Obamacare in Florida

Health Insurance Marketplace in Florida

If you live in Florida, you’ll use this website, HealthCare.gov, to apply for coverage, compare plans, and enroll. Spanish language speakers can contact cuidadodesalud.gov.

Choosing the Right Health Insurance Plan

There are 5 categories of Marketplace insurance plans: Bronze, Silver, Gold, Platinum, and Catastrophic.

Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Florida has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Florida’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Who can help you (the Navigators)

Get local help

University of South Florida

Florida Covering Kids & Families (FL-CKF) is a community and consumer-focused nonprofit initiative of The Lawton and Rhea Chiles Center for Healthy Mothers and Babies, based in the College of Public Health, at the University of South Florida (USF), located in Tampa, Florida. FL-CKF, in collaboration with a state-wide consortium of 10 partners, will assist consumers and small employers with the enrollment process and conducting public education activities to raise awareness about the Marketplace.

Epilepsy Foundation of Florida

The Epilepsy Foundation of Florida is a not-for-profit. The Epilepsy Foundation of Florida plans to utilize their existing partnerships with schools and universities, government agencies, hospitals, and faith-based entities to educate and help enroll consumers in the Marketplace.

Advanced Patient Advocacy, LLC

For nearly 14 years, Advanced Patient Advocacy has partnered with health care providers and state and local governments in 21 states to provide services to communities to help educate and enroll uninsured consumers. Advanced Patient Advocacy will work with medical centers to identify uninsured individuals and provide education and assistance to help them make informed decisions about enrollment in the Marketplaces.

Legal Aid Society of Palm Beach County, Inc.

The Legal Aid Society of Palm Beach County will provide navigators in Palm Beach, Martin, Okeechobee and Hendry Counties. These counties include urban and rural communities that are racially, ethnically, linguistically, culturally and socio-economically diverse. The Legal Aid Society plans to do both direct engagement with consumers and well as provide information and public service announcements in multiple languages.

Pinellas County Board of County Commissioners

The Board of County Commissioners in Pinellas County, FL will be working to conduct outreach to vulnerable populations in the region. The Board will provide education, information services and work to facilitate enrollment in qualified health plans or other programs primarily to uninsured residents in Pinellas County in a manner that is sensitive to cultural, linguistic, physical, and educational differences.

National Hispanic Council on Aging

National Hispanic Council on Aging (NHCOA) works closely with its Hispanic Aging Network composed of 39 community-based organizations across the continental U.S., the District of Columbia, and Puerto Rico. The NHCOA will deploy Navigators in Dade County, Florida, and Dallas County, Texas, to enroll the uninsured Hispanic population in these two counties with a focus on members of this population that are socially isolated due to cultural and linguistic differences.

Cardon Healthcare Network, LLC DBA Cardon Outreach

Cardon has reportedly decided that due to the burden of responding to Congressional oversight requests, they will return the grant money they received ($800,000) and cease assisting in explaining Obamacare in Florida, Oklahoma, Utah, and Pennsylvania.

Mental Health America

The Mental Health America Navigator Initiative will target underserved individuals with behavioral health disorders who are uninsured or underinsured. The National Office of Mental Health America (MHA) will serve as the lead agency in the Initiative. The Mental Health America of East Central Florida (MHAECF) will serve Brevard, Flagler, Orange, Putnam, St. Johns, and Volusia counties in Florida.

Who you can contact for more help

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know  with the form below and we’ll get right back to you.

