Florida’s health care options are below average. It’s ranked the 34th best state for healthcare. This rating comes from a US News study, which considers health care access, health care quality, and good public health.
Health insurance options in Florida
According to the Florida Office of Insurance Regulation, there are several ways for residents to get health insurance:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Floridians get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 40% | ||
| Individual or family | 10% | ||
| Medicaid | 18% | ||
| Medicare | 17% | ||
| Military | 2% | ||
| Uninsured | 13% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
13 percent of Floridians are uninsured. That’s one of the worst uninsured rate in the US, far above the nine percent national average. These numbers aren't good for policyholders in the state. The more people uninsured in a state, the higher the rates for those with insurance.
Best Florida health insurance companies
Now that you know a little more about health insurance factors, it's time to find a provider. Florida is home to several insurance companies that offer both family and individual plans:
- Florida Blue
- Florida Health Care Plans
- Ambetter
- Molina Healthcare of Florida
- Health First Health Plans
- Oscar
- Blue Cross Blue Shield
- Bright
- Cigna
Florida health insurance costs and rate factors
Floridians spend an average of $8,076 per year on health insurance expenditures, only a few dollars more than the national average. Health care costs are highly dependent on the individual. Here are some factors that will influence your costs:
Plan type
The more health insurance coverage you have, the more you'll pay in monthly premiums. Marketplace health insurance plans use metal tiers to categorize coverage. These metal tiers are bronze, silver, gold, and platinum.
What can you expect to pay for health coverage as a Florida resident? The 2020 table below outlines the average monthly premium for a 40-year-old Floridian.
| Bronze | Silver | Gold | |
|---|---|---|---|
| $338 | $454 | $501 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
In Florida, a gold plan costs about 48 percent more than a bronze plan. This is a significant leap in monthly costs. However, investing a gold plan might be worth it. Gold plans cover 80 percent of medical costs, whereas bronze plans only cover 60 percent. Paying more money each month may save you money in case of a medical emergency.
Catastrophic coverage is the lowest level health plan. If you are under 30 or have a hardship or affordability exemption, you may be eligible for this type of coverage. This plan has the lowest monthly premiums, but it comes with a $8,150 deductible.
Body mass index
A high BMI can lead to a serious risk of health conditions and diseases. Health insurance providers look at your BMI because it affects your risk as a policyholder. People with a higher BMI will likely have higher premiums.
In 2018, Florida had a 30.7 percent obesity rate, ranking 27th in obesity in the US. Of the many Floridians who use QuoteWizard to shop for health insurance, 30 percent have a BMI in the obese range.
Tobacco use
Tobacco use often leads to several serious health conditions, which is why tobacco users face higher insurance rates. In 2018, 16.1 percent of the Florida population were smokers, the 21st lowest rate in the country.
Age
According to healthcare.gov, age is a factor in the cost of your insurance plan. The site states that older people often pay three times as much as younger people for coverage. FL residents who used QuoteWizard to compare health insurance plans are, on average, 42 years old.
Location
Every state has different laws, regulations, and health care providers, and the Sunshine State is no exception.
Insurance rates are also usually community-regulated. This means that the number of claims your neighbors file could influence your monthly price tag. If your area files more claims than average, your premiums could rise.
That means that the healthier your state is, the lower your premiums could be. According to America's Health Rankings, Florida is the 32nd healthiest state in the US.
Florida health insurance laws
In 2014, the Affordable Care Act (ACA) made it so that insurance companies cannot consider these factors when pricing your policies:
- Pre-existing conditions: Before the ACA, insurance companies were able to charge higher rates based on pre-existing conditions. Now, insurance companies cannot charge higher rates to people with pre-existing conditions.
- Gender: A 2004 Health Services Research study found that women historically pay more for health care. But with the ACA, insurance companies cannot charge men and women different premiums for the same plan.
- Insurance and medical history: Insurance companies used to be able to analyze your medical history and past insurance coverage. Those with medical problems or lapses in insurance were often charged much higher premiums, if they were able to get coverage in the first place.
Marketplace plans have out-of-pocket maximum limits that are not included in your monthly premiums. For 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
According to the Centers for Medicare & Medicaid Services, insurance companies must provide Florida residents with some coverage for these services:
- Mammograms
- Use of drugs for cancer treatment
- Dental anesthesia
- Bone marrow transplants
- Diabetes treatment
- Child health supervision services
- Mastectomy
- Autism spectrum disorders
Find the full list of benefits and how they vary based on small group, large group, and individual coverage here.
Medicare and Medicaid in Florida
People from all different walks of life can get coverage with government-funded health care programs Medicare and Medicaid. These programs cater to two different categories of people. Medicare offers health coverage to senior citizens, and Medicaid helps low-income families and children.
Medicare
Medicare is a program available to people 65 years and older in Florida. There are multiple options within the program, including parts A, B, C, or D and supplemental coverage plans. There are also several ways to get support through a Medicare Savings Program. There are four types of savings programs in Florida, and you can qualify for one if you meet these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Florida Medicaid is a state and federal program that offers coverage for certain categories of people who reside in the state. These are Florida's Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Florida Office of Insurance Regulation
- Website:
- Homepage
- Insurance Commissioner:
- David Altmaier
- Consumer Insurance Helpline:
- 1-877-MY-FL-CFO (1-877-693-5236)
- Office Hours:
- Monday - Friday
9:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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