With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Florida, including individual and family health insurance plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Florida
Florida ranked 32nd in United Health Foundation’s 2014 America’s Health Rankings. Its strengths include low air pollution, obesity and whooping cough (pertussis) infections, while it’s challenged with a high rate of drug deaths, low rates of high school graduates and—as stated above—a high percentage of uninsured.1
The U.S. Department of Health and Human Services reported that 983,775 individuals in Florida selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Florida enrolled in a marketplace plan increased to 1,596,296 during the open enrollment period.3
Florida individual and family health insurance
When the Obamacare health insurance exchanges opened for 2014 enrollment, Florida defaulted to the federal health insurance marketplace, healthcare.gov. Individuals and families living in Florida may purchase health insurance coverage through the state’s federally facilitated exchange and in the private marketplace.
Those who buy health insurance through healthcare.gov may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Florida small group health insurance plans
In Florida, small businesses with 50 or fewer employees may purchase small group health insurance plans through the federally facilitated Small Business Health Options Program, SHOP Marketplace, at healthcare.gov and in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from healthcare.gov.
Florida state COBRA variations for small groups 4 5
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may qualify for health insurance continuation through mini-COBRA programs. State mini-COBRA programs allow those who work for a small business and lose health insurance coverage due to a qualifying event to continue coverage, too. These programs generally work like the federal COBRA continuation coverage, but their terms may vary. Florida’s small group COBRA continuation variations are as follows:
|Eligible group sizes||2–19|
|Maximum continuation period – standard||18 months|
|Maximum continuation period – disabled||29 months|
|Maximum premium increase||115 percent (100 percent of premium, plus 15 percent processing fee)|
|State legislation reference||None|
|Consumer helpline||877-MY-FL-CFO (877-693-5236)|
|Additional notes||Employees must notify the insurer within 63 days of losing group eligibility that they are eligible to continue coverage. Within 14 days of receiving this notification, the insurance carrier must an election and premium notice form. Within 30 days of receiving the insurance carrier’s notice, individuals must elect coverage and pay the initial premium.|
Florida high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.6
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPS and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 138 percent of the federal poverty level.
Florida opted not to expand its Medicaid program. A resulting coverage gap exists for those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping healthcare.gov.
The information below is specific to Florida’s Medicaid program.
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Florida Agency for Health Care Administration|
|Where to apply||healthcare.gov |myflorida.com/accessflorida|
|Residency requirements||Florida resident, U.S. citizen, qualified non-citizens|
|Eligibility||Determined by the Department of Children and Families or the Social Security Administration|
|More information||DCF Family-Related Medicaid Programs Fact Sheet|
|Open-enrollment period||Year-round in all states|
|Adult income eligibility limits as a percent of the federal poverty level (family of three)||35 percent of FPL; annual income limit of $6,809|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines. The information below is specific to Florida’s CHIP program.
|Program name||Florida KidCare|
|Where to apply||healthykids.org/apply | healthcare.gov|
|Eligibility||Four programs available—Medikids, Healthy Kids, Children’s Medical Services Network, Medicaid—based on age and family income|
|Residency requirements||Florida resident, U.S. citizen, qualified non-citizens|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Florida Department of Financial Services. Health Insurance and Health Maintenance Organizations: A Guide for Consumers. 2013. Retrieved fromhttp://www.myfloridacfo.com/division/consumers/UnderstandingCoverage/Guides/documents/HealthGuide.pdf.
5 627.6692 Florida Health Insurance Coverage Continuation Act. Retrieved from http://www.flsenate.gov/Laws/Statutes/2014/627.6692.
6 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.