[contact-form-7 id=”73″ title=”Contact form 1″]

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Accountable Care Organizations in Florida

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

Health care facilities where Innovation Models are being tested

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Florida

In December 2012, Governor Rick Scott (R) announced that Florida would not be pursuing efforts to implement a state-based health insurance exchange.1 Governor Scott has been a vocal opponent of federal health reform and the state has refused multiple funding opportunities available through the Affordable Care Act (ACA).2 Florida was also the lead plaintiff in a lawsuit brought by 26 states seeking to declare parts of federal health reform unconstitutional.3

At the same time, Florida has been proceeding with an initiative, Florida Health Choices, to create a new marketplace for small businesses that predates the passage of federal health reform.4,5The initiative, begun in 2008 with the enactment of SB 2534, will include a web portal where employers with 50 or fewer employees and some individuals, such as state retirees, can shop for health plans offered in their county.6,7 The state provided a one-time appropriation of $1.5 million for start-up funding, with on-going support provided through a fee of 2% of the premium for every policy sold through the marketplace paid by participating health plans and a $300 annual payment from agents who sell policies through the marketplace. Florida Health Choices has appointed a Board of Directors, hired staff, and appointed two steering committees to advise the Board- one for vendors and another for agents. In May of 2012, Florida Health Choices identified a third party administrator to provide a web portal, online plan selection tools, and a statewide customer contact center.8 In September 2012, the state began beta testing the web portal.9 Florida Health Choices does not currently comply with provisions in the ACA, such as providing subsidies to assist eligible low-income individuals with purchasing insurance or mandating that health plans sold through the exchange cover certain health benefits.

In 2011, the Governor signed HB 97/SB 1414, which prohibits coverage of abortions when insurance is purchased through an exchange using state or federal funds, except in cases of rape, incest, or life endangerment of the pregnant woman.10 The legislation allows health insurance policies to offer separate coverage for abortions not purchased with state or federal funds.

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Florida has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Florida- BlueOptions, PPO.

Exchange Funding

Florida’s Agency for Health Care Administration received a federal Exchange Planning grant of $1 million in 2010, but has since returned the grant.11

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Florida has not authorized its participation in Medicaid expansion. They are leaning toward not accepting.

Next Steps

The federal government will assume full responsibility for running a health insurance exchange in Florida beginning in 2014.


1. Young, Jeffrey. “Obamacare: Florida GOP Gov. Rick Scott Won’t Implement health Care Reform.” HuffingtonPost. December 14, 2012. http://www.huffingtonpost.com/2012/12/13/obamacare
2. “Florida Shuns Funds Tied to Health Care Reform.” Florida Today. March 26, 2012.http://www.wtsp.com/news/article/247143/19/Florida-shuns-funds-tied-to-health-care-reform
3. Baribeau S. “Florida’s Scott May Press for U.S. Health Aid.” Bloomberg. August 9, 2011.http://www.bloomberg.com/news/2011-08-09/florida-s-scott-may-press-for-u-s-health-aid.html
4. Scott, Rick. “ObamaCare: One Year Too Many.” http://www.flgov.com/2012/01/03/obamacare-one-year-too-many/
5. Galewitz P. “Florida to Launch Its Own Health Insurance Marketplace.” The Washington Post. October 8, 2011.http://www.washingtonpost.com/national/health-science/florida-to-launch-its-own-health-insurance-marketplace/2011/10/07/gIQA1Ns8VL_story.html
6. SB 2534 (Chapter 2008-32). Florida act related to health insurance and Cover Florida Health Care Access Program. 2008. http://laws.flrules.org/files/Ch_2008-032.pdf
7. See: http://myfloridachoices.org/about/
8. Florida Health Choices Names Xerox as Program Administrator.” May 2012. Health Choices.http://myfloridachoices.org/florida-health-choices-names-xerox-as-program-administrator/
9. See Florida Health Choices: https://www.floridahealthchoices.com/
10. HB 97/SB 1414 (Chapter 2011-11). Florida’s 2011 act related to health insurance.http://laws.flrules.org/files/Ch_2011-111.pdf
11. Baribeau S. “Florida’s Scott May Press for U.S. Health Aid.” Bloomberg. August 9, 2011.http://www.bloomberg.com/news/2011-08-09/florida-s-scott-may-press-for-u-s-health-aid.html

Also of interest

Provided by the Henry J. Kaiser Family Foundation