Frequently asked questions about health insurance
coverage options in Florida
Florida uses the federally run health marketplace (exchange), so individuals and families who need to buy their own health coverage use HealthCare.gov to enroll. The marketplace is used by individuals and families who don’t have an option of coverage from an employer or Medicare.
Individual/family health plans are purchased by people who are self-employed, people who have retired prior to age 65 and need to buy their own coverage until they become eligible for Medicare, and by people employed by small businesses that don’t provide health benefits. The marketplace is also the only place Florida residents can get income-based financial assistance with their individual major medical health coverage.
Read our overview of the Florida health insurance marketplace – including news updates and exchange history.
Enrollment options are much more flexible in 2021 than they normally are, due to the ongoing COVID pandemic. Outside of the annual open enrollment period, Florida residents normally need a qualifying event in order to sign up for coverage. But in 2021, there’s a COVID-related enrollment period that continues through August 15.
Florida residents do not need a qualifying event to use this enrollment window, and it’s available to uninsured residents as well as current enrollees who would like to switch to a different marketplace plan. People with off-exchange coverage can also use it to switch to an on-exchange plan, as many of them may be newly eligible for premium subsidies as a result of the American Rescue Plan, and the subsidies are only available through the exchange.
During the open enrollment period for 2021 coverage, 2,120,350 people enrolled in individual market plans through the Florida health insurance marketplace. This was a record high, and the first time that Florida’s marketplace enrollment had surpassed 2 million people.
During the first 2.5 months of the COVID/American Rescue Plan enrollment window in 2021, another 264,088 people enrolled in plans through Florida’s exchange — well over double the normal pace of enrollment at that time of year.
Ten insurers offer plans for 2021 in Florida’s individual market, all of which will offer plans in the exchange. This includes AvMed, which is joining the exchange for the first time (in past years, AvMed has offered plans outside the exchange). Insurer participation in Florida’s exchange also grew for 2020, with Bright Health joining the marketplace, and Cigna rejoining in some areas after exiting the exchange at the end of 2015.
For 2021, Cigna expanded its coverage area again, adding Leon, Lake, Seminole, Orange, Osceola, Broward, Indian River, Martin, and St. Lucie counties to its Florida service area.
For individual-market plans sold in Florida’s exchange, the average rate increase after the state approval process was 0.0 percent for 2020. Although there was variation from one insurer to another, overall premiums (before taking subsidies into account) were flat from 2019 to 2020.
For 2021, average premiums increased by 3.1% in Florida’s individual market.
Although the Sunshine State has not embraced the Affordable Care Act from a legislative standpoint, the healthcare reform law has had some positive impacts there.
Florida’s federally facilitated health insurance exchange has the nation’s highest enrollment numbers, all of whom have coverage for the ACA’s essential health benefits. And nearly 2 million of them are receiving premium subsidies, which make monthly health insurance premiums much more affordable than they would otherwise be.
According to U.S. Census data, Florida’s uninsured rate was 20% in 2013, and had dropped to 12.5% by 2016 (it had risen slightly, to 13%, by 2018, and to 13.2% by 2019, mirroring a nationwide increase in the uninsured rate under the Trump administration).
The national average uninsured rate stood at 9.2% as of 2019, but Florida’s rejection of federal funding to expand Medicaid has locked a significant portion of the population out of coverage. If Florida were to expand Medicaid, the uninsured rate would drop substantially.
Although a growing number of states have since opted to expand coverage, there are a dozen – including Florida – that have taken no action to expand Medicaid eligibility to include low-income, non-elderly, non-disabled adults without children.
Florida’s decision not to expand Medicaid leaves an estimated 415,000 people in the coverage gap, meaning they do not qualify for Medicaid nor are they eligible for tax subsidies to help them afford private health insurance. According to a Robert Wood Johnson Foundation analysis, more than 1.3 million people in Florida would gain Medicaid coverage if the state were to expand coverage, and the uninsured rate would drop by 30%.
Since 2013, monthly Florida CHIP/Medicaid enrollment has increased by just 10% — versus a nationwide average increase of 38%.
Read more about Medicaid expansion in Florida.
Because Florida does not have state regulations for short-term plans, federal regulations apply in the state. Insurers can offer short-term plans with initial terms up to 364 days and the option to renew for a total duration of up to 36 months.
The Florida Health Insurance Advisory Board recommended that lawmakers add a provision to Florida statute to require stronger disclosure language for short-term plans, and a requirement that consumers sign a statement indicating that they have read the disclosure or had it read to them by a salesperson (the recommendation was approved during a December 2019 FHIAB board meeting, to be forwarded to leaders in the Florida House and Senate. But no action has been taken by lawmakers thus-far).
Read more about short-term health coverage in Florida.
As of March 2021, there were more than 4.7 million Florida residents enrolled in Medicare. Most are eligible because they’re at least 65 years of age. But 13% of Florida Medicare beneficiaries are under 65, and are eligible because of a disability that’s lasted at least two years, or ALS, or end-stage renal disease.
Learn more about Medicare enrollment in Florida, including the state’s rules for Medigap plans.
Learn more about the Medicare open enrollment period for Medicare Advantage and Medicare Part D prescription drug plans.
- Florida Consumer Action Network (FCAN)
- Florida Kid Care
- Florida Office of Insurance Regulation — Licenses and regulates health insurance companies, brokers, and agents. Provides information and assistance to consumers who have questions or complaints.
- Medicare Rights Center — A nationwide service (call center and website) that can provide advice and information for Medicare beneficiaries.