The Affordable Care Act gave states the option to create their own website for comparing and buying insurance policies, or using the federal system. The State of Florida has selected to use the federal system, which is called the Federally-Facilitated Marketplace (FFM), otherwise known as the "Marketplace" or "Exchange". To participate with the Marketplace, insurance companies must be a Qualified Health Plan (QHP) approved by the US Department of Health & Human Services (HHS).
Update: Health First's application to be a Qualified Health Plan is currently pending approval.
Starting in October 2013, you will be able to access the Federal Marketplace for Florida website to see what health plans are available in your area, find out if you're eligible for financial assistance to help pay for your plan, get quotes for the cost of each plan, and apply for an insurance policy.
Update: The Affordable Care Act also requires the Marketplace to allow small businesses the opportunity to compare and choose coverage through the Small Business Health Options Program (SHOP). This year, small business will be able to select a carrier and plan but the "Shop and Compare" feature will be delayed until next year.
To choose and buy an individual/family policy, you can:
You can also ask a "Navigator" for help understanding your options. Navigators may be employed by the federal government or an agency that has received grants or funds to help people learn more about healthcare reform and understand their coverage options. In Florida, Navigators are not licensed to sell insurance policies-they can only help you understand the benefits and the trade-offs of the coverage being offered.
Also, since some employers may drop group health coverage from their employee benefits package, they may offer educational sessions to help employees transition to individual/family coverage.
While healthcare reform brings new requirements (or a "mandate") for all American citizens and legal residents to have health insurance, it also makes it easier for more people to get coverage, regardless of their medical history.
Beginning January 1, 2014, anyone (children and adults) with pre-existing conditions cannot be denied coverage, or charged higher premiums because of their medical history. You also cannot be charged more because of your gender. Premiums will only be based on these four factors:
Effective January 1, 2014, all individual/family health plans and those sold to small businesses must include a complete package of "essential health benefits":
Also, preventive services are covered 100% with no cost share (you don't have to pay any copay, coinsurance, or meet a deductible before the service is covered). These benefits include:
Lifetime coverage limits were eliminated in 2012, and in 2014 annual dollar limits will go away.
To help people do an "apples-to-apples" comparison and choose their coverage more easily, policies sold through the Marketplace will have standardized plan names, essential benefits (listed above), and coverage levels:
Catastrophic plans with limited coverage are also available for individuals aged 21-30 who can prove financial hardship.
Some insurance companies, including Health First, may have additional plans available for sale outside of the Marketplace, and may also add extra benefits above and beyond what is required.
If you do not currently have coverage, you can enroll in a new plan during the Annual Open Enrollment Period-October 1 to December 15, 2013-and your coverage will be effective on January 1, 2014. You can also enroll between January 1 and March 31, 2014, and your coverage would begin the first or second month after you enrollment information is submitted and approved.
If you currently have coverage, that coverage may affect when you can enroll in a new plan. Most policies are in effect for one year, so if you have coverage that began sometime during 2013 and want to keep it until it ends, you can. If you don't want to keep it, you can review the plans on the Federal Marketplace for Florida and select a plan that starts on January 1, 2014. If you choose to stay enrolled in your current plan you will be eligible to enroll in a new plan on the anniversary of your coverage renewal. Whatever you decide, your future coverage will renew and be updated effective on January 1 of each year based on choices you are able to make during the annual open enrollment period (October through December).
There are also other special circumstances that may allow you to enroll other times during the year, for example:
Most people want to have health insurance, but simply can't afford it. And they worry about paying a penalty if they don't buy insurance next year.
One of the biggest parts of healthcare reform is financial assistance to help make insurance more affordable for people who earn up to 400% of the Federal Poverty Level (FPL).
You may also qualify for tax credits if you have an employer-sponsored plan and the cost for employee-only coverage exceeds 9.5 percent of your income.
The discount that helps cover the cost of premiums is called the Advance Payments of the Premium Tax Credit (APTC), and the Cost Sharing Reduction (CSR) helps reduce out-of-pocket costs.
Remember: You must use the Marketplace to see if you qualify for financial assistance, and if you do qualify, you must buy your policy through the Marketplace.
People eligible for public health coverage or Medicaid are not eligible for APTCs.