Health Insurance in Florida

Health Insurance in Florida
Health coverage is imperative when it comes to securing your future against huge medical bills and subsequent financial worries. Indeed, purchasing health coverage is quite expensive and requires a good review of all potential risks and its impact on your financial health. In the U.S., nearly 47 million people are uninsured, among whom most of them are working families. These families, especially children, usually bear the brunt of lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.

Florida holds the 45th position on the Healthiest States List as confirmed by the 2008 America’s Health Rankings. The healthcare system of Florida has been declining since past few years mainly due to low public health funding, high crime rate and worst geographical disparity. The state of Florida, with more than 18 million population, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide economical health coverage to the uninsurable citizens of Florida who meet specific eligibility requirements of age and income.

The Florida Office of Insurance Regulation manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, owing to the rising health care costs and reduced accessibility to health care, approximately 20.7% of the state population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 37.7% of uninsured residents come under the above 200% FPL category.

Overall, Floridian lawmakers and the citizens need to work together to build a stronger health system and provide health insurance to everyone. Buying health insurance is a tedious task. With the guidance of a licensed health insurance agent/broker, you can choose a suitable health insurance policy for your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Florida. These regulations apply to all insurance companies offering individual or family health insurance in Florida:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
24 months
Look Back Period
24 months
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women, breast cancer screening, minimum IP mastectomy (5stay of length to be decided by the surgeon), reconstructive surgery after mastectomy, osteoporosis screening, direct access to OB/GYNs
Market Rate Restrictions
None
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Florida. These regulations apply to all insurance companies offering small group health insurance in Florida:

Small Group Size
1-50
Employee Qualifications
Two employees must work for at least 6 months out of the year, and work 20 hours per week for coverage
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
15%
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Florida. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
Yes
Eligible Group Sizes
2-19
Extension of Benefits Period – Standard
18 months
Extension of Benefits Period – Disabled
29 months
Maximum Premium Increase
115%
State Legislation Reference
627.6692 Florida Health Insurance Coverage Continuation Act.
Additional Notes
Individuals have 30 days from the date of termination to accept continuation coverage through the insurance company.
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Florida to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Florida does not offer health insurance coverage through state high risk pool program for individuals who are medically-uninsurable.

H2: Children’s Health Insurance Program

Through shared funding from the federal government, the State of Florida provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Florida KidCare
Website
https://www.floridakidcare.org/
Phone Number
888-540-5437
Apply Online
Yes
Age Limits
Under 18
Insurance Carrier
Varies based on community
Length of Coverage
12 months
Residency Requirements
Florida resident, U.S. citizen, qualified non-citizen
Other Eligibility Requirements
Children in families with incomes up to 200% of FPL qualify for the program
Pre-Existing Condition Exclusions
Yes
Cost
Most families pay between $15 to $20 per month
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Florida:

Governing Agency
Medicaid
Website
https://www.fdhc.state.fl.us/Medicaid/
Phone Number
866-762-2237
Residency Requirements
Florida residents, U.S. citizen, qualified non-citizen
Federal Poverty Line Income Limits
Have an income at or below 200% of the FPL
Additional Resources

Florida Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Florida’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Florida: At-A-Glance
Provides all-inclusive health data of Florida. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.