Florida State Health Insurance

Individual health insurance in Florida can be quite expensive. Moreover, if you suffer from certain medical conditions from the onset, you might even be denied coverage.

But with the spate of job losses and layoffs of late and the spiralling cost of healthcare, ignoring health insurance can lead to financial disaster. Without health insurance, you’ll end up paying way more than you should for healthcare, and you will not have access to the best medical care possible.

For the purpose of evaluation of a medical plan, you need to understand how insurance companies evaluate applicants.

If you’ve shopped around for a health insurance plan in Florida, you would have come to know that health insurance providers in Florida (or any other state, for that matter), are looking for only healthy applicants. While you may debate the logic of such a catch-22 stipulation, the truth is that many insurance seekers are rejected outright based on prior health history. Remember that these insurance companies are owned privately by corporations, not the government; they have no liability to provide you coverage. Thus, the heavy sifting process when it comes to coverage.

If you suffer from serious medical conditions such as diabetes, cancer, or any heart conditions, there’s a very high possibility that your application will be declined automatically. Insurance companies, as I’ve said before, are not looking at taking up customers with a high likelihood of medical problems in the immediate future.

If an agent promises you a guaranteed coverage even when you have the above illnesses ticked off on the applicatin form, you can be sure that he is doing that just to collect the advance commission from the company; a good agent will simply not forward your application or make you promises if he sees cancer/heart conditions/diabetes etc. checked off on the list.

Also, consider the time frame of the illness. Suppose you had cancer 13 years ago that was cured and you do not suffer from any lasting ill effects. Although the application form might ask you if you had a serious medical illness (such as cancer) in the past seven years, and you can rightfully say “no” (since you had it 13 years ago and have been treated for it), there is a likelihood that the insurance officer might decline your application upon reviewing your medical history.

What is covered?

You need to consider the kind of coverage offered by your insurance provider. Will you be covered if you move out of Florida? If yes, then who will cover you? What will be your premium?

There are certain well known insurance providers in the state of Florida that will put you up with the lowest cost provider if you happen to be outside your home area of coverage. For this reason, we recommend that whatever plan you pursue, it must include a nationally recognized PPO network. A strong network will help you find at least a participating doctor who can attend to you in case of medical emergencies.

Be sure to read the insurance providers policy very carefully for any riders on the coverage. For instance, some companies do not cover certain procedures during the first six months of coverage. Also, serious medical operations such as organ transplants might be rare, but insurance companies put several limitations on them that can make getting one when required very difficult. For instance, one well known company we know of doesn’t cover organ transplants beyond $100,000 in most of its policies; such a low cap might even disqualify you for a transplant should you require one. Thus, go through the marketing literature very carefully.

What are Deductibles?

Let’s take an example.

Suppose you recently bought a policy with a $3000 deductible. This means that each year, you’ll have to pay for the first $3000 worth of medical expenses before the insurance company steps in.

What is Coinsurance?

Let’s say you have a coinsurance of 70/30 to $10,000.

What this means is that after the deductible (in the above example, $3000), for the next $10,000 worth of medical expenses, the company will pay 70 percent, or $7000, while you’ll have to pay the rest 30%, i.e., $3000.

What are Co-Pays?

Co-Pays applies to doctor visits. If your policy has a $50 co-pay, it means that every time you visit the doctor, you’ll have to pay $50 form your own pocket. This does not include any tests or procedures the doctor might ask you to take. This is the flat fee you’ll pay to the doctor each time you visit him/her.

So, How Does it All Fit in?

Your deductible directly determines the premium you’ll pay for the year. The higher deductible you’re willing to pay, the lower your premium will be, and vice versa. As you go lower and lower on the deductible scale, your premium will shoot up exponentially. A $500 deductible will probably cost you more than $3000 in yearly premiums, while a $3000 deductible might cost you as little as $300.

Do the math. This means that you’ll actually be better off paying a higher premium than a smaller one. The lure of a smaller deductible might sound appealing at first, but when you consider the fact that your premium will invariably become several times higher, it doesn’t seem all that good an option to go with.

If, say, you get a $3000 deductible, you might end up paying $300 premium per year. On the other hand, if you pay a deductible of $500, you might end up paying $3000 in premiums each year. When you consider the fact that you probably won’t require medical treatment above $3000 in most years, you’ll actually save money on premiums if you take up a deductible. So do the math before you pick up a policy; more often than not, pick one with a higher deductible. It’ll save you money in the long run.
Where to go from here? Check out our article on Florida Health Insurance Plans