Florida provides numerous options for healthcare coverage. Low-income families may qualify for Medicaid; others can use the Affordable Care Act Marketplace and premium subsidies; those waiting on Medicare eligibility or in between jobs might consider short-term health insurance plans as an interim solution.
Open enrollment for Affordable Care Act plans typically takes place November 1 to December 15, though certain life events (like getting married or having a baby ) may allow people to sign up outside this period, such as having one.
Eligibility for Medicaid
Florida requires applicants seeking Medicaid eligibility to meet several financial requirements in order to be considered. Residents of the US with incomes below a certain threshold. Furthermore, they must pass an in-person examination designed to measure how much assistance is needed with two or more activities of daily living.
When applying for home and community services or institutional Medicaid, neither spouse’s income is taken into consideration; however, when applying for regular Medicaid or Extra Help with Medicare premiums, copayments, and prescription drug costs, both incomes will be considered.
Keep in mind that spending down excess assets, like home modifications or funeral costs, on non-countable items can help protect you from losing Medicaid coverage. Otherwise, penalties might apply; although in states with expansion Medicaid is likely that most adults who no longer qualify will qualify for alternative coverage plans such as Marketplace plans that offer subsidies.
Eligibility for ACA Subsidies
ACA subsidies, commonly referred to as premium tax credits, offer assistance for individuals and families purchasing health insurance through the marketplace. Available to people earning between 100 percent and 400 percent of federal poverty level income levels, these subsidies can help lower monthly health insurance costs by up to 85 percent.
COVID-19 legislation expanded premium subsidy eligibility up to 400% of FPL; thus bringing greater access to premium subsidies through 2025 and driving enrollment of Obamacare among households that fall above this threshold – such as Valrico resident Dawn McAlpin who recently became one of those new enrollees.
Ambetter Sunshine Health offered her a Marketplace plan through Ambetter to cover her medical needs, which include visits to an orthopedic specialist and eye doctor for her glaucoma. Her subsidy will be applied towards the cost of monthly health insurance premiums; however, should she earn more than anticipated over the year, some or all of it may need to be returned in return for it.
Eligibility for Short-Term Health Insurance
Florida has one of the most accommodating laws regarding short term health insurance plans, permitting policies to last up to 364 days and renew for up to 36 months. These plans often provide less extensive coverage than marketplace plans – for example they may exclude maternity coverage and limit prescription drug benefits; additionally they often use an informal underwriting process which means people with preexisting conditions could be denied coverage.
Individual health insurance plans provide temporary protection while waiting for their employer-sponsored plan or enrolling during the Affordable Care Act open enrollment period to commence or enroll, though more comprehensive plans like marketplace or Medicare Advantage plans offer cost-effective ways of providing comprehensive coverage without paying an expensive monthly premium and helping avoid penalties associated with not having insurance coverage.
Eligibility for ACA Plans
Florida led the nation this year in enrollment through the Affordable Care Act marketplace – more commonly referred to as Obamacare – reaching more than three million enrollees, an increase of more than one million over last year according to data released Wednesday by Centers for Medicare and Medicaid Services.
People earning between 100% and 400% of the federal poverty level may qualify for premium subsidies to reduce monthly healthcare costs. To qualify, one must reside within the U.S. as either a citizen, national, or legally present resident.
The Affordable Care Act Marketplace offers private health insurance options for individuals and families that provide prescription drug coverage, dental and vision benefits, preventive care services, cost-sharing reductions to help pay deductibles and copayments, cost-sharing reductions for deductibles and copayments and free or low-cost medical and dental care through Medicaid programs in most states, including Florida.
