Florida Health Insurance Cover 101

Health insurance covers come in handy in your hour of need. Policies seek to keep your pockets safe and free from the fear of running up and down in search of a solution when it is too late.

Have you seen posts on how to get health insurance before? If yes, the only reason you came seeking a second opinion here is that you were scared of the high premiums they insinuated you could pay.

The good news is that the Florida health coverage has got you covered; however, there are a few formalities involved before acquiring any. This post aims at lighting your bulb on the things you must know before you go looking for a health cover in Florida.

How much can you pay for a health cover in Florida?

Cost is the most crucial factor when it comes to securing a health cover. You don’t want one that will drain your pockets dry. An average person in Florida pays up $393 as a premium every month for an individual plan. In the event of a family plan, one pays $1021 per month.

However, the payment plan is influenced by several factors, such as whether or not someone smokes or has other underlying issues.

What types of health coverage should you expect?

Your condition or goals for seeking cover is what influences the kind of coverage you will settle for. The type of health coverage plan you go for will also determine how much money you pay for the premium every month.

Here are the three most sought covers

Health Maintenance Organization plans (HMO)

HMO plans require one to see a doctor, specialties, and care providers in the organization network.  It limits one from seeing any doctor that’s outside the network. Also, the HMO cover does not allow you to see any other doctor that is not a specialist.

 These covers are considered the most affordable, and the best part is that they give you the opportunity and freedom to choose the health care providers you want to be with.

Preferred provider organization plans (PPO)

PPO covers are more expensive compared to HMOs. Under the PPO cover, you are guaranteed a network of doctors and specialists. However, you don’t have to see them.  If you decide to see a health care provider outside your network, you will have to pay an additional fee.  The best part is that you do not have to seek a referral to see a specialist within the PPO network.

Point-of-service plans (POS)

POS plans are more of a merge between the HMOs and PPOs. It allows you to see doctors and specialists outside your network.  However, like in the HMOs, you must have a doctor’s referral before seeing a specialist. The best part about POSs you can see any care provider you want at lower rates than in the PPOs.

What is covered by the health insurance?

  • Ambulatory patient services

 This cover mainly entails the outpatient care you get outside the hospital.

  • Emergency services

 Your health insurance provider covers these at all costs. It does not restrict one to any specific hospital, whether or not it is in your network. The best thing is that you are not required to contact the hospital before receiving emergency care. Hence, in the event of an actual emergency, you should visit the closest hospital.

  • Hospitalization

The term hospitalization depicts an extended stay in a hospital. You may be hospitalized for a day or two to receive a prescription of drugs that a nurse or doctor can only administer.

  • Pregnancy, maternity, and newborn care

 This is the care given to a pregnant woman during and after pregnancy. After birth, the cover caters to the child as well.

  • Mental health and substance use treatments

This cover is mandatory. Your health insurance cover must offer you coverage for treatment for substance use, behavioral therapy, and inpatient mental health services.  Under this coverage, you are not limited in terms of tenure of treatment for mental disorders of any kind.

  • Prescription drugs

 Health insurance providers are not permitted to exclude cover for prescription drugs. However, they are allowed to ensure a patient takes such prescriptions step by step. They advocate for less expensive medication first, and if need be, the patient can upgrade to the expensive options.

  • Rehabilitative services and devices

This mainly entails physical therapy and occupational therapy.

  • Laboratory services

This covers sample screening and includes imaging that you may receive in a hospital.  This consists of both outpatient blood work and imaging such as x-rays that you receive in a hospital.

  • Preventive services and wellness screenings

Vaccination physicals and booster shots are what you find here.  In most cases, such services are free of charge.

  • Pediatric services

 If you have children in your plan, the health insurance cover must cater to vision and dental services. When it comes to adults, such provisions are not mandatory.

  • Breastfeeding support: Here, nursing mums receive counseling.

  • Birth control: This cover seeks to provide approved contraceptive methods. It does not include the termination of an already existing pregnancy.

What is not covered in the insurance cover?

Not everything is covered under health insurance covers. Here is what you won’t find in Florida health insurance covers.


  • Male birth control: health insurance covers hardly cover vasectomies and barrier methods. The rationale is that only female birth control is considered an essential benefit.
  • Travel vaccinations: Your insurance provider only caters for the necessary vaccinations. Travel vaccination is considered elective prevention that most insurance providers deem unnecessary.
  • Vision and dental coverage: As mentioned above, such coverage is only available for children in your plan.
  • Weight loss surgery: This is conducted through Bariatric surgery; this procedure is not considered a mandate of insurance providers. The argument remains that this isn’t a federal mandate on any insurance provider to ensure such surgeries are catered for. If you or someone on your cover need to undergo bariatric surgery, always ask first before enrolling.

  • Cosmetic surgery: such procedures are not medically necessary; hence they are hardly included under medical insurance covers.

To wrap it up

The above is a deep insight into your general expectation in your search for a health insurance cover in Florida.

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