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Florida Health Insurance

Florida Medical Insurance Overview

Florida has an estimated population of over 20 million people and 85 percent of those residents receive insurance coverage through various programs as of 2014.  Of the options available, like other states, Florida has group health insurance coverage through workplaces, individual plans for residents to purchase and state-sponsored programs that offer coverage at little or no cost to the resident.  Fifteen percent of the people living in the state of Florida are not covered under insurance of any kind.

Florida has become a hub of changing demographics that show an equal shift across the country as a whole.  The Sunshine State has become known for being a haven for retirees and has a racially and economically diverse population.

With the implementation of the Patient Protection and Affordable Care Act, residents in the state of Florida are able to get access to health insurance options and resources in order to make an educated decision.

Florida’s Health Care Issues
As of 2015, the United Health Foundation ranks the state of Florida in 33rd place for healthiest states when compared to the other states in the country.  Florida’s strengths include the low prevalence for obesity and low levels of air pollution, but among its challenges are the high percentage of those residents who are uninsured, a low rate of high school graduates and a high Salmonella incidence.

Understanding Florida’s Uninsured Population
Fifteen percent of the residents in Florida are not covered under insurance of any kind.  Medicare covers 17 percent of the population, while Medicaid covers 19 percent.  While many of the residents of Florida are elderly, 23 percent of them have no insurance coverage whatsoever.  In an article by the Tampa Bay Times from 2012, Florida was said to be the second worst state when considering the amount of working age people who are without insurance coverage.

Statistics revealed by the Henry J. Kaiser Family Foundation show a breakdown of information on those residents in Florida who are not elderly and are without insurance coverage.  The charts provided show that children represent 16 percent of those uninsured people living in Florida.  Families that have one full-time worker comprise 62 percent of the uninsured population; 15 percent have families that consist of part-time workers and 24 percent of the uninsured people of the state are unemployed.

Florida’s non-elderly and uninsured population consists of 62 percent of people who are above the Federal Poverty Line, but 1.5 million people in the state are below the FPL.  Of the families with incomes below the FPL, 42 percent are uninsured.  Of those non-elderly uninsured residents, 9 percent have incomes that are four times the FPL.

Of those who are uninsured in Florida, 28 percent is comprised of adults while 14 percent is of children.  Of those uninsured non-elderly residents, 52 percent is male and 48 percent is female.

Group Health Plans
Group health plans are offered by the workplace and information regarding them can be obtained from the person in charge of Human Resources.  Group plans are easier to enroll in because of the lack of physical examinations and questions regarding health status.  Through a group plan, workers can receive a wide variety of benefits at more affordable rates because of the employer’s contribution to the plan.  Many of the decisions have already been made with regard to what each of the plans offer, so workers may not have the opportunity to have much of a selection when choosing this option for coverage.  Because of the lowered cost, the advantages far outweigh the disadvantages of group coverage as opposed to individual coverage.

Signing Up
There are typically enrollment periods in which the worker can utilize to sign up for coverage under the employer-sponsored plan.  New hires can expect to be allowed enrollment prior to regular enrollment periods, but no exceptions are usually made for employees who miss the enrollment period.

Be prepared for the open enrollment period by reading through all of the documentation associated with the group insurance plan.  The Human Resources representative is typically in charge of the benefits under group plans and in order to receive the most amount of clarification regarding the options available, it is advised to direct any questions to that specific department.

In the state of Florida, mandatory coverage are in place for all insurance policy types that offer care for the following medical services:

  • Conditions related to diabetes
  • Breast cancer screening
  • Vaccinations for minor children
  • Continuous prenatal care
  • The same coverage maximums and limits are in place for those that suffer from mental illness as those options available for people who suffer from physical illnesses.

Continuation Coverage
Under Consolidated Omnibus Budget Reconciliation Act (COBRA), people who have lost insurance coverage can retain coverage for a period of 18 months following the termination of the individual’s previous health insurance plan.  A drawback to obtaining COBRA coverage is that the employee must pay the portion that was previously paid by the company that originally offered insurance.

