Individualized Insurance Solutions
Insurance Needs
Under the Affordable Care Act (ACA), all health insurance plans offered by the Health Marketplace must cover a set of essential health benefits. These include:
ACA offer coverage for routinary annual wellness check, including:
- Vaccines
- Screenings
- Wellness visits
- Other preventive services at no additional cost to the insured.
Covers a partial cost of hospital stays, including:
- Ambulance
- Admissions
- Surgeries
- Other necessary medical treatments administered at the hospital.
Coverage for emergency services without requiring prior authorization and regardless of whether the care is received out-of-network.
- Urgent Care coverage available in-network.
Coverage for:
- Medical consultations.
- Outpatient care, and treatments that do not require hospitalization.
- laboratory tests necessary for diagnosing and treating medical conditions.
- Imagines (X-Ray, CT scans, MRI’s)
Coverage fo prenatal care, childbirth, and newborn care, such like:
- Pre-natal and post-natal screenings.
- Ultrasound
- Childbirth/delivery professional services.
- Childbirth/delivery facility services.
Coverage for mental health services and substance abuse treatment, offered across both in inpatient and outpatient environments.
Includes therapies and services to help individuals recover from injuries or illnesses, as well as services for those with chronic conditions.
Coverage on a wide range of prescription drugs, including:
- Generic medications.
- Brand named medications.
- Specialty medications.
Coverage for medical care for children, as well as vision and dental services for minors.
Personalized
Protection
- Coverage: Approximately 60% of healthcare costs, with lower monthly premiums but higher costs when receiving care.
- Ideal For: Healthy individuals who prefer lower monthly premiums and are willing to incur higher out-of-pocket costs when they need care.
- Coverage: Approximately 70% of healthcare costs.
- Ideal For: Individuals who want a balance between monthly premiums and costs when receiving care. Additionally, it is the only plan that offers cost-sharing reductions for people with lower incomes.
- Coverage: Approximately 80% of healthcare costs.
- Ideal For: Individuals who need more frequent medical care and prefer to pay higher monthly premiums to lower out-of-pocket costs.
- Coverage: Approximately 90% of healthcare costs, with the highest premiums but very low costs when receiving care.
- Ideal For: Individuals who require ongoing medical care and prefer to pay higher premiums to minimize out-of-pocket costs.
Navigating
Enrollment & Eligibility
One of the key elements of the ACA is the availability of subsidies and tax credits to help Florida residents pay for their health insurance:
- Premium Tax Credits: Available to individuals and families with incomes between 100% and 400% of the federal poverty level (FPL). These credits reduce the monthly premium cost.
- Cost-Sharing Reductions: Available for those who select a Silver plan and have incomes between 100% and 250% of the FPL. This reduces deductibles, copayments, and coinsurance.
An enrollment period for health insurance is a specific time frame during which individuals can sign up for, change, or renew their health insurance plans.
- Open Enrollment Period: It generally takes place at the end of each year and allows Florida residents to enroll in a health insurance plan for the following year.
- Special Enrollment Period: Available under certain circumstances, such as changes in marital status, loss of previous coverage, or moving to a new service area.
To be eligible for a health insurance plan under Obamacare in Florida, you must meet the following requirements:
- Be a U.S. citizen or legal resident.
- Not be incarcerated.
- Not have access to affordable health insurance through an employer.
