Today the Health Insurance Marketplace exists in a very complex state. Obamacare, the Affordable Care Act, Short Term Plans, Limited Benefit Plans, Association Plans, and Health Sharing Ministry Plans all seem to inhabit very similar spaces, provide overlapping messages, and can lead most medical insurance consumers scratching their head. So what can you do to make sense of it all.
BEWARE: The marketplace for medical coverage changed with the advent of Obamacare (Affordable Care Act). Prior to this legislation, you could buy or change health insurance whenever you wanted to. Now, in general, you may apply for ACA (Affordable Care Act) coverage only during the annual election period which begins on November 1, 2019 and ends on December 15, 2019. There are special election periods which do exist year round for some people. Some examples of this are for people who moved, turned 26, got married (or divorced), lost their insurance from their job, or lost Medicaid coverage. To learn if a Special Election Period would apply to you, call us or make an appointment to speak with us by using our scheduling link. We also have a more complete listing of Special Election Criteria on our website.
First, do you qualify for a subsidy?
You may qualify for a subsidy, here in the state of Florida, if you (or your spouse) does NOT have the availability of health insurance through your company AND your income is less than 400% of the Federal Poverty Level. In 2019 the minimum income for a single person is $12,140 and for the enrollment period beginning in 2020 the number will increase to $12,490. Below that number and you don’t qualify. If you are close to that number (but below it) the key is to get to that number or just above it. Getting to that number will allow you to get excellent health insurance benefits at an extremely competitive price. There are tables to show you these results in more details which can be found at: https://floridahealthagency.com/subsidy_tables.
Each year you may only have one choice to make the right decision for you and your family. In many cases, you will have several options in terms of choosing a health insurance provider. Each of these companies often have several plans and each of those plans have unique Benefits and Doctor Networks. Remember that the medical insurance coverage choice you make will impact your ability to get health coverage until you can make another choice, often this is one year away, so make this choice wisely.
First tip on saving money when looking at Medical Insurance Coverage:
Don’t smoke! In almost any situation the use of tobacco will increase your insurance cost. With the Affordable Care Act (ACA) Health Insurance plans you can assume that the base cost for a smoker will increase by 25 percent. Any subsidy will not increase to compensate for this, so smoking can often make Obamacare Insurance much, much more expensive then it would otherwise be.
The ACA Marketplace (Healthcare.gov): If you get a large subsidy then you’ll be making choices mostly within the Federal Marketplace, using either and agent or going directly to www.Healthcare.Gov We recommend that going to us, rather than the marketplace directly is that we have the ability to give you guidance as to how various health insurance plans work, their networks and how they may apply to you, and provide crucial support in making decisions about the income that you should attempt to achieve in order to get appropriate coverage at a cost effective price. You can get to this information by calling us at (954)332-9768, or by using our scheduling link.
If you find that the cost of the insurance through the marketplace is too high, then alternatives may exist off of the marketplace. If you have pre-existing conditions, or you want the protections offered by the Affordable Care Act in terms of pre-existing conditions, maternity coverage, mental health, or preventative benefits, then besides the marketplace plans, you can often find additional choices for full ACA coverage off of the federal marketplace. If those considerations are not important then we can look at other alternatives. To learn more about Obamacare Plans and some additional tips go to our webpage
First, you must decide what you really want. Do you want plans that will just have some protection and cost the least? If that is the case, then Short Term Insurance plans (especially if you have no pre-existing conditions) may prove the best bet, unless you qualify for a subsidy with the Affordable Care Act (Obamacare). There are also Association Plans, Healthcare Sharing Ministry Plans, and some Limited Benefit Plans to also consider. We recommend, in general, that talking to a well-respected, qualified agent is your best bet in making decisions among these various choices.
Obviously, we have a website (https://floridahealthagency.com) but we strongly recommend that you have a conversation with us. Our goal is not necessarily to sell you something, but to assist you in making the choice that is in your best interest. If you have a COBRA option, and that is the best option for you we will absolutely recommend that COBRA is the way to go.
We live by our motto:
we know, we care, YOU Decide!
Now let’s look at some of these options in depth.
Short Term Medical Insurance or Short Term Insurance is generally a policy which covers people for a short period of time. These policies have gone through several iterations over time. When Obamacare first was enacted these plans were limited to 90 days and buying these plans would subject you to a tax penalty if you didn’t have Obamacare coverage for a period exceeding 62 days. The penalties no longer exist. Neither do the limitations on 90 days. Today, there are plans that exist for up to six months, plans that cover you for a year, and some that will guarantee you coverage for as long as 3 years.
