Suwannee Health Insurance

Are you shopping for a Suwannee health insurance plan? Are you looking to better understand the health insurance market? Here you will find key resources to help you make an informed decision and an instant quoting tool showing all Suwannee health insurance options. Start by entering your zip code above to find plans offered in your area.

Facts and Figures

  • Place in County
    Health Report Card
    54th
  • Insured 36,633
  • Uninsured 7,503
  • Insurance
    Carriers
    4
  • Number of
    Primary Care Physicians
    6
  • Number of
    Hospitals
    4
  • Avg. Cost of
    Health Insurance Age 27*
    $396
  • Avg. Cost of
    Health Insurance Age 40*
    $483
  • Avg. Cost of
    Health Insurance Age 60*
    $1026

Breakdown of Insureds

  • Private Health Insurance 12%
  • Public Health Insurance 13%
  • Employer-Based Health Insurance 11%
  • Direct Purchase Health Insurance 11%
  • Medicare 9%
  • Medicaid 12%
  • Tricare/Military Health Insurance 11%
  • VA Health Care 11%
  • Uninsured 10%

What to Know When Shopping for Health Insurance

Below are some of the most commons concerns when shopping for a Suwannee health insurance plan.


Are Your Doctors In-NetworkBefore purchasing a health insurance plan you should always make sure that your doctor(s) are part of the network. Going to an out-of-network doctor may cost substantially more than if that doctor is in-network. Don’t just ask the doctor’s office if they accept a certain insurance plan before you enroll. You should always confirm with the insurance company or an agent that your doctors are in-network. Why the concern? Well, keep in mind that if an out-of-network provider suggests services, then all of those services provided by that recommended doctor will be considered out of network, even if the facilities and providers are in-network

Lower Monthly Premium May Result in Higher CostsHealth insurance follows a simple formula: the lower your monthly premium is, the more likely you are to pay higher costs when you use the insurance. If you’re someone who happens to be in good health and does not foresee any health-related issues and doesn’t use medicine on a very regular basis, then perhaps you’re better off opting for a lower costing health insurance plan. However, if you find that your medical expenses and prescription usages are high, then you may save money by purchasing a plan that costs more per month. Be sure to consider your current health condition when shopping for a health insurance plan. 

Health Insurance is a ContractWhen purchasing a plan, both parties agree to live up to the contract (usually for a period of one year). If you find that you are not happy with your plan, you can’t go back to your insurance company mid-year and ask them to change coverage. You’ll have to wait for your contract to expire. Additionally, if you buy an individual health plan on your state exchange or through healthcare.gov and you allow that plan to lapse or you stop coverage, then you don’t qualify to buy a health plan on that exchange for the rest of that calendar year. As such, be sure to choose the right plan that suits your needs before signing the contract. 

Types of Insurance Coverage – EPO, PPO, POS, HMO, HDHP and HSA. The first 4 are acronyms that describe different types of health insurance coverage, which provide you with or without the flexibility to see specialists and receive out-of-network and out-of-state care. Also, different plans have different requirements related to the need for referrals. If you’re often seeing specialists out-of-network then you want a plan that offers that flexibility. If you find that you travel often for work or live in multiple states per year, then perhaps a plan that offers that flexibility is needed. The last two types, HDHP and HSA’s allow you to set up a tax-free savings account specifically for qualified medical costs For a better understanding of these types of coverage please refer to the following article.

Metal LevelsIn order to make shopping and comparing health plans easier, a metal system to represent different insurance coverage levels was created. These insurance levels are grouped into 4 metals based on actual metal value. Bronze, silver, gold, and platinum all represent the metal worth and the level of coverage offered under each metal plan. In theory, a bronze plan will cover 60% of your medical costs and provide you with a maximum out of pocket dollar amount that does not equal the remaining 40% but instead is a threshold set for most bronze plans. Silver is set at 70%, Gold 80%, and the most valuable metal platinum is set at 90%. Based on your medical needs you should be able to relatively compare an appropriate metal level. For example, if you find that you have minimal health insurance needs then perhaps a bronze plan would best suit you. However, if your health status requires a good deal of care, then perhaps a gold or platinum plan, which costs more, will actually cost you less in the long run.

Are Essential Health Benefits Covered? One way of ensuring the plan you purchase or intend to purchase covers the 10 essential health benefits, is to buy an on-exchange plan. All exchange plans must cover 10 essential health benefits. This provides you with a guaranteed minimum level of coverage, which is the standard set by the Affordable Care Act. Why would we need a minimum standard level? Well, the cost of medical care is prohibitive without insurance in place and can often lead to financial ruin. Ensuring that a plan includes the minimum essential health benefits provides a safeguard.

Premium, Deductible and Out-Of-Pocket Costs. Each term relates to the cost of using and maintaining your plan.

