It's time for an open enrollment for the Affordable Care Act marketplace, which could be a good option for people who don't get health insurance through their jobs. But open enrollment ends on December 15, so it's time to act. What you pay depends on your income and your age, and for those lower incomes, the price may be little or nothing.
Otherwise, you won't be able to register again until next fall, unless you find a qualifying "life change". Includes loss of job that provides insurance.
What companies offer ACA insurance in Miami-Dade?
These companies provide insurance through the ACA (known as Obamacare) in South Florida:
- Ambetter from Sunshine Health
- Florida Blue (both HMO and EPO plans)
- Molina Marketplace
- Oscar Insurance Co. of Florida
- Bright Health (new for 2021)
- AvMed (new for 2021)
Each insurance company offers options with different coverage plans and discounts, which makes it important to consider your medical needs before choosing. Miami-Dade and Broward residents have 122 plans to choose from this year. Buying ACA can take a lot of work, but we recommend doing your research, especially if you use Medicare a lot.
Florida Blue, the most popular option in South Florida, offers three networks:
- An HMO. This option requires referrals from a primary care physician to see a specialist.
- An EPO (similar to PPO) called BlueSelect. This option has a smaller network but does not require referrals.
- An EPO called BlueOptions. These plans have the largest network but also the most expensive.
Molina and AvMed only offer HMO plans.
Plans are rated from Bronze (lowest premium) to Silver, Gold, and Platinum (highest premium).
If you pay full price for the ACA plan, it's not cheap, but most freelancers have no other good options. What you pay depends on where you live, your income, and your age. If you qualify for a benefit, your cost can be surprisingly small, especially if you are young. Smokers pay twice the rates as non-smokers.
If your family earns less than 400 percent of the poverty level ($ 51,040 per person and $ 104,800 for a family of four), you can get a benefit to help pay for your health insurance. Your income is the adjusted gross income after deductions.
If your income after deduction is less than 250 percent of the poverty level ($ 31,900 for a single person and $ 65,500 for a family of four), you have access to plans with lower copays and deductions. These are called cost-sharing cuts. These plans are good options for people who qualify.
I have been using ACA to purchase my health insurance since it took effect in 2014. As a self-employed of a certain age, I have found it to be the best option, although it is not ideal and it can be costly not to get support.
Who can use ACA in Florida?
The ACA is designed for people who do not receive health insurance from their employers. This includes part-time workers, freelancers, artists like musicians and writers, professionals like real estate agents, lawyers and doctors, the unemployed, casual workers like Uber drivers and construction workers, early retirees who are too young to qualify for Medicare, and any other person. You do not have health insurance provided by your employer.
Anyone who is a U.S. citizen or legal immigrant can purchase insurance on the exchange, but in Florida, which hasn't expanded Medicaid, only those who earn at least $ 12,760 per year qualify for benefits, even if they don't qualify for Medicaid. (Other states have created options for low-income residents who are not eligible for Medicaid, a government-funded program for the poorest Americans. The Florida legislature has chosen to leave these people without assistance.)
Who cannot use ACA or receive benefits?
- Those with employer-provided health care (although there is an exception if the employee's cost is more than 9.56 percent of the employee's income or the plan does not provide a minimum level of coverage).
- Those who receive Medicaid or Medicare or use CHIP or military insurance.
Many other groups can use the exchange but are not eligible for benefits. These include:
- People who do not earn at least poverty level income in states that have not expanded Medicaid, which includes Florida. The legislature can change this, but has chosen not to act.
- Spouses and family members to whom the employer provided insurance, regardless of cost. This is called a "family disorder" because some of these plans are out of reach for everyone.
- People who earn more than 400% of the poverty level.
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