Health Insurance in Florida

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Health insurance is essential to protecting both yourself and your budget. Have you read up on how to get health insurance in the past? If so, you might have been scared off by high premiums and deductibles. Thankfully, there are plenty of companies that provide affordable health insurance plans that you can use to get coverage for yourself and your family.

We’ll take a look at how health insurance works in Florida and show you what health insurance covers, what it doesn’t cover and a few of the best companies that provide low-cost plans. Cheap Health Insurance in Florida

Best Health Insurance in Florida:

Average Cost of Health Insurance in Florida

The average Floridian pays about $393 a month for their health insurance premium if they have an individual plan. The average premium is $1,021 per month if you have a family plan. However, the specific amount you’ll pay for coverage depends on a number of factors, ranging from whether you smoke or not to your plan type. 

Types of Health Coverage

There are multiple types of health insurance plans. The type of plan you choose will dictate how much you pay, whether you need a referral to see a specialist and which health care providers you may see. Let’s go over the 3 most common types of health insurance plans: HMOs, PPOs and POS plans.

  • Health maintenance organization (HMO) plans: HMO plans require that you only see doctors, specialists and care providers within the organization’s network. You cannot see any health care providers outside of the network and you must get a referral to see a specialist. HMOs are the most affordable type of plan, but they give you the least amount of freedom to choose which care providers you see.
  • Preferred provider organization (PPO) plans: PPO plans offer a network of doctors and specialists but do not require that you see them. You’ll pay an additional fee if you see a health care provider outside of your network. You don’t need a referral to see a specialist with a PPO plan. PPO plans are usually more expensive than HMO plans.
  • Point-of-service (POS) plans: POS plans are a mix between an HMO and a PPO. You can see doctors and specialists out of your network with a POS plan — like a PPO. However, you’ll still need a doctor’s referral to see a specialist like you would with an HMO. POS plans can allow you to see the care providers you want with lower rates than PPOs. 

What Does Health Insurance Cover?

Every health insurance plan could essentially include or exclude any type of coverage they wanted before the introduction of the Affordable Care Act’s (ACA). This made it incredibly tedious to compare plans because there was little standard of coverage between dozens of options. Now the ACA dictates that every permanent health insurance plan must include at least the following ten “essential benefits”:

  • Ambulatory patient services: This is outpatient care that you receive outside of a hospital.
  • Emergency services: Your health insurance provider must cover emergency care at any hospital, regardless of whether the hospital is in-network or not. Similarly, your health insurance provider cannot require you to contact the hospital prior to receiving emergency care. You should visit the closest hospital to you in a true emergency.
  • Hospitalization: This includes things like overnight stays and prescription drugs administered by a doctor or nurse as well as surgeries.
  • Pregnancy, maternity and newborn care: This includes care before birth and after birth. It also includes labor and pregnancy complications.
  • Mental health and substance use treatments: Your health insurance provider must offer coverage for behavioral therapy, inpatient mental health services and treatment for substance use. Your health insurance provider cannot put an annual or lifetime limit on treatment for a particular disorder or substance use issue.
  • Prescription drugs: Though health insurance providers cannot exclude coverage for prescription drugs, they may require you to try less expensive generic treatments before going onto more expensive or habit-forming medications. This is called “step therapy.”
  • Rehabilitative services and devices: This includes things like physical therapy, occupational therapy and mobility devices.
  • Laboratory services: This includes both outpatient bloodwork and imaging that you receive in a medical facility or hospital (like x-rays or upper GI scans).
  • Preventive services and wellness screenings: This includes things like physicals, vaccinations and booster shots. Many health insurance plan providers offer these services for free.
  • Pediatric services: Health insurance plan providers must offer health, vision and dental services to children on your plan. However, vision and dental benefits aren’t ACA requirements for adult plans. You may be able to purchase add-on plans through your insurance provider.

Your plan must also include the following benefits for women:

  • Breastfeeding support: This includes counseling and equipment for nursing mothers.
  • Birth control: ACA-compliant plans must include prescribed FDA-approved contraceptive methods. This includes emergency contraceptives but does not include drugs intended to terminate an already viable pregnancy.

Your employer may be exempt from covering certain contraceptives if you work for a house of worship or a religious non-profit. 

What Does Health Insurance Not Cover? 

Most health insurance plans don’t cover the following benefits:

  • Male birth control: Barrier methods and vasectomies are not covered under most plans because only female birth control is considered an essential benefit.
  • Travel vaccinations: Your insurance provider must cover routine, medically necessary vaccinations only. Travel vaccinations are usually seen as elective prevention and not covered under most plans.
  • Vision and dental coverages: Insurance providers are only required to cover these services for children on your plan. If you want adult coverage, consider buying an add-on plan.
  • Weight loss surgery: There is no federal mandate that requires insurance providers to cover bariatric surgery. However, many insurance providers elect to include this coverage. If you or someone on your plan may need bariatric surgery, be sure to consult your representative and make sure it’s covered before you enroll.
  • Cosmetic surgery: No type of health insurance plan covers cosmetic surgery because these procedures aren’t medically necessary. 

Unless a particular treatment is an essential benefit, most insurance providers won’t cover it. These are just a few examples of treatments and services that aren’t usually covered. If you’re concerned about coverage for a particular treatment or service, contact your health insurance provider and inquire about it.

Cheapest Health Insurance Providers in Florida

Let’s take a look at some of the best providers of cheap health insurance in Florida. 

1. Aetna

Aetna is one of the most affordable health insurance plan providers in Florida and offers low-cost individual, family and business plan options.

ACA-approved plans are available for as little as a few hundred dollars a month and makes Aetna one of the best health insurance choices for those living on a budget. Do you qualify for Medicare or Medicaid?

Aetna also offers special low-cost plans for you and even has student health plans available if you attend a two- or four-year university. 

2. Humana

Humana offers both HMO and POS plans in Florida at competitive rates.

Plans from Humana are also some of the lowest if you’re over the age of 45.

Some of Humana’s most affordable plans also include home health care, a rare addition to ACA-required plans. Medicare plans are also available for those who qualify. 

3. Florida Blue

Florida Blue is a subsidiary of Blue Cross, a nationwide health care provider. Florida Blue offers PPO plans, which give you the most freedom to choose your doctors and health care service providers.

This can be beneficial if you have a chronic condition or longstanding relationship with a health care provider and you don’t want to begin treatment with a new doctor.

Florida Blue offers subsidiaries to help you reduce the cost of health care if you’re living on a fixed income.

Florida Blue’s ACA-compliant plans also include free preventive care like physicals, vaccines and mammograms. 

4. Cigna

Cigna’s health care plans are affordable and include all ACA-compliant benefits. Four out of 5 people who choose a Cigna plan qualify for some sort of federal subsidy to lower their premium.

Cigna plans include free preventive care — you’ll pay nothing for medically necessary vaccinations, health screenings and even some preventive prescription drugs.

You can even unlock discounts on gym memberships, health clubs and more to help you maintain your health.

Protect Your Health Affordably 

Choosing a health insurance plan prior to the ACA meant endlessly comparing plans and reading about what’s covered and what isn’t. Now, permanent health insurance plans must offer at least the ACA’s 10 minimum essential benefits. However, this regulation only applies to ACA-compliant plans. Make sure you thoroughly read what’s covered and what isn’t before you choose a short term health insurance plan or a gap coverage plan.