Florida Health Insurance

Our goal is to make Florida health insurance understandable by explaining how these coverages differ. We do not currently offer health insurance through our office, but we have provided the following information as a reference for our clients. You can also get online quotes by visiting our quoting page.

*The two most popular forms of health insurance are traditional and managed care insurance.


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What is traditional health insurance?


What is managed care?


What additional coverages might protect me?


What is a health savings account?


What is group health insurance?


What is COBRA?


How can I save money on my Florida health insurance?


What is traditional health insurance?

Traditional health insurance is typically made up of basic medical insurance or major medical insurance.

Basic Medical Insurance

Basic medical insurance usually pays a portion of your medical expenses. Generally the carrier will offer a fixed maximum payment for reasonable and customary medical expenses. You will normally be offered a fixed amount of coverage for a doctor visit or hospital room and board. It may also pay a specified limit for operating room expenses, tests, and x-rays. Several plan options will generally be offered. The least expensive policies will offer lower coverage limits while a more expensive plan will pay more for each of the covered expenses. Review these plans very carefully to make sure you are getting protection for all the coverages you want.

These plans generally pay from the first dollar of the medical expense and do not have deductibles or copayments. For example, a basic medical insurance plan may pay $30 toward a doctor visit, or if you are hospitalized it may pay $150 a day for your room and board. You will typically be able to choose the limit of coverage for the covered expenses. Of course the higher coverage amounts you purchase, the higher your premium will be.

Major Medical Insurance

Major medical insurance protects against the high cost of hospitalization due to a serious injury or illness. A major medical insurance policy will cost more than a basic insurance policy. A major medical plan will generally require you to meet an established deductible before the carrier begins to pay. Deductibles typically range from $1,000 to $5,000. After you meet your deductibles most carriers will pay 80% of your medical expenses (this is called a copay), while some carriers will pay 100% after your deductible is met. Make sure you know what your copayment is, if any. Between the deductible and copayment the carrier will offer a maximum out of pocket expense on your plan.

A major medical plan may work like this; you are hospitalized and your bill is $20,000. You are required to pay your deductible of $1,000 in this case. This leaves $19,000 remaining. After your deductible is met you have a copayment of 20% (of the first $10,000) or, in this case, $2,000. And the insurer would pay the remaining 80% or $17,00 difference. Your maximum out of pocket expense in this example is $3,000 leaving the insurer responsible for the remaining $17,000.

You will generally pay for your doctor visits out of pocket since the cost is less than your $1,000 deductible. That is, of course, unless your annual deductible has already been met.

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What is managed care?

Managed care generally involves 2 types of insurance:

Health Maintenance Organizations (HMOs)

In an HMO you pay a fixed monthly dollar amount in exchange for health care services (similar to an insurance premium). Generally you would have a predetermined amount that you are required to pay for doctor visits, emergency room visits, and prescription drugs. The HMO settles up the rest of the payment with the provider you have chosen. You must use providers within the HMO network.

Preferred Provider Organizations (PPOs)

A PPO is also made up of a network of providers. These providers contract with traditional insurance companies and agree to charge lower fees for their services. You will generally pay a higher monthly fee for a PPO plan, but you have more freedom in choosing the providers who care for you.

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What additional coverages might protect me?

There are additional supplemental health insurance policies available. These include:

