florida health insurance
The ACA marketplace classifies health insurance plans by four metal tiers, based solely on premiums and out-of-pocket costs.
Here are the tiers and specifics about each one:
Who may benefit from which plan depends on your financial situation and whether you’d rather pay more upfront by way of premiums or more out-of-pocket costs when you need care.
Here’s a look at who many benefit more from each metal tier:
Bronze level
- Young, healthy people who don’t need many health care services.
- Someone who wants to pay the lowest premiums.
Silver level
- People who qualify for additional Silver level subsidies that help pay for health insurance.
- Those who want to pay low premiums but want to avoid the out-of-pocket costs found in a Bronze plan.
Gold level
- Floridians who want to avoid substantial out-of-pocket costs when they need care.
- People who expect to need many health care services.
Platinum level
- Those who want to pay more upfront via premiums than out-of-pocket costs later.
- Someone who expects to make regular doctor and pharmacy visits.
The metal tiers only focus on costs. You’ll also want to consider which benefit design you prefer. Two types found in Florida’s ACA marketplace are health maintenance organization (HMO) and exclusive provider organization (EPO) plans.
Both networks have restrictive provider networks. That means those plans don’t pay for out-of-network care.
One major difference between HMOs and EPOs is that you need provider referrals to see specialists with an HMO. You don’t need referrals to see specialists with an EPO.
You’ll also want to consider the provider network when you pick a plan. Make sure your providers are part of the network. If not, you’ll have to pay all of the health care costs without help from the plan. Also, check that there is a wide network of providers in your area if you ever need to see specialists or go to a hospital.
Find out more about the differences between health plans.
No individual mandate in Florida
Floridians aren’t required to get health insurance. The ACA established an individual mandate that required most Americans to have coverage, but Congress eliminated the individual mandate tax penalty.
A handful of states have since implemented their own individual mandate. Though Florida doesn’t have an individual mandate, it’s still wise to consider health insurance so that you can avoid hefty medical bills.
Health insurance subsidies in Florida
The ACA created subsidies to help Americans pay for marketplace plans.
Floridians with household income below 400% are eligible for cost-saving subsidies or tax credits. Here’s who is eligible:
- Household of 1 -- income less than $51,040
- Household of 2 -- income less than $68,960
- Household of 3 -- income less than $86,880
- Household of 4 -- income less than $104,800
- Household of 5 -- income less than $122,720
The ACA marketplace website will request your household income, size and location. With that information, the website will provide cost estimates for plans with subsidies in mind.
How much is health insurance in Florida?
Monthly health insurance premiums differ by metal tier. Here are the average monthly premiums by metal level, not including subsidies:
- Bronze -- $339
- Silver -- $447
- Gold -- $489
Source: Kaiser Family Foundation
Ten health insurers offer ACA marketplace plans in Florida.
Here are the companies, plans and monthly premium averages in Florida:
Average monthly premiums by plan
| Company | Plan type | 2021 monthly average premium |
|---|---|---|
| AvMed | HMO | $558 |
| Blue Cross and Blue Shield of Florida | EPO | $666 |
| Bright Health | EPO | $551 |
| Celtic Insurance | EPO | $592 |
| Cigna | EPO | $523 |
| Florida Health Care Plan | HMO | $605 |
| Health First | HMO | $612 |
| Health Options | HMO | $622 |
| Molina Healthcare | HMO | $501 |
| Oscar | EPO | $530 |
Source: Florida Office of Insurance Regulation
Only one of the 10 insurers offers plans in every county -- Blue Cross Blue Shield of Florida (also known as Florida Blue).
How to buy health insurance in Florida
Floridians can sign up for an ACA marketplace plan during open enrollment between Nov. 1 and Dec. 15.
People can also qualify for special 60-day enrollment periods during other parts of the year. Florida residents can sign up during a special enrollment period if they experience:
- Losing their job
- Losing their health insurance
- Having or adopting a child
- Moving
- Turning 26 and fall off a parent’s health plan
- Getting married
If you experience one of these qualifying life events, you can go to the ACA marketplace site and state why you need a special enrollment period.
COBRA insurance in Florida
COBRA allows you to keep your employer-sponsored health plan for up to 18 months if you lose your job.
The federal law covers businesses with 20 or more employees. The federal law also allows for longer COBRA eligibility periods for certain instances, such as a spouse’s death.
Florida has a similar state COBRA law for companies with fewer employees. The Florida COBRA law also allows for an 18-month extension.
Florida’s law additionally lets eligible people who are disabled keep COBRA or an additional 11 months.
The plus side of COBRA is that you get to keep your former employer’s health plan. However, the employer will no longer help pay premiums, so you have to pick up all of the costs plus up to a 2% administrative fee. That can be costly.
It’s a good idea to compare the costs to a COBRA plan with an ACA marketplace plan to see if you could save by going with an ACA plan. You may find a better deal on the marketplace -- especially if you qualify for subsidies.
If you decide to go with an ACA marketplace plan, make sure your providers accept the health plan.
Other ways to get health insurance in Florida
Floridians who don’t have an employer-sponsored health plan have other options.
Here are three other ways to get coverage:
A health plan outside of the ACA marketplace -- Insurance companies offer individual plans off the marketplace that may not provide as much coverage as one on the marketplace. These plans, which are sold directly by health insurers, may cost less than a marketplace plan.
Catastrophic health insurance -- These plans are available for people under 30 or those who can receive a hardship exemption. Catastrophic plans are considered a safety net. They have low premiums but offer similar coverage found in a marketplace plan. However, they also have high out-of-pocket costs. Catastrophic plans can have deductibles of up to $8,550 for individuals and $17,100 for family coverage. People with a catastrophic health plan would have to pay for health care services until they reach the deductible. Once they reach the deductible, the health plan picks up the rest of the costs for the year.
Short-term health insurance -- Florida allows people to get short-term health insurance plans to help them bridge a gap in coverage. These plans are available on a yearly basis, with the option to extend the coverage to three years. Short-term health plans have low premiums. However, they have high out-of-pocket costs and offer limited coverage. Short-term plans often don’t cover prescription drugs, mental health and maternity costs. People with those plans may have to pay for all health care costs for those services. Find out more about short-term health insurance and how they compare with ACA plans.
Still not sure about health insurance eligibility? Check out Insurance.com’s Health Plan Finder tool to explore your health insurance eligibility.