Valrico, FL, United States, Florida
Individual Health Insurance
Individual Health Insurance Under Age 65
Public Marketplace insurance, also referred to as Affordable Care Act (ACA) or Obamacare insurance, represents a category of health insurance plans accessible to individuals through the Health Insurance Marketplace. These plans, though provided by private insurance companies, are obligated to adhere to specific government-set criteria and can potentially qualify for subsidies based on income.
Overview Of Florida's Exchange
In Florida, the federal health insurance exchange operates via HealthCare.gov. There are fourteen carriers in the state’s Marketplace for 2023. Bright Health stopped offering coverage after 2022, while AmeriHealth Caritas joined in 2023. Initially, Oscar plans for 2023 were available, but new enrollments were halted on December 12, 2022.
Existing Oscar members before that date can keep their coverage for 2023, with automatic renewal unless they choose a different plan. In 2022, Florida had the highest enrollment with 2,723,094 individuals signing up through HealthCare.gov. The state’s open enrollment lasts from November 1 to January 15, allowing special enrollment outside this window for specific cases. Native Americans and those with income below 150% of the poverty level also have exceptions. For more details, refer to our comprehensive guides on open and special enrollment.
Existing Oscar members before that date can keep their coverage for 2023, with automatic renewal unless they choose a different plan. In 2022, Florida had the highest enrollment with 2,723,094 individuals signing up through HealthCare.gov. The state’s open enrollment lasts from November 1 to January 15, allowing special enrollment outside this window for specific cases. Native Americans and those with income below 150% of the poverty level also have exceptions. For more details, refer to our comprehensive guides on open and special enrollment.
As of 2023, a selection of fourteen insurers is extending plans within Florida’s Marketplace. This count includes one new entrant, AmeriHealth Caritas, and one departure, Bright Health, which ceased plans after 2022. Common to most states, the participation of insurers varies by region, yet the majority of Florida counties boast a minimum of five insurers offering plans for 2023. The subsequent insurers are providing coverage for the year 2023 via Florida’s exchange:
- AvMed
- AmeriHealth Caritas (introduced in 2023)
- Blue Cross Blue Shield of Florida (Florida Blue)
- Capital Health Plan
- Ambetter/Celtic
- Cigna
- Aetna CVS Health/Coventry Health Plan of Florida
- Florida Health Care Plan Inc
- Health First Health Plans
- Molina
- Oscar Health (Enrollment for 2023 coverage ceased after December 12, 2022; however, those who enrolled by the deadline are entitled to retain their Oscar coverage for 2023. Existing Oscar plans will also automatically renew for 2023, unless the enrollee opts for a different plan. Notably, Oscar observed substantial enrollment in the early stages of open enrollment, with enrollees transitioning from Bright to Oscar. To sustain an optimal level of enrollment, Oscar temporarily suspended new enrollments for 2023.)
- Florida Blue HMO (Health Options)
- Sunshine State Health Plan (affiliated with Ambetter)
- UnitedHealthcare
Featured Carriers
In September 2022, Medicare enrollment in Florida was 4,898,260, about 22% of the state’s population, compared to 19% nationally. Eligibility is at age 65 or due to disability. Around 10% of Florida’s beneficiaries are disabled, while 90% are 65+.
Medicare offers options like Advantage plans from private insurers or Original Medicare from the government, with coverage including hospital stays (Part A) and outpatient care (Part B). Medicare Advantage combines coverage with extras like dental and vision.
Enrollment periods include a fall window (Oct 15 – Dec 7) and an open enrollment period (Jan 1 – Mar 31) for changes. In fall 2022, over 53% of Florida’s Medicare beneficiaries chose private plans, mostly Medicare Advantage. Florida has a notable 46% nationwide enrollment in Advantage, led by Humana with 31% market share in 2022. (See Table Below)
Medigap Plans in Florida Medigap plans supplement Original Medicare, covering out-of-pocket costs like coinsurance and deductibles. The Florida Office of Insurance Regulation (FLOIR) offers a user-friendly website for comparing Medigap plan premiums by county. In 2020, around 913,759 Florida Medicare beneficiaries had Medigap coverage, though this number had decreased from the previous year due to the rise of Medicare Advantage enrollment.
