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Health Insurance in Florida

For individuals and families alike, health insurance coverage in the state of Florida has been increasingly expensive and increasingly difficult to obtain over the last few years and nationwide the situation isn't looking any better. If the Census Bureau's latest estimates are to be believed, both the numbers and percentages of Americans living without medical insurance coverage have increased from a high of 43.6 million or 15.2% back in 2002 to a high of 46 million or 15.8% in 2004. Generally speaking, the study also revealed that the numbers of Americans receiving health care coverage through employer-based medical benefits plans fell from 175.3 million or 61.3% of us in 2002 to 174 million or only 60.4% of us today. But the problems faced by Floridians and others are illuminated less by the rates of decline than by the fact that over the past three decades healthcare costs of have risen steadily alongside Florida's growing population of uninsured.

Unfortunately, especially considering the state of Florida's particular demographics, when state-federal Medicaid programs make headlines lately, the news has gone from bad to worse: costs are on the rise, the state's budget is reeling under the strain of a growing population and a less than ideal economic climate and left the program's frustrated administrators warning of possible benefits cuts and expanded eligibility restrictions besides.

More and more the two situations above have combined to leave the task of finding an affordable and comprehensive florida health insurance plan here in Florida up to individual consumers. We're here to help you do that, to help our fellow Floridians find the best values health insurance has to offer. Below, we've laid out a few of the questions Floridians will need to ask and little of what they'll need to know in order to shop for a health benefits plan here in the sunshine state successfully:

  • What will health plans actually cover?

  • Which health plans will best suit the needs of the state's Seniors, Children, Individuals and Families?

  • How they can determine when an added dollar of health insurance premium costs will yield less than a dollar in medical benefits?

  • Which insurance companies are Florida's major health indemnity providers, what unique health insurance and or health insurance services do they offer consumers and how precisely do they operate? And what, if any, are the important differences between ostensibly similar plans offered to Floridians by companies that can range from Blue Cross Blue Shield of FL to The CIGNA HealthCare Company to United Healthcare?

  • Exactly which types of health care plans are actually available to Florida's residents, how do they function individually and what specifically are the different sorts of medical plans designed to do for their participant members?
  • Today, the healthcare marketplace in Florida consists of a sometimes daunting range of medical insurance offerings that all basically boil down into four basic health plan structures . . . The HMO or Health Maintenance Organization, The Point of Service Plan or POS, the PPO or Preferred Provider Organization and conventional Private Health Indemnity Plans. In the simplest terms, HMO Plan's generally tend to offer their member-participants the least freedom-in terms of choice when it come to selecting their care providers and or clinics, Private Health Indemnity Plans the greatest degree of participant freedom and POS and PPO's fall somewhere between. On the other hand, costs wise, the HMO tends to be the least expensive of the three followed in order by Point-of-Service Plans then Preferred-Provider-Organizations and finally Private Medical Indemnity Plans. But what does that mean for Floridians, what are the important differences between the plans, and what can those differences mean to Florida's consumers? The following outlines should help:

    HMO's or Health Maintenance Organizations:

    The HMO is probably the oldest form of managed care plan. In the Health Maintenance Organization structure, rather than paying for received medical services separately, for a pre-set monthly premium, an HMO offers its membership a range of healthcare options, ranging from dental and vision in some cases to general practitioner preventative care. The physicians responsible for member care are typically employees of one particular health plan and members and their families are generally required to visit them at the HMO's central medical office or clinic. But there are alternate HMO structures wherein physician groups and or individual doctors have private practices or offices and the HMO in question will provide its members with lists of approved primary care physicians, nurse practitioners, physician's assistants, medical specialists and hospitals.

    Characteristically, with the majority of HMO's there are pre-set co-payments for office visits, hospital stays and a variety of other health services.

    PPO's or Preferred Provider Organizations:

    The PPO is the form of managed health care closest to private medical indemnity plans. Florida's PPO's negotiate arrangements with general practitioners, hospitals, clinics and specialist or alternative health care providers to accept lower fees for service from specific insurers for their patient services. For seniors and other consumers, this results in a situation wherein their cost sharing will be lower using "in-network" physicians than if they were to go outside of the network of pre-approved care providers. In addition, their co-insurance rates will be based on the reduced fees of the PPO's doctors and physicians. PPO's also provide their participant-members with an increased level of freedom to see any care provider they choose. Plan members are able to refer themselves or their children to any general practitioner they'd like to, including medical specialists from both inside and outside of the network.

    However, plan members are likely to incur added charges as a result of using out-of-network health providers. POS or Point of Service Plans

    To better address marketplace demands as they expanded, many HMO's in Florida offer their plan members the option of "self-directing" their health care, as participants in indemnity plans do, rather than requiring them to get referrals from their primary care physicians prior to seeing specialists or visiting a hospital. HMO's with such opt-out provisions have become known as Point-of-Service or POS Plans. How a particular POS Plan functions depends principally on what an individual plan's participants decide to do about their families medical needs at the "point-of-service." Within POS Plans however, that generally means that when care is required, individual plan members essentially have three choices. Said participant can decide to use their pre-selected primary care provider, in which case the healthcare services rendered will be fully covered under standard HMO guidelines.

    Nevertheless, the plan participant also has the option to access their medical care through a PPO (Preferred Provider Organization) provider in which case the services rendered will be covered in accordance with in-network PPO Organization rules. Finally, if the plan participant chooses to seek out care from a medical provider from outside of the PPO or HMO network, said medical services will be reimbursed in accordance with POS out-of-network rules.

    But above all, Florida's emergent population of health insurance consumers must remember to always take the necessary time to learn everything they possibly can concerning the various kinds of health care coverage readily available across our state, and irregardless of whether they seeking an insurance right for the health benefits needs of children, seniors, growing families or private individuals, which of those options will be right for their requirements. Most of us have at least a basic knowledge of how health care related insurance plans work, but in a marketplace as large as the state of Florida, where there so many more potential health child, elderly, family or individual health insurance alternatives than ever before it can only be helpful to have access to a resource like The Agency For Health Insurance. We're here to offer Florida's justifiably cautious consumers the help they need to find the insurance answers and insurance coverage all of us need.

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