The Sunshine State is a magnet for hurricanes, plastic surgery, retirement, bad drivers, and a perma-tourist mentality. Florida brings many odd and interesting attractions to U.S. tourism, from beaches to cities, art museums to amusement parks, and has established itself as a cross between the cultural and the bizarre. But there is more to Florida than pink stucco and imported palm trees (though it does comprise much of the landscape). Everglades National Park consumes about 1/3 of the state, and there are a host of colleges and large corporations (well, mainly just Disney). For those who live full-time in the land of gators, manatee-shaped mailboxes and Margaritaville shirts, there is access to some great health insurance companies such as Aetna, Coventry, Cigna, Humana, and UnitedHealth.
East Coast Health Insurance also calls Florida home! We know the state’s health insurance market like the back of our [sunburned] hand, and have been in business in Deerfield Beach, South Florida for many years. Feel free to speak with any of our licensed agents/Florida residents if you need help choosing the best health plan for you in Florida – call 888.803.5917. To compare plans in Florida on your own, enter your zip code in the quote engine below.
Despite the tropical clime, abundance of parks and recreation, and miles of orange groves, statistics show that Florida is not utilizing its access to healthy living. Ranking fairly low compared to the rest of the country when it comes to health in various categories, Floridians could make some lifestyle improvements. The rate of obesity is increasing, with over four million residents falling under this category, which is 1.7 million more than a decade ago. Over 1.5 million Floridians are diabetic, and 2.5 million are smokers.
Though there are several downfalls of the overall health status of Florida, there are some positives. Binge drinking has a low presence among Floridians and smoking has decreased (statistic does not include Spring Breakers). There is also a high level of immunization coverage, and the air quality is very good, with minimal pollution. These factors, as stated by UnitedHealth, are strong enough to indicate that the health of the Florida population has the potential to improve in years to come.
Health Insurance Plans
- Health Network Option PPO plans provide access to Aetna’s PPO network, as well as coverage for out-of-network providers. Preventive care, lab work, and immunizations are covered at 100%, and generic prescriptions and first three doctor’s office visits are available for a copay – all before meeting your deductible. These high deductible plans offer a broad range of coverage after deductible, on hospital care, surgeries, home health care, emergency services and more. Some of these can also be paired with dental coverage.
- Health Network Option HMO plans have similar benefits to the above plan, but receiving care through Aetna’s HMO network. Many services are available for a copay, such as primary care doctor and specialist office visits, emergency room, urgent care, and generic prescriptions. Though seeing an in-network provider will save you a great deal, there is still coverage for out-of-network care after you have met your deductible. These plans also cover preventive care in full before deductible. Some of these are also eligible for a dental coverage option.
- Health Network Option High Deductible (HSA Compatible) plans are, as described, available in a variety of high deductibles with the option of opening a health savings account (HSA). The funds from an HSA are tax-advantaged, and can be used for certain medical expenses only – such as your deductible, copayments, and coinsurance. These plans give you access to Aetna’s Health Network, or the option to go out-of-network for twice the cost. There is 100% coverage on the majority of medical services once you meet your deductible, and preventive care totally covered before deductible.
- Easy plans from AvMed are PPO plans with a wide variety of options to choose from. You can choose Easy plans with dental coverage options, as well as prescription coverage options. These plans are “easy” because your medical expenses are available for a copay in most instances. Primary care physician visits, specialist visits, hospital treatment, outpatient care and testing, as well as emergency and urgent care are available for a copay. Preventive services do not require any payment, which includes well-woman exams, annual physicals, well-child care, immunizations, screening for breast and colorectal cancer, and family planning.
- Elite plans are also connected to a PPO network through AvMed, and these plans also provide many health care services for a copay before deductible. Elite plans have a higher deductible, and you have the freedom to see in-network or out-of-network providers, though in-network will be much less. After you have met your deductible, you will have most major medical services covered at a certain percentage by your plan, depending on which you choose.