Generally, these policies do ask you underwriting questions, and they may have no or limited preventative medical services. Some of these plans have serious limitations when it comes to prescription coverage, or as an example mental coverage. These plans usually do not cover maternity, at least not as of the writing of this blogpost. Whereas an ACA plan for a young adult (ie 21) would cost over $200 in most places in Florida (without a subsidy), some Short Term Medical Plans offering a $1,000,000 or $2,000,000 in coverage may be less than $100. To get specifics for your situation you can go to our website or by calling us at (954-332-9768).
In addition, Short Term Plans are generally PPO networks, using networks like, United Healthcare’s Choice Network, Aetna’s PPO network, PHCS- Multiplan Network, or First Health Network. Each of these networks is very large and may provide superior network choice compared to many of the plans on the Florida Federal Government Marketplace. You can get a good overview of the Short Term plans we offer by going to our Short Term Plan web page.
Association Plans: Another option which is somewhere in-between the cost of Short Term Insurance but often less than the Affordable Care Act Plans are Association Plans.
These plans are relatively new options here in Florida. They differ from the other plans because the cross state lines and provide almost all of the benefits of Affordable Care Act plans, generally using a National PPO Network like United Healthcare Choice or the CIGNA PPO Network, but because they ask health questions (and will disqualify those with pre-existing conditions) they end up having a much healthier pool of people for which they are providing insurance for and as such you will likely see significantly lower monthly premiums, especially for those who are over 50 years of age and who don’t qualify for large health insurance subsidies. These plans generally have decent deductibles, manageable maximum out of pocket coverage protections, and copays for Doctor and may even cover lab work and X-Rays at no cost. These plans, generally were not available until after the Obama administration left office.
Other Idea’s that may save you money on Health Insurance
How can I increase my ACA subsidy?
- Consider opening up an IRA. If you open an IRA and fund that IRA, the monies you place into that IRA will reduce your taxable income. That may mean that you qualify for a bigger subsidy or perhaps allows you to get a Silver Plan with enhanced benefits. Using this strategy may not only allow you to pay less taxes now, but lower your health insurance premium and get better coverage. Pretty neat trick. Don’t understand IRA’s, give us a call. We don’t sell IRA’s but will gladly steer you in the right direction. Some very low cost options for IRA”s would be Vanguard, Fidelity, TD Bank – Ameritrade, or Schwab. You can also ask your financial advisor.
- Consider opening up an HSA (Health Savings Account). Health Savings Accounts allow you depending on age to choose an HSA plan. These plans give you special tax savings, and may offer you again to qualify for subsidies you would otherwise fail to be able to obtain. In addition, these accounts allow you to pay for medical services with pre-tax dollars. We recommend using HSA bank to set up your account, but we also recommend that you discuss this with your Accountant to make sure this type of account is right for you.
- Buy a Higher Deductible Plan and couple that with GAP insurance GAP insurance is a policy which will pay you a benefit based upon certain specific incidents. We particularly like the GAP insurance which will pay you a cash benefit (which you can use to lower your exposure to medical costs) in the case of any accident or injury, along with a payment should you need to spend one or more nights in a hospital as an in-patient. These are often the major expenses that will cause you to have to go out of pocket in a large way. Coupling this additional coverage to a plan with a higher deductible often makes a great deal of sense. Let us get you a quote on this valuable coverage. Details of this plan can be found on our website. While this is one approach there are many ways to use this technique. Some carriers offer a range of cost reduction GAP plans which will pay you for cash benefit for a surgery (non-cosmetic), or certain tests (i.e. An MRI), or perhaps even for some doctor visits. Another offering could be a benefit paid if you have a critical illness (cancer, stroke, heart attack). Each of these options may make sense and the ones that are best suited for you is really deeply personal. We look forward to assisting you in seeing if using this technique makes sense for you.
- Considering buying separate plans for different family groups. While this can lead to a larger potential family out of pocket maximum, this strategy may make a great deal of sense. Let’s say that one member of your family has a preexisting condition, while other’s do not. Allowing the one person to get a suitable plan specific to their needs may reduce their health insurance costs and allow other family members to get different coverage that makes sense for them. Don’t discount the use of Florida Kidcare in the equation as that may offer another valid option for you to consider. You can calculate your cost for kidcare here and use that as a basis for other decisions you may need to make. Florida Kidcare states “Florida children from birth through the end of age 18 are eligible for coverage. It is free to apply and with year-round enrollment, the time to apply is always now. Begin your family’s application by clicking the pink ‘Apply Now’ button. Then Florida KidCare does the rest. Based on the age of the child, household size, and family income, we automatically match each child with their best fit of the four Florida KidCare programs – Medicaid, MediKids, Florida Healthy Kids, or the Children’s Medical Services Managed Care Plan. It’s that easy! Florida KidCare includes free, subsidized and full-pay options based on family income and household size. Most families pay nothing at all, and many pay as little as just $15 or $20 a month for all children in the household. Families who do not qualify for free or subsidized coverage may purchase a competitively priced full-pay plan.
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