Individual Health Plans
Individual health insurance plans are a less preferable option to residents all over the nation because of the ability to do underwriting on the part of the insurance company.  If you lack insurance coverage through your workplace and are unable to qualify for coverage under a state-funded program, you may need to get coverage under an individual insurance plan.  Before selecting an individual plan that meets your medical needs, be prepared to read through each plan and the benefits that come along with them.

According to the law in Florida, individual insurance plans must offer the same provisions as those of group health insurance plans.   Regulations are in place to offer protections to insurance policyholders in Florida.  Guaranteed coverage is accessible by residents under different scenarios, such as:

  • A woman who was diagnosed and treated for breast cancer over two years prior to the insurance application cannot be turned down for insurance coverage.
  • If you have been covered under a group plan for at least three months, then you are guaranteed access to insurance coverage.
  • For those who are qualified for HIPAA, you can’t be rejected for your application for insurance coverage.
  • If you have moved out of your insurance provider’s service area, you cannot be turned down for insurance coverage.

Similar to group coverage, if individuals come together in groups of up to fifty people, they can all receive coverage under an insurance policy in the state of Florida.  This provides the participants with the chance to negotiate the terms and benefits of their own group health insurance plan.

Florida Health Benefit Exchange
As mandated by the Affordable Care Act, Florida now has a health benefits marketplace as of November 2015.  Exchanges were required to be implemented by the beginning of 2013, but Governor Rick Scott fought a long and hard battle against the Obama administration and the ACA.

In the predominantly Republican state, the health benefits marketplace was not approved and many implementation deadlines were missed.  In 2010, Florida returned a $1 million federal grant that was awarded to the state for the creation of the marketplace.

Florida has since launched its marketplace called Florida Health Choices.  Using this website, consumers and business people can access their available options for health insurance coverage under the Affordable Care Act.

Governor Scott was recently criticized by a resident of Florida who claimed that he cut funding for Medicaid resulting in her inability to receive health insurance under the ACA.

Florida State Insurance Programs
Now that the health benefits exchange is active for nearly a year, the state has made plenty of options available to low income residents.  Among those plans are:

Florida Medicare
Medicare is available to people who are disabled, are suffering from end-stage renal disease or seniors over the age of 65-years-old.  For those who have (or their spouses have) worked in a Medicare-covered job for ten years or more, coverage is guaranteed.

The Medicaid program offers health insurance coverage to adults and children who are part of low income families.  The individual or family’s income level determines their eligibility and those covered under this plan can receive a myriad of medical services such as doctor’s visits, shots and prescription medications.  Retroactive insurance benefits may be available to cover services received within a three month period of time prior to the application for coverage.

Florida KidCare
Florida KidCare is an insurance program offered to children under the age of 19 who do not otherwise have insurance coverage.  For this Medicaid for children program, there is typically no charge for coverage, but other KidCare programs cost $15 to $20 per month.  For eligibility information and program details, visit the website for KidCare.

Mary Brogan Breast and Cervical Cancer Program
This program offers treatment options for women who have been diagnosed with breast and cervical cancers.  The program centers on the use of mammograms as a method for early detection and encourages women who receive abnormal mammograms to receive appropriate treatment within a 90 day period of time.

Florida Public Health Dental Program
This program works to improve and maintain the oral health of residents in the state of Florida.  It also offers education on dental matters and preventive dental programs to residents through schools and water fluoridation.

HIPPA and Conversion Health Plans
HIPAA was enacted to offer protections to patients with regard to their medical records, but has since expanded to govern health insurance companies.  Under HIPAA, regulations were created stating that insurance providers could not deny coverage to group plan enrollees based on a pre-existing condition.  Also mandated were rules regarding exclusionary periods, premium costs and affiliation periods.

The Department of Health imposed strict compliance with the regulations set forth by HIPAA and Florida’s standards have exceeded those of HIPAA.  For how residents in Florida are affected by HIPAA, consult the Florida Health website.