Premium is the cost of the insurance that you usually pay on a monthly basis to the insurance company. Premiums are often locked in for a period of one year, meaning the insurance carrier cannot arbitrarily charge you a higher premium within that year

Deductible is a yearly dollar threshold that you must meet prior to the insurance company paying for medical services. This almost always excludes preventative care.

Out-of-pocket costs are the maximum annual dollar amount that you can spend on health care services and medicine.

Health Insurance Subsidies A Subsidy is a dollar amount provided by the federal government paid directly to your insurance company based on your current yearly income. This money does not have to be paid back, however, if your income does increase, there is a strong possibility that your subsidy may change, which would then increase your monthly premium (retroactively). Conversely, if your income decreases within the year, that may reduce your monthly premium at which point you have the right to contact your insurance company and inform them of your income change.

Essential Health Benefits

What Are Essential Health Benefits? Essential Health Benefits are a set of 10 health care benefits established by the federal government under the Affordable Care Act of 2014. The purpose is to ensure that all persons are covered by a set of minimum standards. Specific insurance services may vary by state and all plans must provide dental coverage for children.

1.Ambulatory Patient ServicesMedical care provided without admission to a hospital, including doctor’s office visits, clinics, and outpatient surgery centers.

2.Emergency ServicesOrganizations that are responsible to deal with emergencies when they occur. This includes medical care that if not treated could lead to serious conditions or disabilities.

3.HospitalizationMedical care that patients receive when they are hospitalized. This includes the care of nurses, doctors, and other staff. This also includes medication received, room and board, tests and laboratory work.

4.Maternity Medical care that a woman receives during pregnancy and post pregnancy. This includes labor, delivery, post delivery and the care for newborn babies.  

5.Mental Health Services and Addiction Treatment – Patient care provided to evaluate, diagnose, and treat any mental health conditions or substance abuse disorders.

6.Rehabilitative Services and DevicesServices provided after an injury, accident, disability, or a chronic condition. The purpose is to attempt to help regain the patient’s mental and/or physical skills that were lost (to make the person whole again).

7.Pediatric Services – Medical care that is provided to children and infants, including regular check-ups, recommended vaccines, dental and vision care.

8.Prescription Drugs – Medicine that is prescribed by a doctor, and nurse practitioner, to treat any illness or existing condition.

9.Preventative and Wellness Services and Chronic Disease Treatment – Physicals, Immunizations, and cancer screenings to prevent or detect certain medical conditions, and to provide care for chronic conditions.

10.Laboratory Services Medical tests that are usually ordered by your doctor which include coverage for X-Rays and diagnostic imaging, blood and fluid tests, biopsies, pathology, and pregnancy tests.



Which Types of Insurance Plans are Not Required to Cover the Essential Health Benefits? The following insurance plan types are not required to include essential health benefits and most often don’t.

Short Term Medical Insurance

Accident

Critical Illness/Cancer

Hospital Confinement

Association Health Plans

Faith-Based Healthcare

Large Group Insurance plans (50 employees or more)

Travel Insurance

Dual Citizenship insurance (As long as you have proof of Identification)


State Government Insurance Programs Offered

Adult Cystic Fibrosis (ACF) Program

Florida Department of Health 
4025 Esplanade Way
Mail to: 4052 Bald Cypress Way
Tallahassee, FL 32399

TEL: 850-245-4444

Services related to ACF: physician services, lab/x-ray, certain prescription drugs, nutritional supplements, certain home supplies etc.

Florida resident diagnosed with Cystic Fibrosis and meeting “at risk of hospitalization” level of care; 18 years or older; medically stable; apply to the Brain & Spinal Cord Injury Program (BSCIP) Central Registry; and be financially eligible for Florida Medicaid.

Aging & Disability Resource Centers (ADRC)/FL

Department of Elder Affairs
4040 Esplanade Way
Tallahassee, FL 32399

TEL: 800-963-5337

Staff members are trained and knowledgeable about programs/agencies that specialize in older adults and the disabled. Examples of potential issues include: health issues such as nutrition and management of chronic medical conditions; adaptive equipment; assistive technology; long term care options; low-income housing; assisted living; financial issues such as paying your bills; elderly and disability benefits; community resources; adult protective services, etc. Staff can help with completing applications for public and private benefit programs including but not limited to: Social Security, SSI, Medicare, Medicaid, etc. This is a federal/state program.

Elderly or disabled adult resident of this state (or their caregiver).

Breast & Cancer Early Detention Program – Treatment

Department of Health -Bureau of Chronic Disease Prevention
4025 Esplanade Way
Mail to: 4052 Bald Cypress WY, Bin A18
Tallahassee, FL 32311

TEL: 850-245-4330

Full range of Medicaid healthcare services (physician care, lab services, emergency room, inpatient hospitalization, etc.) for qualifying women who do not qualify for the standard Medicaid program.

