Private Health Insurance in Florida: Is It Worth It Over an ACA Plan?

I sell both. That matters, because most people writing about this only sell one.

If you are self-employed in Florida and your premium jumped this year, you are choosing between the public marketplace — healthcare.gov, what most people call Obamacare — and the private market. They are priced on completely different things, and that is the whole answer.

The one difference that decides it

The marketplace is priced on your income. The private market is priced on your health.

That is it. Everything else follows from that sentence. If your income is low enough to earn a real subsidy, the marketplace is usually unbeatable and I will tell you so. If your income is above the cutoff, you pay full retail there, and full retail on a marketplace plan in Florida is expensive.

When the marketplace genuinely wins

• Your household income lands inside the subsidy range for your household size.
• You have significant ongoing treatment and specific doctors you are not willing to change.
• You take expensive brand-name specialty medication.
• You are pregnant or planning to be within the next year.

In any of those cases I will help you enroll on the marketplace and I will not try to talk you out of it. It costs you nothing either way — the carrier pays me, you do not.

When private is worth a serious look

• Your income is over the subsidy cutoff, so the marketplace is charging you full price.
• You are generally healthy and tired of paying for a deductible you never reach.
• You want to see a doctor without spending thousands first.
• You are 1099 or a small business owner with no group plan behind you.

The deductible trap nobody explains

A lot of Florida marketplace plans at full price come with a deductible in the thousands. People look at the monthly number and stop there. The question worth asking is: if I got sick in March, what would I actually pay before this plan did anything?

A $9,000 deductible plan at $550 a month is not a $550 plan. It is a $550 plan plus $9,000 of exposure you are carrying yourself. That is the math that sends healthy self-employed people to the private side.

What the private side does not do

Being straight about this is the point of the page. Private plans take an application with health questions. Underwriting decides, and approval is never guaranteed. Some products on the private side are not major medical at all — fixed indemnity pays set amounts per event, and health sharing is a membership and a community guideline, not an insurance contract. All of those can be right for the right person, and all of them are wrong for somebody who needs comprehensive coverage.

Anyone who tells you private is always better is selling, not advising.

How I would decide it in ten minutes

Three numbers: your household income, your household size, and your ZIP. Those three tell me whether the marketplace subsidy is in play. From there it is one conversation about your health and your doctors, and the answer is usually obvious to both of us by the end of it.