Categories: Health Care, Health Law,

In the insurance world, October 2014 marks the first full year of the Health Insurance Marketplace. Over the last year, Florida updated the insurance marketplace to accommodate the law’s requirements and changes, putting a new face on the insurance business in the state. At Lubell Rosen, our health insurance lawyers want to take a minute to update Florida residents about the facts and figures for insurance coverage in the Marketplace in the wake of Affordable Care Act (ACA).

The Florida Health Insurance Marketplace is the centralized site where state residents who qualify for health care coverage can select their insurance plans in person, over the phone or online. The state’s Marketplace is run by the federal government and is used primarily by people who do not currently have insurance or do not have coverage through their employer or their spouse’s employer. Others who use the Marketplace include small business owners, people with pre-existing medical conditions and private insurance purchasers who are looking for other options. 

What You Need to Know 

The ACA made it mandatory for most Americans to have health insurance as of this year. People who are already covered by an employer-sponsored plan, Medicaid, Medicare or TRICARE do not need to use the Marketplace for their insurance needs, but nearly every other Florida resident can benefit from its services. The next enrollment period for this year begins on Nov. 15, 2014, and runs until Feb. 15, 2015. At that time, uninsured or previously insured consumers can select new options for coverage from the Marketplace. Anyone with a significant life-changing event—such as a job change, unemployment, birth of a child or a move to a new state—can apply for insurance as soon as the event occurs without waiting for the open enrollment period. Applicants with life-changing events have 60 days from the event to procure coverage.

Every insurance plan in the Marketplace is sold by a private company or a co-op. There are four different plan options, and each is broken down by the percentage the consumer pays versus the percentage the plan provider pays. For example, in the bronze plan, the consumer pays 40 percent, and the plan pays 60 percent. In the silver plan, the split is 30/70, while the gold is 20/80 and the platinum plan is 10/90. While all four plans cover the same benefits in Florida, not all plans offer the same insurance provider payout. The lower cost plans—or catastrophic plans—offer consumers the opportunity to pay less money in premiums; however, they will face less coverage, as well as higher out-of-pocket expenses. Such plans are typically sold to consumers under the age of 30 who are in good health.

Health conditions play a role in determining how much consumers will pay to have insurance coverage and what conditions or stipulations will be attached to or excluded from their plan, health insurance attorneys in Florida say. For instance, Florida law allows insurance companies to charge tobacco users up to 50 percent more than consumers who do not use tobacco. Additionally, all plans include the same package of benefits, which are also known as the “essential” health benefits. These include most preventative and emergency services, but exclude outside treatments, like weight loss programs and cosmetic surgery.

Our health insurance attorneys at Lubell Rosen recommend that all Florida residents check out the plans offered on the Marketplace during the next enrollment period to determine which plan will best meet their needs. For questions or legal inquiries regarding insurance plans in Florida, contact a Lubell Rosen attorney today.