Questions people ask before they call.
If yours is not here, ring and ask. Nobody minds.
What does your help cost me?
Nothing. The carrier pays us a commission set by the state when you enroll, and it is the same commission whichever plan you choose. Your premium is not higher for using an agent than for enrolling yourself on HealthCare.gov.
When can I enroll?
Open Enrollment for a Marketplace plan runs from November 1 to January 15. Enroll by December 15 and coverage generally starts January 1; after that it usually starts February 1. Outside those dates you need a qualifying life event, which opens a 60-day Special Enrollment Period.
What counts as a qualifying life event?
Losing other coverage, moving, getting married, having or adopting a child, certain income changes, gaining citizenship or lawful presence, and leaving incarceration are the common ones. Choosing to drop your coverage does not count, and neither does simply getting sick.
How is my subsidy worked out?
The premium tax credit is based on your household income, your household size and the cost of the benchmark Silver plan in your county. Separately, if your income falls roughly between 100% and 250% of the federal poverty level, a Silver plan also carries cost-sharing reductions that lower your deductible and copays.
I think I earn too little to qualify. What then?
That is the Florida coverage gap and it is real. Premium tax credits start at 100% of the federal poverty level, and Florida did not expand Medicaid to cover adults below that. Children are usually a different story: Florida KidCare covers many families who assume they earn too much. Call and we will check the household properly.
Can I keep my doctor?
Only if that doctor is in the plan's network. Most Florida Marketplace plans are HMOs, so out-of-network care generally is not covered except in an emergency. We look your doctors and your prescriptions up by name before recommending anything, because this is the most common reason a plan disappoints.
Will a preexisting condition stop me?
No. Marketplace plans cannot refuse you, charge you more, or exclude treatment because of a preexisting condition. Age, location, tobacco use and household size affect your price; your medical history does not.
What if my income changes during the year?
Tell us and we will report it. If your income rises and you do not report it, some of the advance credit can be reconciled back at tax time. If it falls, you may be owed more credit right away. Either way it is a short call, not a form.
Do you speak Spanish?
Yes, and Haitian Creole and French as well. The whole site exists in Spanish, and you can ask for a particular agent by name or extension.
What if I miss Open Enrollment entirely?
Without a qualifying life event you generally wait for the next Open Enrollment. Ring us anyway, because there are exceptions worth checking, and because children may still be able to enroll in Florida KidCare at any time of year.
Pick up the phone. We will take it from here.
Mon to Fri, 9am to 7pm. Saturdays until 2pm. Ask for English or Spanish, either is fine.