10 Essential Tips for Navigating the Florida Health Insurance Market

ByHarold Cadena

Finding the right health insurance policy for you and your family can be overwhelming. A lot of people fail to get health insurance for various reasons. Around 30 million people in the United States don’t have health insurance coverage.

You have a short amount of time to find a plan when open enrollment starts. It’s important not to rush picking out a plan. Knowing the best ways of navigating the Florida health insurance market will help you throughout the process.

This guide will discuss our top 10 tips for finding the best Florida health insurance plan for you and your family. Save yourself time, money, and stress by preparing yourself for choosing health insurance.

1. Figure Out What’s Available to You

How and where you shop for health insurance depends on what types of plans you can access. For example, if you can get health insurance through your employer, or your partner’s employer, you won’t have to use government health insurance marketplaces. You’ll only have to look elsewhere if you want a supplemental plan or a different option that’s not available.

Keep in mind that health insurance plans in the Florida marketplace will likely cost more than what’s offered by your employer. That’s because your employer will typically pay part of your health insurance premium.

You’ll have to shop in Florida’s online health insurance marketplace if your workplace doesn’t offer health insurance. Other options for looking for health insurance include:

Florida’s health insurance marketplace offers policies from a wide range of companies. These include:

  • Blue Cross Blue Shield of Florida
  • Cigna
  • Florida Blue HMO

Most insurance companies participate in all counties throughout Florida.

2. Think About Your and Your Family’s Health

You’ll probably only look at one or two health insurance plans if you and your family are healthy overall. You can look for the least expensive option that gives you whatever coverage you think you need. However, it’ll get more complicated if you think you need more coverage.

The number of possible health insurance plans can be overwhelming. Ask yourself the following questions to help narrow down your options:

  • Do you or a loved one have a chronic health condition that requires ongoing care?
  • Do you need health insurance in case a catastrophic health issue happens?

If you’re fairly healthy, multiple plans might work for your needs. If you, a dependent family member, or your spouse has a chronic health condition, that information can help you narrow down potential insurance choices.

3. Review the Types of Health Insurance Plans

Coverage isn’t the only thing you need to think about when shopping for health insurance. There are different kinds of policies that offer various benefits. They include:

  • PPO: Preferred provider organization
  • HMO: Health maintenance orgnaization
  • EPO: Exclusive provider organization
  • POS: Point of service plan

Each type has different out-of-pocket amounts. They might also limit what doctors you can see based on who’s in the network of each plan.

The first thing you should look at when reviewing Florida health insurance coverage is the summary of benefits. The online marketplace will have an area where you can read about them. The summary of benefits explains all of the coverages and costs included in the plan.

It’ll also give you a provider directory. Clinics, hospitals, doctors, and nurse practitioners that are in the plan network are listed in the directory. You’ll want to check that your current doctors are in the network of whatever plan you choose.

4. Look at Out-of-Pocket Costs

Out-of-pocket costs refer to money that you have to pay for your medical care outside of your premium. You’ll find information about this inside your summary of benefits.

The Florida healthcare marketplace offers side-by-side comparisons of each plan’s out-of-pocket costs. However, these comparisons are full of technical terms that you might not know the meaning of. It’s important to educate yourself beforehand so you can make the right choice.

Some common terms you should know include:

  • Premium: The cost you pay each month for health insurance
  • Coinsurance: The percentage of medical bills that you have to pay after your plan covers the rest
  • Copay: A flat fee that you pay every time you go to the doctor or have a procedure
  • Deductible: The amount of money you pay for your medical care before your health insurance kicks in
  • Out-of-Pocket Costs: Costs that you have to pay other than your premium, like deductibles and copays
  • Out-of-Pocket Maximum: The maximum amount of money you’ll pay each year out-of-pocket

These costs can quickly add up if you see the doctor often throughout the year. Keep in mind that the higher your premium is, the lower your average out-of-pocket costs will be.

You might want to consider a health insurance plan that pays more of your medical costs if some of the following things are true:

  • You go to a specialist or primary physician often
  • You regularly take brand-name or expensive medications
  • You frequently go to the emergency room
  • You know you’re going to have a procedure or surgery
  • You are planning to have a baby, are currently pregnant, or have small kids
  • If you have a chronic condition like cancer or diabetes

Not everyone can afford a health insurance plan with a higher premium. The lower your monthly premium, the higher your out-of-pocket costs will be. This might be a great option for you if you rarely go to the doctor or can’t afford expensive health insurance.

5. Stay on Top of Your Deadlines

You don’t have a ton of time to enroll in health insurance during open enrollment. In Florida, this period usually lasts from November 1 to January 15.

