Health Saver Plus – Affordable Health Insurance Coverage in Florida for Those Under 65

If you qualify for a subsidy through Healthcare.gov (Obama-Care) you may be able to get coverage for little or no premium. This is determined by your income, age, whether you are married or single, have dependents, etc… Unfortunately, although you may be able to get coverage for very little, you need to make sure that you have the access that you need, in terms of providers (network strength) for the coverage you may purchase. If you income subsidy is a large one, you may qualify for cost-share reduction on Silver Plans through Helathcare.gov. With cost share reduction, your deductible and co pays will be lower than they would be on Bronze, Gold or Platinum plans.

Florida Blue offers three types of plans on Healthcare.gov. The offer the Select, My Blue and Blue Options. Blue Options is typically the most expensive and also has the largest network. With these plans, PPO options are not available but rather EPO’s. EPO’s are similar to PPO’s in terms of you don’t need referral to see Specialists. The major difference between with an EPO and a PPO is that with EPO’s you need to stay in-network (the exception is an emergency) and with PPO’s you are covered both in and out of network (out of network will cost more) I feel that Florid Blue does not offer very attractive health plans in Florida. Additionally, unless you are getting a substantial subsidy, the plans are very expensive with huge deductibles. Some annual deductibles are over $9000.00 and for a family over $18,000.00.

Most people who are not employed get their health coverage through the Marketplace (Healthcare.gov). If their income is low enough they will qualify for subsidy which offset the cost of some or all of the premium. If you have children and are receiving a subsidy, your children may have to get their insurance through CHIP (Children Health Insurance Plan) or through Medicaid.

If you do not have health insurance for you or your family, you are assuming great financial risk. The risk of accumulating g huge medical bills that you may not be able to pay back. This can have a major negative impact on your credit score and may drive you to bankruptcy, doctors and hospitals want to be paid just like any other business or profession. There are many people in the US that can afford to have insurance and don’t. They are jeopardizing their financial futures. In my opinion it’s an unnecessary risk. Although hospitals are not allowed to refuse you care, they need to be compensated for their work. For those who have resource es you’re likely to be sued for unpaid medical bills and may even have your wages garnished.

When you pay more for insurance in terms of premium, you generally receive better coverage. Better coverage means a lower deductible, lower co pays and probably a better overall network. When shopping for health insurance you need to find a plan that allows you access you need and a cost you can afford. The more money one has the higher the deductible they should go with. This will keep their premiums lower. The more risk you can assume, the less you will pay. This strategy is generally for someone who is healthy and does not need a lot of continuous care., If you are not in the best of health, it might be better to pay little more because this can lower your copays and deductibles and in then long run you can end up spending less.

The least expensive for of insurance in Florida is through Medicaid. If you don‘t qualify for Medicaid you can still qualify for a subsidy which can offset up to all of you monthly premium to make your health insurance very inexpensive. If you are in a bind, like between jobs or your waiting to, become eligible for group health insurance, an inexpensive option could be short term coverage. However, short term coverage generally does not cover pre-existing conditions.

The least expensive option for health insurance in Florida in 2022 is roughly $180.00 per month. The average cost of health insurance for a resident of Florida would be around $470.00 per month.  Several factors come into play including age, where you reside and your income.

On the Marketplace (Healthcare.gov) the Bronze plans are the least expensive and approximately 60 percent of your costs will be covered. Silver plans are the next least expensive option. Under Silver plans approximately 70% of your healthcare costs would be covered.  The next one would be the Gold Plan. Under Gold plans approximately 80% of your healthcare costs would be covered. Lastly there are Platinum plans. Under Platinum plans approximately 90% of your healthcare costs would be covered.  The way to save money on these plans is if you qualify for a subsidy or “tax credits”. If you’re within 100% to 400% of the poverty level, you will receive a subsidy.

If you have pre-existing conditions Healthcare.gov (the Marketplace) may be your only viable option. Health plans found on the exchange, do not ask any questions about your health history. The only questions they ask is whether you use tobacco. If this is your only option, it might be worth it to get this insurance coverage. Having health coverage can financially protect you in the event of something catastrophic happens to you or someone in your family. With no coverage you can potentially lose everything you have worked for. To get value from your health plan you will need to make sure that your doctors accept the coverage and that your prescriptions are covered affordably.

If you are a single or married with substantial income it can be very expensive to get your health insurance coverage through the Marketplace because you will not receive a subsidy on your coverage and you will have to pay the full retail price. Depending on your age health insurance premiums for people in the late 50’s to early 60’s (pre-Medicare) premiums can easily be $2000.00 a month if not more.