Diagnosed with breast or cervical cancer thru the Florida Breast and Cervical Cancer Early Detection Program.

Breast and Cervical Cancer Early Detection Program (BCCEDP)

Bureau Chronic Disease -Comprehensive Cancer Control
4025 Esplanade Way
Mail: 4052 Bald Cypress Way Bin A18
Tallahassee, FL 32311

TEL: 850-245-4330

Breast and cervical cancer screening exams including mammograms, Pap smears, and clinical breast exams. There are many BCCEDP sites throughout FL.

Applicant must be a woman age 50-64, must be uninsured, and must have an income at or below 200% of the Federal Poverty Level

Children with Special Health Care Needs Program- Title V

Department of Health -Division of Children’s Medical Services
Mail: 4052 Bald Cypress Way Bin A07
Tallahassee, FL 32399

TEL: 850-245-4200

Doctor visits, early intervention services, hospital care, immunizations, lab tests, prescription drugs, routine physical exams, screening services (genetic, metabolic, newborn hearing), therapy services, x-ray/diagnostic imaging, care coordination, family counseling, health education, social services, home health care, medical supplies, transportation.


Children under age 21 whose serious or chronic physical, developmental, behavioral or emotional conditions require extensive preventive and maintenance care beyond that required by typically healthy children.

Early Steps

Department of Health -Bureau of Early Steps & Newborn Screening
Mail: 4052 Esplanade Way/Bin A06
State of Florida, FL 32399

TEL: 800-218-0001

Diagnosis and evaluation; physical and occupational therapies, speech-language pathology and other appropriate services.


Children birth to age 3 who are experiencing developmental delays or who have a diagnosed condition that has a high probability of resulting in a developmental delay.

Florida Alliance for Assistive Services & Technology (FAAST)

FAAST, Inc.
820 E Park AVE -D200
Tallahassee, FL 32304

TEL: 844-353-2278

Examples of AT include (but not limited to): wheelchairs/motorized scooters; hearing aids; computers; home modifications (grab bars, ramps, widened doorways, etc.); aids for communication etc.

Resident of this state; physically or mentally disabled, regardless of age.

Florida KidCare

Healthy Kids Corporation
P.O. Box 980
Tallahassee, FL 32302

TEL: 888-540-5437

Comprehensive medical coverage including, but not limited to: Doctor/Dentist office visits; ambulance, urgent or emergency care, eye exams, well child checkups, hospital care, immunizations, lab services, pharmacy/prescriptions, x-rays, etc. 

Under age 19; meet family income eligibility requirements; U.S. citizen or qualified non-citizen (see website); not eligible for Medicaid; do not reside in a public institution. See program website for details.

Housing Opportunities for Persons with AIDS – FL HOPWA

Department of Health -Division of Disease Control & Health Promotion-Bureau of Communicable Diseases -HIV/AIDS Section
4025 Esplanade Way
Mail to: 4052 Bald Cypress Way
Tallahassee, FL 32399

TEL: 850-245-4422

Short-term assistance in paying rent, mortgage payments, utility payments, basic phone service and other payments essential to stable housing. Services are provided by locally funded agencies (e.g. Housing authorities, Health Departments, community-based organizations).

Resident of this state diagnosed with HIV/AIDS; household income meets income guidelines; and be homeless or at risk for homelessness. 

iCanConnect – FLORIDA

Helen Keller National Center for SE Region
PO Box 380
Concord, GA 30206

TEL: 516-393-7733

Provides hardware, software, applications, etc.; installation and training may be provided. Examples include: telephones (including wireless phones); interoperable video conferencing services; computers, access to the Internet, etc. 

Resident of Florida; have a combined vision and hearing loss that causes extreme difficulty in attaining independence in daily life activities or working; household income equal to or less than 400% of the FPL. See web site for details.

MEDICAID (Florida)

Agency for Health Care Administration
2727 Mahan Drive
Tallahassee, FL 32308

TEL: 888-419-3456

Comprehensive medical care, including, but not limited to, physicians, hospitals, lab and x-ray services etc. This is the original Medicaid program. There is no cost for those who meet income guidelines; however, co-pays may apply to some services.

A U.S. citizen or qualified alien who resides in this state and has low income, limited resources, and is included in one of the following categories: age 65 or over; families with dependent children; pregnant women; children under age 19; disabled adults; or have permanent kidney failure.

Medicare Savings Programs (MSP) (FL)

Agency for Health Care Administration
2727 Mahan DR
Tallahassee, FL 32308

TEL: 888-419-3456

QMB helps pay for Part A & B premiums, deductibles, copays, and coinsurance. SLMB and QI both help pay for Part B premiums only; however, their income guidelines differ. QDWI helps pay for Part A premiums. If you qualify for QMB, SLMB or QI, you automatically qualify for a federal program, Extra Help, which helps pay for Medicare prescription drug coverage.