- Open Access plans are connected to Cigna’s PPO network, with discounted rates available for in-network services. These are available in a variety of coverage and deductible options, with preventive care covered in full from the day your coverage starts. Most medical services are covered at the percentage indicated by your plan (70, 80, or 100%) before your deductible has been met. Prescription coverage is also available for a copay under most of these plans, in addition to primary care and specialist office visits. Cigna also has a great home delivery pharmacy option for prescription drug services. Some of these plans have a dental coverage option as well.
- Health Savings plans are HSA-qualified high deductible plans, with which you can manage your own health care. Use your health savings account to pay for any eligible medical costs (like your deductible or services not covered), and decide on your own providers. After your deductible has been met, you have free reign with many medical services, as Cigna covers 100% of the expenses. Such covered services include emergency and urgent care, inpatient hospital care, X-ray and lab work, and prescription drugs. Prior to meeting deductible, you will receive preventive care at no charge.
- Copay HMO plans give you a simplified, structured approach to your health care. With a primary care physician to orchestrate your care, and predictable copays for services like office visits and outpatient hospital care and surgery, these plans can be very easy to use. HMO plans are similar to employer group coverage, with preventive care given at no cost to you, and a flat rate for most other medical services. Though some services are not covered depending on the level of the plan you choose, there are a variety of deductibles and coverage types available for Copay plans. There is also a prescription option with select Copay plans.
- Momentum plans are PPOs, with access to Coventry’s Preferred network of providers, and the option of seeking out-of-network care. Annual physical and GYN exams, as well as routine care for children and mammograms are all covered by your plan immediately at 100%. In-network doctor’s office visits and family planning services are also available right away before meeting your deductible for a flat rate. These plans have high deductibles, therefore your level of coverage is more comprehensive. Prescription drugs can be acquired for a copay for Tier 1 -3 medications.
- Premier Value plans are also PPO plans with very similar benefits and coverage to the Momentum plan. These have a variety of deductibles to choose from, as well as predictable copays for in-network doctor’s office visits and urgent care. After paying your deductible, Coventry pays for most services such as inpatient hospitalization, rehabilitative care, outpatient treatment and skilled nursing care. There is also prescription drug coverage for a simple copay with a Premier Value plan.
- Saver HSA plans are high deductible plans qualified for use with a health savings account, or HSA. These plans are optimum for individuals with the means and the desire to manage their own health care. Saver HSA plans from CoventryOne cover preventive care completely from the day your coverage begins. Most other medical services received in-network are covered at the selected percentage (70, 80, or 100%) once you have paid the deductible. Funds from an HSA are able to be withdrawn tax-free to pay for certain health care costs including copays, coinsurance, and deductibles.
- Plus plans give members access to a PPO network, with lower deductibles and copays for office visits. Preventive care is available at no cost when you seek in-network care, and there are set copayments for other in-network services, like office visits, emergency room and urgent care. Once the deductible has been met, there are many other types of care covered by your plan, at the percentage indicated by the specific policy you choose. You have the freedom to choose your doctors, medical facilities, and use out-of-network providers as well, though it will be more costly.
- Value plans in Florida through HumanaOne are POS (Point of Service) plans, which have several deductibles to choose from, as well as coverage options up to 100%. After you have paid your deductible, you have the ability to seek a wide variety of medical care. The day your plan becomes active, you and your dependents can receive preventive care services covered at 100% in-network. Out-of-network services are also available, through it will cost you double the amount of using the appointed Humana network. Another benefit to these plans is the unlimited lifetime maximum, which means your plan does not put a cap on your health expenses and will continue coverage regardless of what you spend.
- Copay and Enhanced Copay plans can come in several types of coverage options, and have a range of deductibles within each type. Preventive care is paid for by insurance before meeting the deductible, including child immunizations, X-ray, prostate screening, pap smears, mammograms, and office visits for children and adults. These plans make paying for medical services simple by establishing a flat rate for various types of care. Certain plans will cover you at 100% after you have paid a copay for your first three diagnostic office visits. Enhanced copay simply offers a greater amount of coverage once you have met your deductible.
