Question 1

Should I get a marketplace plan or stay on COBRA?

Accepted Answer

COBRA continues your former employer's plan but at the FULL cost (employer + employee portion plus 2% admin fee) — typically 3×–5× more expensive than what you paid as an employee. Marketplace plans offer comparable coverage at significantly lower cost for most individuals, especially with ACA subsidies (available for households up to 400% of Federal Poverty Level, often higher post-2021 reforms). For most departing employees, marketplace shopping produces meaningful savings versus COBRA. Exception: those with mid-year deductibles already met under the prior plan may benefit from COBRA continuation.

Question 2

What's an HSA-compatible high-deductible plan?

Accepted Answer

HSA-compatible high-deductible health plans (HDHPs) require minimum deductibles ($1,600+ individual / $3,200+ family in 2024) and qualify holders to contribute to Health Savings Accounts. HSAs offer triple tax advantages: tax-deductible contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses. For healthy individuals and families with predictable, low medical costs, HDHP+HSA combinations can produce significant long-term savings and tax-advantaged retirement healthcare savings. HDHPs require careful budgeting for the higher deductible — the strategy fails for those who can't fund the deductible when needed.

Question 3

Do I need supplemental coverage with Medicare?

Accepted Answer

Most Medicare beneficiaries need supplemental coverage. Original Medicare (Parts A and B) covers about 80% of approved costs, leaving 20% co-insurance with no out-of-pocket maximum — significant exposure on serious health events. Medicare Supplement (Medigap) policies fill the 20% gap and limit out-of-pocket exposure. Medicare Advantage (Part C) replaces Original Medicare with managed-care plans often including drug coverage and additional benefits like dental and vision. The choice between Medigap and Medicare Advantage depends on travel needs, network preferences, drug coverage, and budget.

Question 4

What about ACA subsidies?

Accepted Answer

ACA marketplace plans offer income-based subsidies (premium tax credits) that significantly reduce monthly premiums for qualifying households. Subsidies extend up to 400% of Federal Poverty Level (about $60K for an individual, $120K for a family of four) and often higher under post-2021 expansion. Households at lower income levels also qualify for cost-sharing reductions on Silver-level plans. Florida's ACA marketplace produces substantial subsidy enrollment — many Florida self-employed and gig-economy workers pay $50–$300/month for comprehensive coverage after subsidies versus $500–$1,200/month unsubsidized.

Question 5

How do dental and vision coverage work?

Accepted Answer

Dental and vision are typically separate from major medical coverage. Some health plans bundle limited dental and vision; most don't. Standalone dental plans typically cover preventive care (cleanings, exams) at 100%, basic procedures (fillings) at 70–80%, and major procedures (crowns, root canals) at 50%, with annual maximums around $1,500–$2,500. Vision plans cover eye exams, frames, and lenses with frequency limits. Coverage quality varies dramatically — most dental plans offer modest value beyond preventive care, making them a coverage of convenience rather than significant financial protection.

Question 6

Can snowbirds use their Florida coverage in their other state?

Accepted Answer

PPO plans typically work in any state at network and out-of-network levels (with in-network coverage in the home state's network and out-of-network coverage elsewhere). HMO plans typically don't work outside the home state except for emergencies. Medicare works nationwide; Medicare Advantage HMO plans may have limited out-of-state coverage, while Medicare Advantage PPO offers more flexibility. Snowbirds should specifically select plans that accommodate their multi-state living patterns — geographic flexibility is the key consideration.

Question 7

How is health insurance priced in Florida?

Accepted Answer

ACA marketplace plans are priced based on age, location, family composition, and tobacco use (no health-status pricing under ACA). Florida ACA premiums vary significantly by county — Miami-Dade and Broward typically pay more than rural Florida counties. Income-based subsidies dramatically affect actual cost. Medicare Part B premiums are income-tested and standardized nationally. Florida Medicare Advantage and Medicare Supplement premiums vary by county and carrier. Working with an advisor specializing in Florida health insurance navigates carrier selection, network coverage, and cost optimization.

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