Best Health Insurance in Florida • Open Enrollment & Short Term Plans

4. Cigna Health Insurance Florida

Cigna’s health care plans are affordable and include all ACA-compliant benefits. Four out of 5 people who choose a Cigna plan qualify for some sort of federal subsidy to lower their premium.

Cigna plans include free preventive care — you’ll pay nothing for medically necessary vaccinations, health screenings and even some preventive prescription drugs.

You can even unlock discounts on gym memberships, health clubs and more to help you maintain your health.

5. Pivot Health Insurance Florida

Uninsured and living in Florida? Hesitant about buying an ACA plan or need coverage in between enrollment periods. A short-term health insurance plan from Pivot Health may be your answer.

With a short-term health insurance plan, there are both pros and cons. A major pro is affordability — many temporary plans have cheaper premiums than regular coverage. But this type of coverage isn’t ACA-compliant, meaning these plans may offer less coverage, less benefits and lower annual maximums.

If you lost your job and benefits, or recently retired and have a gap between now and your Medicare coverage, this type of plan may be a solid alternative for you. The same goes for recent Florida transplants from another state, young adults whose parental coverage recently ended and so forth. Before you buy, there are some things to consider when it comes to temporary health insurance in Florida.

• Short-term policy terms range from 30 to 364 days in the Sunshine State
• You can renew your plan up to 36 months
• You can buy at any time — there’s no enrollment periods
• With Pivot Health, you can get coverage as soon as the next day after applying
• No network restrictions

Types of Health Insurance Plans

There are multiple types of health insurance plans. The type of plan you choose will dictate how much you pay, whether you need a referral to see a specialist and which health care providers you may see. Let’s go over the 3 most common types of health insurance plans: HMOs, PPOs and POS plans.

• Health maintenance organization (HMO) plans: HMO plans require that you only see doctors, specialists and care providers within the organization’s network. You cannot see any health care providers outside of the network and you must get a referral to see a specialist. HMOs are the most affordable type of plan, but they give you the least amount of freedom to choose which care providers you see.
• Preferred provider organization (PPO) plans: PPO plans offer a network of doctors and specialists but do not require that you see them. You’ll pay an additional fee if you see a health care provider outside of your network. You don’t need a referral to see a specialist with a PPO plan. PPO plans are usually more expensive than HMO plans.
• Point-of-service (POS) plans: POS plans are a mix between an HMO and a PPO. You can see doctors and specialists out of your network with a POS plan — like a PPO. However, you’ll still need a doctor’s referral to see a specialist like you would with an HMO. POS plans can allow you to see the care providers you want with lower rates than PPOs. 

Short-Term Health Insurance Florida

Federal regulations regarding short-term temporary health insurance apply in Florida as they do not have state regulations on this matter.

This means that insurers can offer plans with terms of 364 days or less with up to 3 renewals totaling 36 months. Short-terms health insurance plans are not considered ACA-compliant and therefore may not offer the same benefits and coverage. Be sure to do your research before signing up for a temporary health insurance plan.

Florida Health Insurance Marketplace

Florida doesn’t have its own state marketplace and relies on the federally run Affordable Care Act (ACA) marketplace. Typically, using the marketplace and enrolling through Healthcare.gov is best for those who don’t have employer-sponsored coverage, such as the self-employed, retired people who aren’t eligible for Medicare or low income residents looking for financial support for their individual health insurance.

As of 2021, more than 2 million people are enrolled in coverage through the Florida health insurance marketplace during Open Enrollment and the American Rescue Plan Special Enrollment Period, which was enacted in response to the COVID-19 pandemic.

What are Open Enrollment Dates for Florida Marketplace Coverage?

• Open Enrollment begins Monday, November 1
• Must enroll by December 15
• Coverage begins January 1
• If you need coverage for the rest of the year, you may try to enroll through a Special Enrollment Period or apply for Medicaid or the Children’s Health Insurance Program (CHIP)

What Does Health Insurance Cover?

Every health insurance plan could essentially include or exclude any type of coverage they wanted before the introduction of the Affordable Care Act’s (ACA). This made it incredibly tedious to compare plans because there was little standard of coverage between dozens of options. Now the ACA dictates that every permanent health insurance plan must include at least the following ten “essential benefits”:

• Ambulatory patient services: This is outpatient care that you receive outside of a hospital.
• Emergency services: Your health insurance provider must cover emergency care at any hospital, regardless of whether the hospital is in-network or not. Similarly, your health insurance provider cannot require you to contact the hospital prior to receiving emergency care. You should visit the closest hospital to you in a true emergency.
• Hospitalization: This includes things like overnight stays and prescription drugs administered by a doctor or nurse as well as surgeries.
• Pregnancy, maternity and newborn care: This includes care before birth and after birth. It also includes labor and pregnancy complications.
• Mental health and substance use treatments: Your health insurance provider must offer coverage for behavioral therapy, inpatient mental health services and treatment for substance use. Your health insurance provider cannot put an annual or lifetime limit on treatment for a particular disorder or substance use issue.
• Prescription drugs: Though health insurance providers cannot exclude coverage for prescription drugs, they may require you to try less expensive generic treatments before going onto more expensive or habit-forming medications. This is called “step therapy.”
• Rehabilitative services and devices: This includes things like physical therapy, occupational therapy and mobility devices.
• Laboratory services: This includes both outpatient bloodwork and imaging that you receive in a medical facility or hospital (like x-rays or upper GI scans).
• Preventive services and wellness screenings: This includes things like physicals, vaccinations and booster shots. Many health insurance plan providers offer these services for free.
• Pediatric services: Health insurance plan providers must offer health, vision and dental services to children on your plan. However, vision and dental benefits aren’t ACA requirements for adult plans. You may be able to purchase add-on plans through your insurance provider.

Your plan must also include the following benefits for women:

• Breastfeeding support: This includes counseling and equipment for nursing mothers.
• Birth control: ACA-compliant plans must include prescribed FDA-approved contraceptive methods. This includes emergency contraceptives but does not include drugs intended to terminate an already viable pregnancy.

Your employer may be exempt from covering certain contraceptives if you work for a house of worship or a religious non-profit. 

What Does Health Insurance Not Cover? 

Most health insurance plans don’t cover the following benefits:

• Male birth control: Barrier methods and vasectomies are not covered under most plans because only female birth control is considered an essential benefit.
• Travel vaccinations: Your insurance provider must cover routine, medically necessary vaccinations only. Travel vaccinations are usually seen as elective prevention and not covered under most plans.
• Vision and dental coverages: Insurance providers are only required to cover these services for children on your plan. If you want adult coverage, consider buying an add-on plan.
• Weight loss surgery: There is no federal mandate that requires insurance providers to cover bariatric surgery. However, many insurance providers elect to include this coverage. If you or someone on your plan may need bariatric surgery, be sure to consult your representative and make sure it’s covered before you enroll.
• Cosmetic surgery: No type of health insurance plan covers cosmetic surgery because these procedures aren’t medically necessary. 

Unless a particular treatment is an essential benefit, most insurance providers won’t cover it. These are just a few examples of treatments and services that aren’t usually covered. If you’re concerned about coverage for a particular treatment or service, contact your health insurance provider and inquire about it.

Protect Your Health Affordably 

Choosing a health insurance plan prior to the ACA meant endlessly comparing plans and reading about what’s covered and what isn’t. Now, permanent health insurance plans must offer at least the ACA’s 10 minimum essential benefits. However, this regulation only applies to ACA-compliant plans. Make sure you thoroughly read what’s covered and what isn’t before you choose a short term health insurance plan or a gap coverage plan. 

Frequently Asked Questions