- HSA and Enhanced HSA plans are high deductible plans that can be connected to a health savings account (HSA) for use on medical expenses. HSA accounts can help you meet your deductible, pay for other qualified health services and save for future needs. Some of these plans are available with dental coverage options, as well as prescription discount cards. Depending on which level of coverage you choose, your plans can pay for up to 100% of most in-network services after your deductible has been met.
- Copay plans from UnitedHealthOne are PPOs, which come in either 70/30, 80/20, or 100% coverage after deductible. These plans provide convenience and consistency by setting fixed prices for your most frequently used services, such as doctor’s office visits and prescription drugs. UnitedHealth is the nation’s largest health care company, and therefore boasts a large preferred network, which you will pay much less for when you use its providers. It is similar to a employer-sponsored plan in terms of coverage, which can be helpful to those who have just left such a plan.
- High Deductible plans also give you access to the UnitedHealth PPO network for discounted rates, while you still have the choice of seeking care out-of-network if that suits you better. There are three types to choose from: Plan 100, Plan 80 and Saver 80. Plan 100 is a user-friendly plan, with the ability to receive 100% coverage on in-network services after you meet your deductible. Plan 80 provides 80% coverage from your plan after deductible, and Saver 80 is more economical, with the lowest premiums offered by UnitedHealthOne.
- HSAplans are high deductible health plans with the opportunity to open a health savings account (HSA) with tax advantages. These plans feature low monthly premiums, a range of deductibles to fit your budget, and the ability to either save for retirement or put your HSA funds towards qualified medical expenses. UnitedHealth also offers an incentive program with these plans through a deductible credit, with which you can earn rewards for taking charge of your health care.
Public Health Options
Florida’s state-funded health programs are available for a variety of groups, and should be used by those who qualify. Of course, there is Medicaid coverage for those who cannot afford a private insurance plan, or qualify for other reasons. The Florida Department of Health has many programs and services to accommodate the needs of each county, all of which have their own set of programs unique to their area. For a list of all public health programs available, select your county from the Florida Department of Health site.
- Medicaid: provides health care coverage to low income children and families, pregnant women, disabled, blind, aged, and other qualifying individuals
- Florida KidCare: state-funded health insurance to children up to age 18
Health Insurance Laws
Many health insurance regulations in the State of Florida are similar to the rest of the country, such as complying with HIPAA. Under HIPAA laws, Florida insurers are required to renew your plan at the end of a term, and cannot terminate your policy if you become ill after your plan has been issued. HIPAA also ensures the privacy of all insured individuals of their personal medical information. A medical provider is not permitted to send your information to another entity without your consent or having notified you first.
Private health insurance companies in Florida have the legal right to use their discretion in certain cases, therefore having the ability to deny applicants for health insurance. Insurers can determine the definition of a pre-existing condition, using a prudent person standard. This means that even if the individual did not seek treatment for a condition, but so much as showed symptoms at some point, they can be rejected for a health plan, or charged a higher premium.
Insurance companies can also issue exclusion periods for those who have a pre-existing condition for up to 24 months, or attach an elimination rider. These exempt the insurance company from covering medical costs related to the specified condition for either a certain length of time or permanently. If an individual gets denied coverage altogether, they are eligible for a Pre-Existing Condition Insurance Plan, which is run by the U.S. Department of Health and Human Services in Florida. If this applies to you, you may compare cost and availability in your area by filling out a quote.
As health care changes under the Affordable Care Act, Florida will see the implementation of state health exchanges in 2014, as well as the inability for insurers to deny any adult for a pre-existing condition. Florida, as well as the rest of the U.S. will have exchanges set up as a means to make health insurance more fair and affordable, and encourage private health market plans to come down in price and up in benefits. It is up to the state to make specific rules regarding its exchanges, though every state must meet the criteria for essential benefits. These benefits are a set of ten types of medical services that must be covered, including maternity and infant care, emergency room services, and mental health care.