The best health insurance in Florida

You may have researched Florida health insurance before and ended up running away because of the costly premiums and deductibles. And indeed, you come in search of the best and cheapest medical plans in Florida.

Many companies provide health insurance services, some more affordable for you. So you can enjoy coverage for yourself and your family. 

First of all, we explain how health insurance works in Florida, what it covers, and what it doesn’t, so you can understand why we present these companies as the best health insurance in Florida.

What is health insurance? 

You may already know this, but it’s okay to clear it up before we go any further. 

Health insurance, medical plan, or medical insurance offers total or partial coverage on the expenses related to health incurred, according to the policy or program you have purchased. 

Health insurance is not mandatory. Unlike others, however, it is essential to have health insurance to be prepared for any medical contingency that you have to face at any given time.

Health insurance, like most insurance, has fixed periodic payments to the insurance company as established in the policy. These are part of the so-called insurance premium.

On the other hand, the insurance company is obliged to cover all or part of the costs for medical care under what is known as the “deductible.”  

The most common is that the insurance company partially covers the expenses resulting from medical care after you have met your deductible.

The deductible is the amount of money you have to spend before the policy takes effect and covers the expenses.

After you meet that deductible amount, all you’ll have to pay is coinsurance (it’s a small percentage of your care costs). 

What are the deductibles and coinsurance of health plans in Florida?

Suppose your deductible is US$4,000. You will have to spend $4,000 on your health and medical care before the insurance starts to cover.

If you have 15% coinsurance, your insurance will pay 85% of medical expenses after meeting the deductible. You must deliver the remaining 15%.

Average Cost of Health Insurance in Florida

For those with an individual plan, the average monthly health insurance premium for those living in Florida is $393.

You must be clear that this amount is variable and will depend on your policy, which consists of several factors. It can influence whether you are a smoker to the type of plan you choose.

Types of medical coverage

The type of health insurance plan you choose is one of the most critical points in defining how much you will end up paying.

There are many types of plans when it comes to health insurance. The three most common types of health plans are HMO, PPO, and POS.

HMO Plan or Health Maintenance Organization

This is one of the cheapest plans, but they do not give freedom when choosing who will provide medical care. If not, for those who are in the network, to go to specialists, you have to get a referral. 

In other words, with the HMO insurance plan, you can go only to doctors, specialists, and providers that are part of the organization.

PPO Plan or Preferred Provider Organization

The PPO plan can generally be more expensive than an HMO or POS.

With the PPO, you will have at your disposal a vast network of doctors and hospitals from which you can choose. But it does not mean that it is mandatory or restrictive, as in the case of HMOs.

If you choose to seek care from out-of-network providers, you will have to pay an additional fee. But you do not need a prior referral to see a specialist.

POS Plan or Point of Service Plan

You can see POS plans as a mix between HMO and PPO medical plans. 

Since they do not restrict you from going to doctors, hospitals, or other health service providers outside the plan’s network as in the PPO, although for lower rates. 

But on the other hand, you need the referral to see a specialist, as with HMO plans.

What does health insurance cover?

Before, it was complicated to compare insurance plans because of the variety of companies and what each one included or did not include, as well as how much they charged.

As of the Patient Protection and Affordable Care Act ( ACA ) entry into force, “10 essential benefits” were included that must be part of the policies, ” which managed to standardize the services and allow a better comparison.

Of course, you should know that the policies may include better or more excellent benefits, but this is what health insurance in Florida covers from a fundamental and essential point of view.

Best Health Insurance in Florida – 10 Essential Benefits

• Outpatient Service: Must include outpatient care received outside of a hospital.
• Emergency service: It is mandatory to have emergency care at any hospital, also those outside the network.

They cannot require you to contact the hospital before receiving emergency care. If there is an emergency, you should go to the nearest hospital.

• Hospitalization: Must include overnight stays, as well as medications that are prescribed and administered by doctors or nurses, as well as surgeries. 
• Pregnancy, maternity, and newborn care: Includes care given before, during, and after pregnancy. As well as any complications that may occur in labor and pregnancy. 
• Mental health and substance use treatment: Another essential service included in health insurance is coverage for behavioral therapies, inpatient mental health services, and treatment for substance use. May not have annual or lifetime limits on treatment for particular substance use disorders or problems.
• Prescription Drugs – Although health insurance companies cannot avoid covering prescription drugs, they may require you to use less expensive generic treatments before using more expensive and potentially habit-forming ones. It is called: “step therapy.”

Other Essential Florida Health Insurance Benefits

• Rehabilitation Services and Devices include physical therapy, occupational therapy, and mobility devices. 
• Laboratory Service: Refers to outpatient blood tests and images you receive at medical centers or hospitals (x-rays).
• Preventive Service and Wellness Exams include physical exams, immunizations, and booster shots. Some health insurance plans provide this service for free.
• Pediatric service: health, vision, and dental services for children must be included in your plan. However, vision and dental services are not required in the ACA for adults.

It is usually possible to purchase additional services with your provider for your policy. 

And if you are a woman:

• Breastfeeding support: Advice and equipment for breastfeeding mothers should be included.
• Birth control: to comply with the obligations indicated by the ACA, contraceptive methods that the FDA has approved must be included. 

Although emergency contraceptives are included, those medications whose purpose is to interrupt already viable pregnancies are not part of this. 

ACA- compliant plans must include FDA -approved birth control methods. This includes emergency contraception but does not include drugs intended to terminate an already viable pregnancy.

If an employer provides the insurance, the employer may exclude some contraceptives if your work involves temples or nonprofit religious organizations.

What does health insurance not cover? 

Here’s what Florida health insurance plans generally don’t cover: 

• Male birth control: Methods such as barrier or vasectomy are not included because they are not considered an essential benefit. 
• Travel vaccinations: there is only an obligation to cover those vaccinations that are routine and necessary. They are considered elective prevention when you go on a trip and are not covered.
• Vision and Dental Coverage – Covered only for children. If adults require it, they must add them to their policy, but they are extra.
• Weight loss surgery: Although this is not an essential obligation for health insurance companies, some choose to include it. If you wish, consult before contracting your policy.
• Medical insurance does not cover cosmetic surgeries since they are not considered medically necessary. Unless the treatment you want provides essential benefits, health insurance will not cover it. 

The above are examples of expenses not included in health insurance plans. Contact your insurance company if you have any questions about a specific treatment or service.