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Health Care Reform:

Health Insurance & Affordable Care Act

Florida Health Insurance Marketplace

Who is the Marketplace for?

The Florida Health Insurance Marketplace is where eligible residents can shop for and buy insurance in person, online, or by phone. In Florida, the Marketplace is run by the federal government. The Marketplace, also called an Exchange, is mainly for people who:

  • Don’t have insurance
  • Aren’t insured by their employer
  • Don’t have Medicare
  • Aren’t included in their spouse’s employer insurance
  • Have pre-existing conditions and may have had trouble getting insurance before
  • Have private insurance but want to look at other options
  • Own a small business

The Affordable Care Act required most Americans to sign up for health insurance in 2014. Generally, you don't need to buy insurance through the Marketplace if you are covered by Medicaid, Medicare, TRICARE, or an employer-sponsored plan.

When You Can Enroll:  The next open enrollment period is Nov. 15, 2014, to Feb. 15, 2015. Enroll online at HealthCare.gov or call 800-318-2596. You can also download an enrollment application at HealthCare.gov, or insurance brokers can help you enroll.

If you have a life-changing event -- such as the birth of a child, losing your job, or moving to a new state -- you don't have to wait for the next enrollment period. You can sign up or change coverage within 60 days of the event.

Plans and Costs

Getting Started: You’ll need to provide information about you and your family members when you apply. Here’s a checklist of what you’ll need:

  • Social Security number (or document number if you are a legal immigrant)
  • W-2 forms: Wage and tax statements or pay stubs for all employed members of the household.  For people who are self-employed or do not have a regular salary, include an estimate of household income.
  • Policy numbers of health insurance plans covering any members of the household
  • Immigration/citizenship status
  • Tobacco use

 

Types of Plans: All insurance plans on the Marketplace are sold by private companies or co-ops. They can offer four types of coverage: bronze, silver, gold, and platinum. These “metal level” plans all cover the same kinds of benefits. The difference is how much they pay on average toward the costs of health care services.  Another type of plan is called catastrophic. These have less expensive monthly fees called premiums, but they also offer less coverage. Catastrophic plans are mainly for healthy people under 30.

Go to HealthCare.gov to compare plan costs.

  • Bronze Plan: You pay 40% and the plan pays 60%.
  • Silver Plan: You pay 30% and the plan pays 70%.
  • Gold Plan: You pay 20% and the plan pays 80%.
  • Platinum Plan: You pay 10% and the plan pays 90%.
  • Catastrophic Plan: You pay 100% of a set amount of money called the deductible before the plan's coverage kicks in. Three primary care visits per year and preventive services are covered for free before you meet the deductible.

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