Medigap Coverage in Florida for Those Under 65 Federal rules standardized Medigap plans and provide a six-month guaranteed-issue window for those turning 65 and enrolling in Original Medicare. Florida allows a similar window for residents under 65, starting from Medicare Part B enrollment. While premiums are higher for those under 65, they can switch to lower-cost plans at age 65.
Medicare Part D in Florida Original Medicare lacks prescription drug coverage, but beneficiaries can get it through Medicare Advantage, employer plans, or stand-alone Medicare Part D plans.
As of September 2022, about 1.4 million Floridians were in stand-alone Part D plans, and nearly 2.5 million had Part D integrated with Advantage plans. Stand-alone Part D enrollment dropped as Advantage plan enrollment rose.
2023 Part D Plans in Florida There are 23 stand-alone Part D plans in Florida for 2023, with premiums ranging from $8 to $170 per month. Enrollment occurs during the fall window (October 15 – December 7), also used for Medicare Advantage plans.
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Featured Carriers
frequently asked questions
? What is the Florida Health Insurance Marketplace?
The Florida Health Insurance Marketplace, also known as the Health Insurance Exchange, is an online platform where residents of Florida can shop for and purchase health insurance plans. It was established as part of the Affordable Care Act (ACA) to provide individuals and families with access to affordable health coverage.
? When is the Open Enrollment period for the Florida Marketplace?
The Open Enrollment period typically runs from November 1st to December 15th. During this time, you can enroll in a new health insurance plan, renew your existing plan, or make changes to your coverage. It’s important to enroll during this period to ensure your coverage starts on January 1st of the following year.
? Can I apply for coverage outside of the Open Enrollment period?
You may qualify for a Special Enrollment Period (SEP) if you experience certain life events such as getting married, having a child, losing other health coverage, moving to a new area, or experiencing other qualifying circumstances. SEPs allow you to enroll in or change your plan outside of the standard Open Enrollment period.
? What types of health insurance plans are available on the Florida Marketplace?
The Florida Marketplace offers different levels of health insurance plans: Bronze, Silver, Gold, and Platinum. These plans vary in terms of cost-sharing and coverage. Bronze plans have lower premiums but higher out-of-pocket costs, while Platinum plans have higher premiums but lower out-of-pocket costs.
? Are financial assistance and subsidies available to help with premium costs?
Yes, financial assistance in the form of Premium Tax Credits and Cost-Sharing Reductions is available for eligible individuals and families. These subsidies can help reduce monthly premium costs and lower out-of-pocket expenses like deductibles and copays.
? How do I determine if I qualify for financial assistance?
You can use the Florida Marketplace’s online tools to calculate your eligibility for financial assistance. The calculation takes into account factors such as your household size, income, and location.
? What is Medicaid, and does Florida offer expanded Medicaid coverage?
Medicaid is a government health insurance program for low-income individuals and families. As of my last update in September 2021, Florida had not expanded Medicaid under the ACA. However, policies and regulations can change, so it’s recommended to check for the most up-to-date information.
? How do I apply for health insurance through the Florida Marketplace?
You can apply for health insurance through the Florida Marketplace by visiting the official website (HealthCare.gov) during the Open Enrollment period or a Special Enrollment Period. The website guides you through the application process and helps you find the best plan for your needs.
? Can I get in-person assistance with my application?
Yes, the Florida Marketplace has certified enrollment counselors, navigators, and agents/brokers who can provide in-person assistance. They can help you understand your options, complete your application, and select the right plan.
? What if I miss the Open Enrollment period and don't qualify for a Special Enrollment Period?
If you miss the Open Enrollment period and don’t qualify for a Special Enrollment Period, you may have to wait until the next Open Enrollment period to apply for coverage. In the meantime, you might consider short-term health insurance or other options to bridge the gap.
