Lafayette County, Florida Obamacare Guide

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What Florida Residents Need to Know About Obamacare for 2020

The Affordable Care Act, also known as Obamacare, has not been struck down or repealed.

As of July 2020, the ongoing federal court case challenging the ACA is still moving through the courts. The penalty for being uninsured has been struck down but the rest of the law remains in effect.

This website provides information about getting health insurance under the Affordable Care Act (ACA), including:

To begin, keep in mind these key points about health insurance in Florida:

1. Open enrollment has ended for 2020 health care plans, but you can still get health insurance if you qualify for a special enrollment period.

In Florida, the ACA open enrollment period ended on December 18, 2019. This means that, unless you qualify for an exception, you won't be able obtain health insurance through Healthcare.gov until the 2021 open enrollment period begins in the fall of 2020.

If you’ve recently lost your job or income due to the COVID-19 crisis or for any other reason, you might qualify for a special enrollment period that will allow you to sign up for a new health insurance plan or to change your current plan.

To learn whether you qualify for a special enrollment period, see What Happens If I Missed the Florida Obamacare Enrollment Deadline?

2. You won’t face a tax penalty for going without health insurance in 2020—but there are big downsides to being uninsured.

Obamacare’s tax penalty went away in 2019. That means that if you didn’t have health insurance coverage in 2019, you won’t have to pay a penalty when you file your taxes in this year.

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How To Sign Up for Obamacare in Florida

To sign up for a health plan under the Affordable Care Act (Obamacare) you can go directly to the online health insurance marketplace for Florida -- or you can get help in person or over the phone.

For 2020 health plans, Florida open enrollment has ended. However, you may still be able to purchase health insurance for this year if you qualify for a special enrollment period. In particular, if you’ve recently lost your job or income due to the COVID-19 crisis or for any other reason, you might qualify for a 60-day special enrollment period that will allow you to sign up for a new health insurance plan. (See What Happens If I Missed the Enrollment Deadline for 2020?)

Where's the Florida Health Care Exchange?

You can find the health insurance exchange for Florida at Healthcare.gov. This is where you can learn about the various health insurance options available to you under the Affordable Care Act. If you see a plan you like, you'll be guided through the enrollment process online.

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Do I Have to Get Health Insurance in Florida?

Technically, the Affordable Care Act -- aka Obamacare -- still says that you must have health insurance. Practically, however, the federal tax penalty for going without health insurance has been "zeroed out." That means you'll still have to report your coverage status on your federal tax return, but you won't have to pay a penalty if you aren't covered.

A handful of states have passed their own health insurance requirements, but as we approach open enrollment for 2020 health plans, Florida is not one of them.

If you're interested -- or if the tax penalty comes back -- the Affordable Care Act requires that you have "minimum essential coverage" (MEC).

What Qualifies as Minimum Essential Coverage?

If you have any of the following types of health coverage, you won’t have to pay a penalty:

  • an individual insurance plan, whether purchased on your own or through Healthcare.gov, the exchange serving Florida
  • a plan (including COBRA or a retiree plan) provided by your employer
  • Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP)  more...  

Florida Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

The Affordable Care Act (Obamacare) expanded Medicaid eligibility to include more people who couldn’t otherwise obtain health insurance. As written, the ACA would extend Medicaid to all adults with incomes at or below 138% of the federal poverty level. (For a single person in Florida in 2020, that’s $17,609. For a family of four, it’s $36,156.)

However, the U.S. Supreme Court later ruled that it was up to individual states to decide whether to expand Medicaid. As of August 2020, 12 states have not expanded their programs.

Florida Has Not Expanded Medicaid

Because Florida has not yet expanded Medicaid eligibility, you may have fewer options for health coverage than people in states where Medicaid is more inclusive.

The Medicaid Coverage Gap

The Affordable Care Act assumed that Medicaid would be expanded to cover all Americans with incomes at or below 138% of the federal poverty level. And it created health plan subsidies for people with incomes between 100% - 400% of the poverty level.

That means Florida residents with incomes below the poverty level may fall into a coverage gap where they can get neither Medicaid nor ACA subsidies.

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Understanding Obamacare's Preventive Health Care Benefits

Get a colonoscopy, mammogram, vaccinations, and other essential services for free

The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through Healthcare.gov, the health care marketplace for Florida. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.

Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges

Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.

Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.

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Obamacare for Self-Employed Florida Residents

Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest challenges they face. For some, however, the Affordable Care Act (Obamacare) may make things easier by providing new coverage options for the self-employed.

Are You Self-Employed or an Employer? 

