Key Takeaways
- Florida Medicaid provides health coverage to low-income residents
- Florida Healthy Kids is the state CHIP program for children
- The Florida Life and Health Insurance Guaranty Association protects policyholders
- Florida participates in the Long-Term Care Partnership Program
- Florida does not have a state-run health insurance exchange (uses federal marketplace)
Florida State Insurance Programs
Florida operates several state programs that producers should understand when helping clients.
Florida Medicaid
Florida Medicaid provides coverage to low-income residents:
Who's Covered
| Population | Income Limit (approx.) |
|---|---|
| Children | Up to 210% FPL |
| Pregnant Women | Up to 191% FPL |
| Parents | Lower limits |
| Seniors/Disabled | SSI-related |
Note: Florida did NOT expand Medicaid under the ACA for low-income adults without children.
Florida Medicaid Benefits
- Doctor visits
- Hospital care
- Prescription drugs
- Mental health
- Long-term care
- Limited dental/vision
Exam Tip: Florida did not expand Medicaid for childless adults. This is important when advising clients about coverage options.
Florida Healthy Kids
Florida Healthy Kids is the state's CHIP program:
Eligibility
| Requirement | Details |
|---|---|
| Age | Under 19 |
| Income | Above Medicaid, up to 200% FPL |
| Residency | Florida resident |
| Citizenship | US citizen or qualified |
Benefits
- Comprehensive health coverage
- Doctor and specialist visits
- Hospital care
- Prescription drugs
- Dental and vision
- Mental health services
Health Insurance Marketplace
Florida uses the federal marketplace (Healthcare.gov):
What It Offers
| Feature | Description |
|---|---|
| Individual Plans | Qualified Health Plans |
| Premium Tax Credits | Federal subsidies |
| Cost-Sharing Reductions | Lower costs for Silver |
| Special Enrollment | Qualifying events |
Metal Tiers
| Tier | Actuarial Value |
|---|---|
| Bronze | 60% |
| Silver | 70% |
| Gold | 80% |
| Platinum | 90% |
Note: Florida does not operate its own state marketplace; residents use Healthcare.gov.
Florida LTC Partnership Program
Florida participates in the Long-Term Care Partnership Program:
How It Works
- Purchase Partnership-qualified LTC policy
- Use benefits for qualifying care
- If exhausted, apply for Medicaid
- Keep assets equal to benefits received
Partnership Benefits
| Without Partnership | With Partnership |
|---|---|
| Spend down to $2,000 | Protect assets |
| May lose home equity | Keep home/assets |
| Standard rules | Enhanced protection |
Policy Requirements
- Meet federal and Florida requirements
- Inflation protection
- Certified producers
- Partnership-certified
Florida Life and Health Insurance Guaranty Association
Florida's guaranty fund protects policyholders:
Coverage Limits
| Policy Type | Maximum Coverage |
|---|---|
| Life Insurance Death Benefit | $300,000 |
| Life Insurance Cash Value | $300,000 |
| Annuity Present Value | $250,000 |
| Health Insurance | $500,000 |
| Disability Income | $300,000 |
| Long-Term Care | $300,000 |
What's Covered
- Individual life insurance
- Group life (Florida residents)
- Annuities
- Health insurance
- Disability insurance
- Long-term care
What's NOT Covered
- Surplus lines
- Self-funded plans
- Variable investment portions
- Amounts above limits
- Unlicensed insurers
Producer Restrictions
Producers CANNOT:
- Use as selling point
- Advertise guaranty coverage
- Compare to FDIC
- Imply "guaranteed"
Exam Tip: Florida's $300,000 life death benefit limit and producers cannot advertise guaranty coverage.
Producer Responsibilities
What to Do
- Know state programs
- Refer appropriately
- Compare options
- Stay current
What NOT to Do
- Guarantee eligibility
- Provide tax/legal advice
- Discourage appropriate coverage
- Make false statements
Does Florida operate its own health insurance marketplace?
What is the Florida guaranty fund limit for life insurance death benefits?
What is Florida Healthy Kids?
Did Florida expand Medicaid under the ACA?
Can Florida producers advertise guaranty fund coverage?
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