While you can make changes to your plan or enroll outside of that timeframe, you have to meet the requirements to do so. A special enrollment period is typically for those who have a qualifying life event. Life events that qualify you for special enrollment in a Florida health insurance company include:

  • Marriage
  • Gaining or becoming a dependent
  • Losing your coverage involuntarily
  • Becoming a US citizen
  • Divorce

A Florida health insurance company brokerage can go over your options with you if you think you qualify for special enrollment.

Your enrollment deadlines will typically be different if you’re signing up for a plan through your employer. However, they usually fall within the same time of year.

You might want to explore other options even if you like your current plan. You shouldn’t just let it automatically renew. In addition to finding a health insurance plan that might fit your needs better, you can also see if you qualify for additional subsidies.

6. Compare Health Insurance Benefits

Evaluating the benefits of each plan is important to know which one to choose. One of the things you should evaluate is their scope of services.

Do you want your health insurance to include things like mental health care or physical therapy? Check to see what plans include that in their summary of benefits. You can narrow down your available choices if those things aren’t high on your priority list.

One way to get direct answers to your questions is by working with a health insurance brokerage. You can also call the health insurance company directly. Have your questions written down ahead of time so you’re prepared for your phone conversation.

Some of the questions you might want to ask include:

  • Is my medication covered?
  • Do you cover maternity services?
  • Which doctors in my area are covered under the plan?
  • What do I need to sign up for a plan?
  • What happens if I get sick while on vacation out of the country?

7. Don’t Forget Dental Insurance

You can explore dental insurance plans when you sign up for health insurance in Florida. The state uses the HealthCare.gov marketplace to offer residents family and individual dental plans.

Not every health insurance company in the marketplace includes dental coverage in their plans. There are some stand-alone plans that you can purchase for children and adults.

The insurance companies you can get dental coverage from include:

  • Cigna
  • BEST Life
  • Delta Dental
  • Guardian
  • Humana
  • DentaQuest

The same enrollment rules apply to dental insurance plans. You can either purchase a plan during a special enrollment period or open enrollment. You can also purchase a dental insurance plan outside of the Florida marketplace.

8. Be Mindful of Suspicious Plans Online

There are many websites out there that are designed to prey on people looking for quality health insurance. Their goal isn’t to help you find an insurance policy. They want you to input your personal information so they can steal it.

You shouldn’t click on online ads for health insurance. You’ll also want to avoid putting your contact information into forms on unknown websites.

While these plans might seem too good to be true, offering you amazing coverage at a discounted rate, they’re not a good deal. They could be short-term health insurance plans that don’t cover basic things, like annual check-ups or monthly prescriptions.

That’s why you need to either go straight to the Florida health insurance marketplace or contact a reputable broker. They’ll help you find the right plan for you.

9. Think About if You Want a Referral System of Care

POS or HMO plans require referrals. That means you’ll have to see your primary care doctor first if you want to visit a specialist. Many people decide to go with other health insurance plans because of this requirement.

However, POS and HMO plans have different benefits. One of them is that your main doctor is overseeing all of your medical care. You’ll build a stronger relationship with your doctor as you go to them for all of your medical needs.

You might want to choose a PPO or EPO plan if you want to go to a specialist without getting a referral first. You’ll have to find providers within your network to keep your costs low. A PPO might be better for those living in a rural area since you’ll likely have to go out of your network for medical care.

10. Explore Health Savings Accounts

A health savings account (HSA) functions like a personal savings account. However, you can only use the money toward your medical expenses. Another aspect of an HSA you should know about is that you can only get one if you have a high-deductible health plan (HDHP).

One of the great things about HSAs is that they have major tax advantages. Some people set them up as part of their retirement plans.

All of the contributions you make to your HSA are done so with pretax dollars. You don’t have to pay income tax on any of the money you put into your HSA. Investing in your HSA will reduce your taxable income when you do your taxes.

The money that you deposit into your HSA will cost you a lot to access if you don’t use it properly. You’ll encounter a 20% penalty plus income taxes if you use the money for non-qualified expenses before you turn 65.

Another advantage of an HSA is that any money you don’t spend rolls over at the end of the calendar year. You can continue to use it for your medical expenses.

This is the key difference between an HSA and a flexible spending account (FSA). The money in an FSA expires at the end of the year.

Some of the things you can use your HSA funds toward include:

  • Dental services
  • Deductibles
  • Vision care
  • Co-pays
  • Prescription drugs
  • Psychiatric treatments

Your insurance premium isn’t something you can use your HSA funds for.

Find the Right Florida Health Insurance for You and Your Family

It can be challenging to navigate the Florida health insurance market. There are countless things to consider when choosing a health insurance plan. The confusing language and onslaught of information can make it difficult to make the right choice for you and your family.

That’s where Caley Insurance comes in. We work with leading Florida health insurance companies. Contact us today to get started on a health insurance quote.