A very solid option outside of Obama Care would be a plan through Philadelphia American (New Era) that offers a substantial fixed indemnity plan that will allow you to see you doctors without penalty, can enroll at anytime throughout the year, and policyholder will receive excess claim dollars mailed to them in the form of a check. The premiums for this type of coverage is approximately 50% less than most non subsidized Obama-Care plans. Another option would be a temporary insurance plan.

There are some companies that offer this and are actually a good fit for someone between jobs or with a few years of Medicare. Both the indemnity option and the temporary insurance option are medically underwritten. They will look at your health history to make sure you are a viable candidate for coverage. Folks with pre-existing conditions are often denied this coverage. If you’re healthy and you can qualify for indemnity coverage or temporary coverage (up to three years for temporary insurance coverage) I would give them serious consideration.

Marketplace plans (ObamaCare) have enrollment periods. The general enrollment period runs from November 1st and runs through January 15.  If you miss this January 15th deadline, in most circumstances you are locked out of enrolling in a plan throughout the year, unless you are eligible for a special election.  The special election periods  stated on Healthcare.gov are:

• Lose Qualifying Health Coverage. This Means If You Lost Your Job And Group Insurance Coverage Through Your Employer, This Would Be Deemed A Loss Of Qualifying Coverage.
• Got Married
• Had A Baby Or Adopted A Child Or Fostered A Child.
• Gained Or Became A Dependent
• Got Divorced Or Legally Separated And Loss Your Health Insurance Coverage.
• Changed Your Residence/Move.
• Had A Qualifying Change In Income.
• Denied Medicaid Of CHIP Coverage.
• Recently Gained Citizenship Or Lawful Presence In The United States.
• Released From Incarceration.
• Employer Offered To Help Me With Then Cost Of Coverage Through A Health Retirement Account (HRA) Or Through A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)
• Member Of A Federally Recognized Tribe Or Alaskan Native Corporation Shareholder.

There are 5 things you should consider when determining what health insurance plan you should go with.

The network: Does the plan you are considering purchasing have a strong provider network. Are your doctors local or are your closest doctors an hour away from where you live. Are the hospital you choose to go to if you get sick your desired facility. If you choose an HMO type plan, you will need referrals to see Specialists. If you choose a PPO, you are covered both in and out of network but out of network will cost more. If you chose an EPO, you would not need referrals, but you will need to stay in-network.

Monthly Premium: Health insurance has to be affordable based on your income. You need to find a plan that fits your budget from a premium standpoint and from the standpoint of deductibles and co-pay amounts. Deductible and co-pay amount have a direct correlation to premium. Generally, the higher the deductible, the lower the premium and vice versa.

Deductibles: Just like I stated in the last paragraph deductible amounts are direct correlated to premium. You need to choose a deductible amount that you can afford.

Copays and Coinsurance: One of the areas that people don’t understand is the term co-insurance. Many plans offer 80/20, 70/30. 90/10 coverage. What this means is that when you reach your deductible, the insurance company will pay the higher number and you will be responsible for the lower amount up to your defined co-insurance limit. If you plan states 100/0, that means once you reach your deductible, everything is paid at 100%. This may include prescriptions, as well. This would depend on whether you have High Deductible Health plan (HDH) or not.

Copays are a benefit that you pay for. Often clients like a defined co-pay for services. If this is important to you, your premiums will higher than if you do not have copays. HDH plans generally do not offer co-pays in their plan offerings. Generally, the premiums are less, as well. If you are small business owner, having a HDH offers tax savings which can offset the cost of the plan in terms of premium. This is generally accomplished by setting up a Health Savings Account. You can contribute set amounts each year. The amount t varies on whether you are single or if you have a family. These contributions to your HAS are tax deductible. I would suggest consulting with a tax advisor before setting this up.

Prescription Coverage: It is imperative that if you are taking prescription medication, that you make sure that your prescriptions are covered under you plans formulary. If your prescription is not on the formulary it may not be covered at this can be an expensive mistake.

Indemnity can be a less expensive option than Obamacare. Generally speaking, indemnity coverage is about half the cost, in terms of monthly premium, than a non-subsidized plan you find through the Marketplace. Indemnity plans allow you get care where you want to. Unlike Obamacare, where you have to enroll during a specified enrollment period, indemnity coverage allows you enroll at anytime throughout the year. With indemnity coverage, just like with anything, you need to understand how it pays and how much it pays for services and procedures.

Philadelphia American offers an Indemnity plan though New Era Life, that has three level of plans. Level 2 and Level 3 plans that you combine with a Specified disease policy, you may have very little financial exposure in most situations and in fact in many situations unused claim dollars are returned to the policyholder in the form of check. Before you get to excite, most Indemnity plans are, medically underwritten. Whereas you must answer health questions on the application and the company will also look at your medical history before issuing coverage. If you are not in good health, it’s unlikely you can get this coverage. Indemnity coverage is only good if it limits your financial risk if you get sick or injured.