Florida health insurance

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.

Who may benefit from which plan depends on your financial situation and whether you’d rather pay more upfront through premiums or more out-of-pocket costs when you need care.

Here’s a look at who may 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 avoid 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 need many health care services.

Platinum level

Those who want to pay more upfront costs via premiums rather 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 choosing 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 requiring most Americans to have coverage, but Congress eliminated the tax penalty.

Though Florida doesn’t have an individual mandate, it’s still wise to consider health insurance to avoid hefty medical bills.

Health insurance subsidies in Florida

The ACA created subsidies to help Americans pay for marketplace plans. You can qualify for subsidies that lower your monthly premiums based on your income compared to the federal poverty level (FPL). As of 2024, the calculation works on a sliding scale.

If your income is 250% FPL, you will only be required to pay up to 4% of your household income toward healthcare premiums. The 250% FPL benchmark in 2024 is $36,450 for an individual and $75,000 for a family of four.

If your FPL is 400% or higher, you pay no more than 8% of your household income on healthcare premiums. In 2024, 400% FPL is $58,320 for an individual or $120,000 for a family of four.

Kaiser Family Foundation offers a tool that estimates health insurance costs for a marketplace plan.

The ACA marketplace website will request your household income, size and location. With that information, the website will provide plan cost estimates 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 in 2024, not including subsidies:

Bronze: $382

Silver: $488

Gold: $486

Source: Kaiser Family Foundation

Average monthly premiums by plan

Fourteen health insurers offer ACA marketplace plans in Florida.

Here are the companies, plans, and monthly premium averages in Florida:

Company	Plan type	2024 monthly average premium
Aetna Health	HMO	$603
AmeriHealth Caritas Florida	HMO	$517
AvMed	HMO	$691
Blue Cross & Blue Shield Of Florida	EPO	$837
Capital Health Plan	HMP	$611
Celtic Insurance Company	EPO	$604
Cigna Health And Life Insurance Company	EPO	$631
Florida Health Care Plan	HMO	$687
Health First Commercial Plans	HMO	$646
Health Options	HMO	$680
Molina Healthcare Of Florida	HMO	$611
Oscar Insurance Company Of Florida	EPO	$630
Sunshine State Health Plan	HMO	$605
UnitedHealthcare Of Florida	HMO	$624

Only one insurer 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, usually between November 1 and January 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 under the following circumstances:

They lose their job
They lose their health insurance
They have or adopt a child
They move
They turn 26 and fall bcuf8 off a parent’s health plan
They get 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

If you lose your job, COBRA allows you to keep your employer-sponsored health plan for up to 18 months.

Federal law covers businesses with 20 or more employees and 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 for an additional 11 months.

The plus side of COBRA is that you can keep your former employer’s health plan. However, the employer will no longer help pay premiums, so you have to pick up all costs plus up to a 2% administrative fee. That can get very expensive.

It’s a good idea to compare the costs of 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 choose 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 marketplac: 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 must 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.

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