The most common way people in Florida receive health insurance is through their employer. The second most common way people receive health insurance is through Medicare and Medicaid, both of which are public insurance programs.
If you do not receive health insurance from an employer or a public insurance program, then you probably have or are currently in the market for a private health insurance plan.
If you’ve never purchased private health insurance before, it may seem overwhelming maneuvering through the process of picking a plan. To help simplify that process, here’s everything you need to know about purchasing private health insurance in America’s sunny state.
When You May Need to Purchase a Private Health Insurance Plan
Private health insurance may be required if you are:
- A part-time employee
- Unemployed or in between jobs
- You have been dropped by your existing carrier
Types of Private Insurance Plans
Assuming you have a choice, you’ll need to decide whether you want a health maintenance organization (HMO), an exclusive provider organization plan (EPO), high-deductible health plan (HDHP), preferred provider organization (PPO), point of service (POS) plan, or a consumer-driven health plan (CHDP).
If you need to fill temporary gaps in coverage, a short-term plan may be a good option for you. If you’re looking to cover emergency medical costs and essential health benefits such as preventive screenings and vaccinations, a catastrophic health plan may also be a good option.
Where to Buy Private Health Insurance in Florida
For those in the market for private health insurance in Florida, there are three ways you can purchase it. The first is through the state’s health insurance marketplace, the second is from a licensed insurance agent, and the third is through an insurance company.
If you’re interested in purchasing a private health care plan through the state’s health insurance marketplace, here’s what you need to know:
- Every fall, there is an open enrollment period, which lasts around 90 days. You must wait until the first day of the open enrollment period to purchase a health care plan through the exchange. Before that time, you can view and compare health care plans online.
- Health plans are divided into four tiers—platinum, gold, silver, and bronze. The different plans in the four tiers vary based on their actuarial value. Healthcare.gov explains actuarial value as the percentage of the total average costs for covered benefits that a health care plan will cover. For example, if your health care plan has an actuarial value of 80% on average, you would be responsible for paying 20% of the costs of all covered benefits out-of-pocket.
- Premium tax credits are available for low to middle-income individuals and families who are looking for coverage in the marketplace. These subsidies help to reduce monthly premiums and out-of-pocket expenses such as copays and deductibles.
If you’re interested in purchasing a private health care plan outside of the exchange from either a licensed health insurance agent or an insurance carrier directly, here’s how an off-exchange plan differs from a plan purchased on the exchange:
- Off-exchange plans do not offer premium tax credits, unlike plans on the marketplace.
- All plans must meet the basic requirements outlined by the ACA. However, unlike plans on the marketplace, off-exchange plans do not need to be considered qualified health plans (QHP).
- The same plans offered on the exchange and off the exchange are sold at the same price.
- Some insurance companies only sell plans off the exchange and some only plans through the marketplace.
- Although plenty of first-rate plans can be found in the marketplace, many insurance companies offer their most high-quality, benefit-rich plans off the exchange.
Choosing a health insurance plan comes down to figuring out what you can afford, the type of coverage you need, and how much freedom you want picking the doctors and hospitals you receive care from.
Taking time to review your budget and considering what is most important to you will help you to choose a plan that best fits your needs.