What is Florida Medicaid?
- Who it’s for: Very low-income children, pregnant women, parents/caretakers, seniors and people with disabilities. Because Florida hasn’t opted into the ACA’s Medicaid expansion, non-disabled adults without minor children generally aren’t eligible regardless of income.
- Income limits for parents/caretakers (effective April 2025):
- 1-person household: $355/month
- 2-person household: $476/month
- 4-person household: $719/month
- Costs: Typically no monthly premium and very small or no co-pays.
- Benefits: Covers all ACA “essential health benefits” plus extras such as non-emergency transportation and long-term care services.
What is Obamacare (ACA Marketplace) Coverage?
- Who it’s for: Floridians who aren’t eligible for Medicaid or job-based insurance, with subsidies available on a sliding scale up to at least 400 % of the Federal Poverty Level (FPL), and—thanks to the Inflation Reduction Act—often beyond. Enhanced tax credits last through the 2025 plan year.
- Enrollment window:
- Open Enrollment: Nov 1 – Jan 15 each year (coverage can start Jan 1 or Feb 1 depending on sign-up date).
- Special Enrollment Periods: Anytime you have a qualifying life event (job loss, marriage, move, etc.).
- Costs: Premiums and out-of-pocket costs vary by plan level (Bronze/Silver/Gold), but most Floridians who enroll receive federal subsidies that cap their premium at 0 %–8.5 % of household income.
- Benefits: All ten essential health benefits (doctor visits, prescriptions, maternity care, mental health, etc.). No upper limit on pre-existing conditions.
Side-by-Side Snapshot (2025)
| Feature | Florida Medicaid | Obamacare Marketplace |
|---|---|---|
| Main Eligibility Test | Income & specific category (child, pregnant, parent, aged, disabled) | Household income up to ≥ 400 % FPL; must not qualify for Medicaid or affordable job plan |
| Adult Income Cut-off | ~30 % FPL (e.g., $355/mo for a single adult) | 100 % FPL minimum in non-expansion states; subsidies phase out above 400 % FPL |
| Monthly Premium | $0 (most groups) | $0–$$ depending on subsidy & plan |
| Typical Cost-Sharing | Minimal or none | Deductible & co-pays vary; extra “cost-sharing reductions” if income ≤ 250 % FPL |
| When You Can Enroll | Anytime once eligible | Open Enrollment (Nov 1–Jan 15) or SEP |
| Key Extras | Long-term care, non-emergency transport | Broad provider networks & plan choice |
Beware the “Coverage Gap” in Florida
Because Florida didn’t expand Medicaid, adults below 100 % FPL who don’t meet a categorical Medicaid rule fall into a gap: they earn too much for Medicaid but not enough for ACA subsidies. If you’re in this situation, call us—some families can still piece together coverage through children’s Medicaid/CHIP, employer plans or limited-duration policies until your income changes.
Choosing the Right Path
| If you… | Likely Best First Step |
|---|---|
| Have very low income and are pregnant, a parent, a child, aged or disabled | Apply for Medicaid immediately |
| Are an adult without minor children and make ≥ 100 % FPL | Shop the ACA Marketplace for subsidized plans |
| Recently lost Medicaid due to the “unwinding” reviews | Check Marketplace special enrollment—many plans are $0–$10/monthafter subsidies |
| Fall into the coverage gap (< 100 % FPL) | Call us; we’ll explore options like spouse coverage, part-time employer plans, or income strategies to reach ACA subsidy range |
How MyEasyRate Insurance Can Help
Understanding Florida’s rules is tricky—but you don’t have to figure it out alone. Our licensed health-insurance advisors will:
- Check your household eligibility for Medicaid or Marketplace subsidies.
- Compare every on-exchange plan, including HMO, PPO and EPO options.
- Enroll you by phone or online in minutes—often at no cost to you.
☎ Call (305) 218-4460 or visit MyEasyRate.com today to get your free, no-obligation review and start the coverage you deserve.
This article is for general information only. Eligibility numbers are current as of April 2025 and may change. Always confirm final qualification and premiums during your application.