  • Hospital Indemnity. This pays a certain amount each day you are in the hospital. Generally amounts range from $100-$1,000 a day. The premium you are charged is based largely on the coverage amount you select. These policies are fairly inexpensive.
  • Disability Income. In the event your injury or illness causes you to miss work, this policy will pay a percentage of your income while you are out. The policy can be purchased for a certain period of time from 3 months to 5 years or a lifetime. The rates will be determined by the risk of your job, how long you want coverage to be available, and how soon you want benefits to start.
  • Accidental Death or Dismemberment. This policy pays a fixed amount in the event of your death, much like a life insurance policy, but only if your death is accidental. It also pays a lower scaled amount if you are dismembered, depending on the severity. These policies are generally very inexpensive because they will only trigger coverage in certain named accidental situations.
  • Long Term CAre. This is a policy everyone should consider. People save money all their lives, only to see it all dwindle away to pay for long term nursing home or in home care. This affects 50% of the population, so the odds are it will affect you. Medicare can only help with these expense in the event you have exhausted all your personal assets such as savings, home, cars, etc. A long term care policy pays a fixed limit each month and allows you the flexibility of choosing where you want to stay. Medicare, on the other hand, dictates where you stay if they are funding your care. This program is very underated, but so important. Rates are based on age, so the early you start one of these policies the better.

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What is a health savings account?

A health savings account is a tax free savings plan that can be used to pay for qualified medical expenses. It works like a traditional plan in that you choose a deductible from $1,000 or more. This would be your annual out of pocket expense for your medical expenses. You pay a premium each month and part of that premium is deposited into the savings account portion of your policy. This is set up by your insurance carrier.

For example, if your premium is say $400 a month, maybe $80 of that is applied to your savings account. At the end of the year you have $960 plus interest in your health savings account. Funds from this account can be used to pay for things such as doctor visits, prescriptions, and other qualified medical expenses. You may also use this money to pay for your deductible when it applies. The tax benefits make this a very smart option for healthcare coverage.

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What is group health insurance?

A group plan is generally offered by businesses to their employees. These plans are a guaranteed issue plan in which you automatically qualify simply because you are an employee of that company. This is helpful for people with pre-existing conditions that may not be able to obtain coverage elsewhere. Typically these plans will cover doctor visits or prescriptions for a small copayment, say $15-$35. You also have access to major medical coverage with a specified deductible of $100 or more.

It is advisable to consider this plan if it is available to you. There are several reasons:

  • You qualify for coverage automatically.
  • Your out of pocket expense, for the monthly premium, is generally less expensive because an employer often pays a portion of your premium under the plan.
  • Your out of pocket expenses for treatment and prescriptions are generally less expensive under these plans.

A drawback to these plans is that they are not portable. Leave your employer and you lose your coverage.

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What is COBRA?

As mentioned above, if you were covered under a group plan and you lose your job you lose your health insurance. COBRA allows you to continue your group coverage for a limited time until you find replacement coverage. You should be offered a continuation of benefits. You have 60 days to accept or lose all benefits.

  • This plan will be more expensive as you are now paying 100% of the premium with no subsidy from your employer.
  • This provides an extension of coverage for an additional 18 months to a maximum of 36 months.
  • Currently, in Florida, you have the option of converting your coverage to an individual policy without the requirement of a physical examination to qualify.

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How can I save money on my Florida health insurance?

  • The best way to save money on your health insurance in Florida is to get quotes from an expert. We have access to top Florida health insurance companies and shop all their rates to see who has the best offer. We know what factors will get you the best rates. Get a quote now!
  • Tobacco use will affect the premium you pay for your health insurance.
  • A higher deductible will lower your monthly premium. This is an important consideration. Most people want the lowest deductible they can possibly get, thinking that this will save them money if something happens. Let’s look at an example. If you are paying $500 a month for health insurance, so that you can go to the doctor for $25 out of pocket, it may be a relief to know you wouldn’t have to pay any more than that if you need medical care. However, if you have a $1,000 deductible for doctor visits, this might lower your monthly premium cost to $300. That means each year you would save $2,400 on your monthly premiums. Saving $2,400 each and every year means even if you have to pay out your maximum deductible of $1,000 each year, your still saving $1,400 every year. Ask yourself, how many times do I go to the doctor each year? Is it worth the extra premium each month to pay for doctor visits, or would it be better to pay those expenses out of pocket to save money on my premiums?

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Disclaimer: This is only an example of how coverage could apply and does not represent any guarantee of coverage. This site contains general information relating to Florida health insurance and is not intended to be a substitute for the law.

 

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