How It Works and Who It’s For

The Marketplace allows you to compare a wide range of private health insurance options, check eligibility for subsidies, and enroll in coverage. It serves individuals, families, and small business employees who do not qualify for Medicaid, Medicare, or affordable employer-sponsored coverage. Most enrollees qualify for financial assistance, making coverage more affordable.

Open Enrollment Period in Florida

• Open Enrollment for 2025: November 1, 2024 – January 15, 2025

• Enroll by December 15 for coverage starting January 1

• Enroll between December 16 and January 15 for coverage starting February 1

Outside this period, you can only enroll or change plans if you qualify for a Special Enrollment Period (SEP).

Special Enrollment Period (SEP) Rules

You may qualify for a SEP if you experience a qualifying life event, such as:

• Loss of other health coverage (including Medicaid, job-based insurance, or COBRA)

• Marriage or divorce

• Birth or adoption of a child

• Change in residence

• Turning 26 and aging off a parent’s plan

• Change in immigration status

• Release from incarceration

You generally have 60 days before or after the event to enroll.

Types of Health Insurance Plans Available

Plans are offered in four “metal” tiers:

• Bronze: Lowest premiums, highest out-of-pocket costs; best for those who rarely use care.

• Silver: Moderate premiums/costs; required for cost-sharing reductions.

• Gold: Higher premiums, lower out-of-pocket costs; good for frequent care.

• Platinum: Highest premiums, lowest costs; best for those needing frequent care.

Catastrophic Plans: Available to those under 30 or with a hardship exemption. These plans have low premiums, high deductibles, and cover essential benefits after the deductible is met.

Plan Types:

• HMO: Lower premiums, limited network, referrals required for specialists.

• PPO: Higher premiums, larger network, out-of-network coverage, no referrals.

• EPO: Must use network providers, no out-of-network coverage except emergencies, no referrals needed.

• POS: Combines HMO and PPO features, less common.

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available for incomes between 100% and 400% of the federal poverty level (FPL), with expanded eligibility through 2025. Over 90% of Florida Marketplace enrollees receive premium subsidies.

• Cost-Sharing Reductions (CSR): For incomes up to 250% FPL on Silver plans, reducing out-of-pocket costs.

• Medicaid/CHIP: Florida has not expanded Medicaid. Medicaid is available to low-income children, pregnant women, and parents with very low income. Florida KidCare (CHIP) covers children in families with incomes up to 200% FPL, with modest premiums.

How to Compare and Choose a Plan in Florida

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Ensure your doctors and hospitals are in-network

• Drug Formularies: Check if your medications are covered

Tips:

• Self-employed: Consider high-deductible plans with HSAs for tax benefits.

• Families: Look for pediatric dental/vision, family out-of-pocket limits.

• Retirees: Marketplace coverage bridges the gap until Medicare at 65.

Top Insurance Providers on the Florida Exchange

Major insurers offering Marketplace coverage in Florida include:

• Florida Blue (Blue Cross Blue Shield of Florida)

• Oscar

• Ambetter (Celtic)

• Health First

• Molina Healthcare

• AvMed

• Aetna CVS Health

• Cigna

• UnitedHealthcare

• Capital Health Plan

• Sunshine State Health Plan

• Florida Health Care Plans

Availability varies by county, and some regional HMOs serve specific areas.

Navigating Florida’s Online Enrollment Portal

How to Apply:

Go to HealthCare.gov and create an account.

Enter household and income information to check eligibility for subsidies.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Free, in-person help is available from certified Navigators, brokers, and community health centers throughout Florida.

• Navigators provide unbiased assistance and can help you compare plans, complete applications, and finalize enrollment.

Alternatives to the Marketplace

• Short-term health plans: Temporary coverage for gaps; not ACA-compliant, may exclude pre-existing conditions, and are limited to four months in duration.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available, but may offer different provider networks.

• Faith-based health-sharing ministries: Not insurance, lack ACA protections, but may be an option for some.

Common Mistakes to Avoid During Enrollment

• Not comparing multiple plans before enrolling.

• Failing to apply for subsidies or cost-sharing reductions.

• Missing the Open Enrollment deadline.

• Entering incorrect personal or financial information.

• Not updating your income or household information if it changes during the year.

• Choosing the wrong metal tier for your needs.

• Not checking if your providers are in-network.

State-Specific Health Programs or Initiatives

• Florida KidCare (CHIP): Covers children up to 200% FPL with modest premiums.

• No Medicaid Expansion: Florida has not expanded Medicaid to cover all low-income adults.

• Consumer Protections: Florida has banned surprise balance billing for state-regulated plans and participates in federal consumer protection laws.

• Local Navigator Programs: Certified Navigators are available statewide for free enrollment help.

Florida’s Marketplace offers a wide range of plans, strong consumer protections, and robust assistance for residents seeking affordable health coverage.