Key Facts for Florida
Medicaid in Florida
Florida has not expanded Medicaid under the Affordable Care Act, despite having one of the highest uninsured populations in the country. This means Medicaid eligibility is limited to specific categories, leaving many low-income adults without coverage options.
Florida has one of the largest coverage gaps in the nation. An estimated 800,000+ Floridians earn too much for traditional Medicaid but too little to qualify for marketplace subsidies. This includes many working adults, particularly in service industries.
Who Qualifies for Florida Medicaid?
- Children: Up to 215% FPL through Florida KidCare
- Pregnant women: Up to 191% FPL
- Parents/Caretakers: Very limited (approximately 26% FPL)
- Elderly and disabled: Must meet income and asset requirements
- Childless adults: Generally do not qualify regardless of income
Florida Statewide Medicaid Managed Care (SMMC)
Most Florida Medicaid recipients receive coverage through the Statewide Medicaid Managed Care (SMMC) program. This includes:
- Managed Medical Assistance (MMA): Primary healthcare coverage
- Long-Term Care (LTC): For those needing nursing home or home-based care
How to Apply for Florida Medicaid
- Online: Visit ACCESS Florida
- Phone: Call 1-866-762-2237
- In Person: Visit your local Department of Children and Families office
Health Insurance Marketplace
Florida uses the federal Health Insurance Marketplace at HealthCare.gov. Florida consistently has one of the highest marketplace enrollments in the nation, with over 3 million residents signing up during Open Enrollment.
November 1, 2024 through January 15, 2025. Enroll by December 15 for coverage starting January 1, 2025.
How to Enroll
- Visit HealthCare.gov
- Create an account or log in
- Complete your application with income and household information
- Compare plans and see what subsidies you qualify for
- Select a plan and complete enrollment
Special Enrollment Periods
You can enroll outside of Open Enrollment if you experience a qualifying life event such as losing other coverage, getting married, having a baby, or moving to Florida.
Average Costs in Florida
Florida has a competitive marketplace with many insurers. Costs vary by county, age, and tobacco use:
- Benchmark Silver Plan: Average of $450-600/month before subsidies for a 40-year-old
- With Premium Tax Credits: Many Floridians pay $0-100/month after subsidies
- Bronze Plans: Lower premiums, higher deductibles starting around $250-350/month
- Gold Plans: Higher premiums, lower out-of-pocket costs
If your household income is between 100% and 400% of the Federal Poverty Level, you likely qualify for subsidies. Enhanced subsidies through 2025 mean many Floridians can find plans for under $50/month.
Alternatives for the Coverage Gap
If you fall into Florida's coverage gap (too much income for Medicaid, too little for marketplace subsidies), consider these options:
- Federally Qualified Health Centers (FQHCs): Florida has over 50 community health center organizations with hundreds of locations offering sliding-scale fees
- Hospital Charity Care: Many Florida hospitals offer financial assistance programs
- Free Clinics: Volunteer medical clinics throughout the state
- Prescription Assistance Programs: Drug manufacturers offer patient assistance programs
- Short-Term Health Insurance: Limited coverage option (review exclusions carefully)
- Health Sharing Ministries: Faith-based cost-sharing programs
Frequently Asked Questions
Has Florida expanded Medicaid?
No, Florida has not expanded Medicaid under the Affordable Care Act. This means many low-income adults do not qualify for Medicaid, creating a significant coverage gap affecting over 800,000 Floridians.
What is the coverage gap in Florida?
Florida has one of the largest coverage gaps in the nation. Adults earning below 100% of the Federal Poverty Level may not qualify for traditional Medicaid (unless they're pregnant, disabled, or elderly) and also don't qualify for marketplace premium subsidies.
When is Open Enrollment for Florida health insurance?
Florida uses the federal HealthCare.gov marketplace. Open Enrollment for 2025 coverage runs from November 1, 2024 through January 15, 2025. Enroll by December 15 for coverage starting January 1.
How do I apply for Florida Medicaid?
You can apply through ACCESS Florida at myflorida.com/accessflorida, by phone at 1-866-762-2237, or in person at your local Department of Children and Families office.
Need Help Finding Coverage in Florida?
Florida's coverage landscape can be challenging to navigate. Our licensed agents specialize in helping Floridians find the best options for their situation.
Get Free Guidance