For all 4 programs: Must be enrolled in or eligible for Medicare Part A and meet assets (resources) and income guidelines. Income limits vary by program. Resource limits are the same for QMB, SLMB, and QI but differ for QDWI. For QDWI, you must be disabled. See program web site for details.

PACE-FL- Program of All-Inclusive Care for Elderly

DOEA -Bureau Long-Term Care & Support
4040 Esplanade Way
Tallahassee, FL 32399

TEL: 800-963-5337

Primary and specialty medical care, emergency care, prescription drugs, physical therapy, adult day care etc.; i.e. all the care and services covered by Medicaid and Medicare. There are neither co-pays nor deductibles. If you are not on Medicaid, there is a premium for the long-term care portion of your care. For most enrollees, you must use PACE physicians. The program is voluntary and you can leave the program at any time.

Age 55 years or older who: require a “nursing facility level of care”; must be able to live safely in the community at the time of initial enrollment; and live in the service area of a PACE organization. You can be on Medicaid or Medicare or both; if you are in neither program, you may private pay. Note: “nursing facility level of care” is defined by the State’s Medicaid office.

Ryan White Part B Program

Department of Health -HIV/AIDS Section
4025 Esplanade Way
Mail: 4052 Bald Cypress Way /Bine A09
Tallahassee, FL 32399

TEL: 850-245-4422

Financial assistance for: specific HIV/AIDS related FDA approved prescription drugs; specific outpatient medical and support services; case management; insurance premiums/deductibles/co-payments; mental health services; substance abuse, etc.

Financial assistance for: specific HIV/AIDS related FDA approved prescription drugs; specific outpatient medical and support services; case management; insurance premiums/deductibles/co-payments; mental health services; substance abuse, etc.

SHINE – Serving Health Insurance Needs of Elders

Florida Dept. of Elder Affairs
4040 Esplanade Way
STE 270
Tallahassee, FL 32399

TEL: 800-963-5337

Assistance with Medicare: eligibility, enrollment, benefits; premiums, costs and claims; comparison of Part D prescription drug plans; Medigap supplemental insurance; health plan options; and programs which help pay Medicare premiums, deductibles, etc. Also, assistance with long term care options and help with filing for healthcare benefits such as prescription assistance programs.

Seniors 60 and over (disabled of any age) who reside in FL.

Specialized Telecommunications Equipment Distribution Program

Florida Telecommunications Relay, Inc. (FTRI)
1820 E Park AVE
STE 101
Tallahassee, FL 32301

TEL: 800-222-3448

Amplified phones, TTYS, voice carry-over (VCO) phones, hearing carry-over (HCO) phones, in-line amplifiers, ringers, specialized telephones on a case by case basis. Lead FL agency: Florida Public Service Commission.

Must be a permanent Florida resident, at least 3 years old, and certified as having a hearing loss or speech impairment.

Step Up For Students (SUFS)

SUFS
PO Box 54429
Jacksonville, FL 32245

TEL: 877-735-7837

Scholarships for children who are in foster care or who are homeless, grades K thru 12. There are two scholarship options: tuition & fees for a private school; or transportation costs to out-of-district public schools. Also, there are scholarship for students with special needs. See program web site for scholarship amounts. 

There is no income requirement for a child in qualified foster care nor for the homeless. Low income families may also qualify for scholarships; see web site for details.

Vaccines for Children Program (VFC) – FL

Bureau of Communicable Diseases -Immunization Section
4025 Esplanade Way STE 235
Mail to: 4052 Bald Cypress Way A-11
State of Florida, FL 32311

TEL: 877-888-7468

Diseases preventable by vaccines include: Diphtheria, hepatitis, influenza, measles, pneumococcal, mumps pertussis, polio, tetanus etc. A small administrative fee (amount regulated by State) may be charged; also an office visit charge may be applicable.

Children thru age 18 who meet one of the following criteria: child is Medicaid eligible; or uninsured; or American Indian or Alaska Native; or qualifying underinsured. See CDC web site for details: www.cdc.gov/vaccines/programs/vfc/index.html

Women Infants & Children Program (WIC) (FL)

Florida Department OF Health -Bureau of WIC Program Services
4025 Esplanade Way
MAIL TO: 4052 Bald Cypress Way, Bin A16
Tallahassee, FL 32311

TEL: 800-342-3556

Provides the following at no cost: health screening at initial appointment for all applying family members; nutritional foods; nutrition education; help finding health care; breast-feeding support.

Low income and nutritionally at risk; resident of this state; and are one of the following: pregnant, breast-feeding a baby under age 1, just had a baby, or have an infant or child under the age or 5. See web site for details.

"Vista Health Solutions" www.nyhealthinsurer.com Tel (888)215-4045 Email info@nyhealthinsurer.com