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Florida Health Insurance Program

Sometimes economic times or life circumstances make it difficult to find affordable Florida health insurance programs that offer adequate coverage. For residents of the state, the FL health insurance program that offers assistance is called Cover Florida Health Care Access Program. This program is advertised as a practical solution to the normally high cost of health care coverage.

Cover Florida helps the estimated 3.9 million people in Florida who do not have health insurance. It was started in 2008 by the governor of Florida and since then has helped many Floridians gain access to adequate, quality health care. Following are some of the basics of Cover Florida that can help you decide if the program is right for you and your family.

The History Of Cover Florida

You might be wondering how the state government offers insurance through Cover Florida. Once the program was approved, the state opened bidding to any insurance company that was licensed to sell in the state. The bidding process lasted four months and each bid was reviewed by a health care committee as well as the governor’s office. After the four months, six insurance companies were chosen to offer insurance through Cover Florida. This is a voluntary plan for both individuals and companies so no tax money is spent.

Each insurance company individually speaks with those interested in this type of coverage to see if they qualify and all communication is between the company and the potential customer. The state government is not involved other than to regulate the companies and handle any complaints that may occur. Each company can answer questions about individual plans.

Companies Involved In Cover Florida

The companies that provide coverage through Cover Florida are Blue Cross Blue Shield of Florida, United Healthcare, Medica Health Plans of Florida, Total Health Choice, Florida Health Care Plans, and JMH Health Plan. Which company you can choose from is based on what county you live in. Not every company offers coverage in every county because of the location of in-network providers.

Plans Offered

Cover Florida offer 27 different plans. Each one has different co-pays, premium rates, deductibles, and more. Coverage rates range from about $83 per month to $313 per month. Rates are based on age and gender. Anyone ages 19-64 who has been without insurance for six months or more is eligible as well as anyone who is recently unemployed from a job that provided health care or recently divorced from or widowed from the main health insurance carrier in the family. Pre-existing health conditions do not affect coverage.

Preventive coverage is offered for both individuals and groups (through employers). Preventive coverage plans have a $0 deductible and offer up to $500,000 in medical benefits over a lifetime. They also offer $10 co-pays for doctor visits up to $450 per year. For preventive care, there is no co pay and 1 yearly exam, mammograms, 1 year OB/GYN exam, and cancer screenings for cervical, prostate, and colorectal are covered. For outpatient procedures, the plan covers 100% of the cost up to $600 per year.

Preventive care coverage also offers a $10 co pay for each generic prescription. Also covered are durable medical equipment, behavioral health, and diabetic supplies in varying amounts. Since it is a preventive care plan, inpatient hospital services and emergency services are not covered. The coverage is the same whether you are an individual or are getting this coverage through a group plan.

The other type of plan that is offered is Catastrophic Coverage for both groups and individuals. Catastrophic plans have a $500 deductible and up to $500,000 in medical benefits over a lifetime. Doctor’s visits have a $20 co pay up to $1,000 a year. For preventive care procedures, that same coverage applies as with the preventive plan.

Since the plan is catastrophic, both inpatient and outpatient hospital services are covered. For inpatient services, 10 days in the hospital per year is covered up to $2,000 per day. Outpatient coverage is $600 per year for preventive procedures and $400 per year for non-preventive care. For hospital care, you have the choice of in network or out of network providers, but out of network will cost you more out of pocket.

Emergency coverage is up to $1,500 per year. For accidents, trauma, stroke, and heart attack, 80% of charges are covered. After a $100 co-pay, ambulance services up to $500 per year are offered. Prescription drugs costs are $10 per generic prescription up to $500 per year. Other services include durable medical equipment, diagnostic services, behavioral health, and diabetic supplies each with their own limits.

Coverage For Children

Since kids under the age of 19 do not qualify for coverage under Cover Florida, they are typically referred to Florida Kid Care. This program is for children under the age of 18 who need coverage and whose parents meet certain income eligibility requirements. This program covers mental health, dental health, vision, hearing, emergencies, prescriptions, surgery, hospitalization, check-ups, shots, and doctor visits. Unlike Cover Florida, it is a state run plan that used tax payer dollars.

Coverage For Employers

Cover Florida offers business owners and companies an affordable option for health care through their group coverage options discussed above. It is completely voluntary as to how much an employer contributes. Employers can decide to contribute none, some or all of the cost of these plans for employees and their dependents.

Contributing is a tax deduction for employers as well. Since the plans are essentially individual plans, they can be transferred to a new employer if an employee quits or transfers. This can be done without any loss of coverage or COBRA involvement. As an employee, your contribution towards you premium, deductibles, co pays, and prescription costs can be paid with pre-tax dollars or can be deducted at tax time.

Deciding If Cover Florida Works For You

Deciding if Cover Florida works for you is an important decision. If you meet the eligibility requirements, it may be the plan for you. Just be aware, that is it probably not ideal in terms of amounts of coverage.

You can use the comparison tool on this page right now to compare rates and quotes from top companies. Seeing rates and quotes side by side will let you know what different companies have to offer. It will give you a better idea, if Cover Florida is the right choice. If you have any more questions, you can contact one of our independent agents to answer them for you.

You don’t have to go with out Florida health insurance because of circumstances or your financial situation. You can find a plan that works for you giving you the right coverage at the right price. Why not start now by typing your zip code into the box above?