Before you start evaluating your options for health coverage, you need understand whether the Affordable Care Act thinks you're self-employed.

The ACA says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) If you are self-employed, you can use Healthcare.gov to compare health insurance plans and sign up for the one that works best for you.

If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace. You will be connected with a registered SHOP (Small Business Health Options) agent or broker who can help you understand your coverage options.

If you aren’t sure whether the people who work for you are independent contractors or employees, read "Independent Contractor (Self-Employed) or Employee?" on the IRS website.

What the Affordable Care Act (Obamacare) Means for Self-Employed People in Florida

Here are six things self-employed people should know about the Affordable Care Act:

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How Obamacare Affects Unemployed Florida Residents

The difficulties of unemployment are often compounded by the lack or loss of health insurance. But millions of Americans who are currently without both a job and health coverage may find relief under Obamacare. That's because low-cost coverage options may be available to you through Healthcare.gov, the health insurance marketplace serving Florida.

All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, as an unemployed person, you probably qualify for significant cost-saving subsidies.

When you sign up for a marketplace health plan, your coverage can start within a few weeks. Usually, you must sign up during an open enrollment period. But leaving your job and losing job-based health insurance makes you eligible for a special enrollment period. That means you'll have 60 days to sign up for a new health plan. 

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What Domestic Partners Need to Know About Applying for Health Insurance Under Obamacare

When registered domestic partners or civil union partners apply for coverage at an Affordable Care Act health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes, or must we include all the income we make as a couple?

The answer depends on the state where you live.

States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)

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Obamacare and Seniors

If you’re over the age of 65, your health insurance options under the Affordable Care Act depend on whether or not you’re covered by Medicare or another insurance plan. To find out what, if anything, you need to do, find the situation below that applies to you.

You have Medicare. If you’re already enrolled in Medicare, you’re considered covered under the ACA, and you don’t have to do anything. In fact, it’s illegal for someone who knows you have Medicare to try to sell you a plan through a health care marketplace.

The Affordable Care Act enhances your existing Medicare coverage in a couple of important ways:

  • You get more preventive care benefits, such as cancer screenings and an annual wellness visit.
  • If you fall into the prescription drug “donut hole,” there are new discounts to help you save money until the hole closes completely in 2020.

For more information on Medicare coverage, go to Medicare.gov.

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Can I Use a Paper Application to Get Obamacare?

When Obamacare first launched, the federal and state health insurance marketplaces (also called “exchanges”) were plagued by technical troubles. Many people who tried to sign up for new health insurance plans online in the early days were unable to complete their applications.

Because of these difficulties, some individuals and application assistants turned to the old-school way of getting health insurance -- paper applications.

Applying on Paper May Not Be Better or Faster

When facing a slow or broken online health insurance exchange, using a paper application may seem tempting -- at least it would provide the feeling of getting something done. However, paper forms may not speed up the process at all. On the contrary, they could slow down your application even more.

The worker who reviews your paper application must manually enter the information from your forms into the same system you would use online at your state’s exchange. It won’t work any faster for them than it does for you. Plus, using a paper application opens up more opportunity for error by putting more people between you and your goal of getting insurance.

It’s still best to apply online if you can. That said, if you feel that you’re unlikely to come back and apply for health insurance later, you may want to go ahead and complete a paper application now. 

To get a paper application, call the Healthcare.gov customer service center and let them know you want to apply on paper. They'll point you to a downloadable application or send you one in the mail. For detailed Healthcare.gov contact information, see How To Sign Up for Obamacare in Florida.

When Are You Legally Required to Report "Life Changes" to the Florida Health Insurance Exchange?

Are you planning to get married, change jobs, or move to a new state? If so, you might have to share your big news with Healthcare.gov.

Which Changes Must You Report? 

If you buy a health insurance plan through the Florida marketplace, the Affordable Care Act requires you to report changes that may affect your insurance coverage. These changes include: 

  • moving to a new state or insurance coverage area
  • significant changes in income
  • getting new health coverage through a job
  • signing up for Medicare or Medicaid
  • getting married or divorced
  • becoming pregnant, having a child, adopting a child, or placing a child for adoption
  • losing or gaining a dependent
  • becoming disabled, and
  • other changes that affect your income or household size.

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About This Website

We built this website to get people the answers they need about the Affordable Care Act (Obamacare). Our goal is to guide you to reliable, local information about your new health insurance options.

When you choose your state or enter your zip code here, you will quickly learn:

  • whether or not you're required to get health insurance

  • what the available plans cover

  • how much coverage will cost, and

  • how to sign up in your state.

For those concerned about cost, we show you how to determine whether you qualify for subsidies.

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