Health Insurance

What Does Comprehensive Healthcare Insurance Cover in Florida?

Read Time

8 Minutes

Written by

Team Curative

Published

Jan 19, 2024

Are you dealing with the stress of choosing an insurance plan that’s right for your talent? It’s not an easy decision, especially when trying to dissect complicated policy terms.

Often, the health insurance Florida employers offer comes with deductibles, specialist care limits, prescription costs, and other terms that can be pretty confusing. If your primary goal is to offer an environment that promotes well-being, you need to understand what your chosen plan is all about.

At Curative, we believe in simplicity. That’s why we’ve put together this guide to help you understand what a comprehensive healthcare insurance policy covers in Florida.

What does comprehensive healthcare coverage mean?

Understanding insurance plans can feel like assembling a jigsaw puzzle with a few pieces missing. On the surface, the word “comprehensive” seems straightforward – a no-brainer for employers deciding on coverage that best supports their talent. But it’s important to understand what’s under the hood of a comprehensive healthcare plan.

Here’s a snapshot:

Preventive care: Coverage for regular screenings, check-ups, and vaccinations is a critical step in preventing potential health issues.
Hospital care: This can include coverage for inpatient stays, surgery, medication, and hospital services.
Emergency services: Comprehensive coverage can provide peace of mind during unexpected medical events.
Prescription medication: Most comprehensive plans cover all or a portion of the cost of prescription drugs.
Mental health and addiction treatment: This can include counseling, therapy, rehabilitation, and medication.
Maternity and newborn care: Prenatal and postnatal care are critical to the health of the mother and baby.

If you’re an employer, you want the best health insurance Florida has to offer. The comprehensive plan you choose should support your organization’s health and wellness goals and also make sense for your budget.

Beach boardwalk in Florida Miami Broward county with sunny day and people walking on promenade coast by cafe and restaurants exercising

The state of health in Florida

A diverse population and large senior demographic make Florida’s healthcare landscape unique. Unfortunately, the state’s healthcare system is underfunded, which means public health initiatives are typically weak. Residents rely heavily on employer-based insurance plans to get the care they need.

To get a better understanding of how employer-based insurance affects overall health, Curative conducted a survey of employees residing in Orlando, Tampa, and Miami.

Here are some key findings:

55% say their out-of-pocket costs have become too expensive.
38% say they need to dip into savings or use credit cards to cover cost-sharing burdens imposed by the insurer.
32% of respondents with employer-based insurance have outstanding medical debt.
44% say they don’t understand what’s covered by their policy.
40% report having to jump through hoops to get the care they need.

These numbers indicate significant financial and healthcare challenges faced by Floridians.

The rising cost of pharmaceuticals adds to this struggle. According to data released by AARP, 29% of Floridians stopped prescription drugs due to the cost. The average annual cost of prescription drug treatment rose by 57.8% between 2012 and 2017, though the annual income for Floridians only increased by 12.7%.

Health disparities

Studies have exposed disparities related to healthcare among racial and ethnic groups in Florida. Based on the state’s demographics, Black and Hispanic Floridians have disproportionately higher rates of diabetes and heart disease.

Mental health

Florida’s mental healthcare system is under serious strain. The American Psychological Association ranked the state 49th in the country in overall access to mental health services. Healthcare officials have an uphill battle in their efforts to overhaul the system.

Does insurance cover specialist visits?

In Florida, comprehensive healthcare insurance commonly encompasses specialist visits. These specialized consultations involve doctors who practice in specific branches of medicine, such as cardiology, neurology, or dermatology.

While most insurance covers this type of care, the extent of the coverage depends on the plan. It’s important to fully understand your coverage details for specialist care to ensure your talent can take full advantage of the policy you choose.

The main points to consider include:

Types of specialists covered by the policy
Whether the copay is different for specialist visits
Deductibles, coinsurance, and out-of-pocket amounts

Find out which local specialist doctors are in-network. Accidentally seeing an out-of-network specialist can result in the insured having to pay for the entire cost of the visit.

Does insurance cover prescription drugs?

For people with ongoing health issues like high blood pressure or diabetes, medication is a big part of preventive health. The long-term use of prescription drugs could be the difference between a high quality of life and constant struggle.

Comprehensive healthcare insurance plans cover prescription drugs, but terms change based on the policy. Even if you’re covered, you could end up spending a significant amount, especially if you require ongoing prescriptions. These costs are often related to copays and out-of-pocket expenses.

Copays

A prescription copay is a fixed amount you pay for your prescriptions. Some policies impose varying copays based on whether a drug is generic or brand-name. This can sometimes cause issues, especially if a generic drug suddenly becomes unavailable. In these cases, it’s important to speak to your doctor and navigate a safe medication change so you can continue to receive coverage.

Out-of-pocket expenses

This refers to the total cost you pay for prescriptions not covered by your policy. Usually, these costs include copays and deductibles. Once the insured has reached the annual maximum out-of-pocket amount defined by their policy, their insurance provider will cover their remaining prescriptions.

Members often have to travel to pick up prescriptions or see a provider, but employees with comprehensive insurance plans often have telehealth appointments available and can access mail-order prescription plans.

How does network coverage work?

A key element of any comprehensive healthcare plan involves the type of network coverage it provides. This is a serious consideration for employers looking for a plan that suits their talent and budget.

Network coverage is a big differentiator between PPO and HMO plans. PPO plans are typically more expensive, but the insured may have the option to receive care from providers who are both in and out of the plan’s network. Additionally, these plans may not require the insured to get a referral for specialist care.

HMO plans typically have lower monthly premiums, but the insured is only covered for care given by in-network providers. These plans also require referrals by a primary care physician if specialist care is required.

Employers must carefully consider the type of network coverage their plan offers. Insurance plans with a small, local network may be less expensive but limits their employees’ care options. However, small networks may result in a closer relationship between the insured and their primary care physician and preventive health.

Businesses with a national reach should consider PPO plans. This gives their talent access to national in-network providers and flexibility when seeking out specialist care.

Does insurance cover COVID-19 testing?

In our post-pandemic world, COVID-19 testing remains a necessity. The virus hit Florida hard, and many residents with preexisting health conditions continue to wear masks and test regularly. Employers are also taking measures to protect their talent.

During the pandemic, insurance plans covered the cost of COVID-19 testing and vaccinations. However, since the end of the Public Health Emergency (PHE) declaration on May 11, 2023, things have changed for many.

While coverage for COVID-19 testing, vaccination, and treatment remains prevalent, the post-pandemic landscape is in flux. Individuals and employers should stay on top of policy changes and coverage breakdowns to maintain the most comprehensive healthcare solutions for themselves and their talent.

About Curative

The takeaway – comprehensive healthcare insurance is about more than coverage; it’s about promoting overall wellness and preventive care and contributing to better health outcomes for your talent.

Curative wants its members to love taking advantage of their healthcare insurance benefits. Our plan focuses on affordability, engagement, and simplicity to deliver better health and well-being.

No copays. No deductibles. No...really. Curative is changing the way we view health insurance.

To see all disclaimers, please view here.

References

AARP Florida Shows Impact of Skyrocketing Drug Prices on Floridians with New Data and Infographic (2019, August 21). Florida. https://states.aarp.org/florida/aarp-florida-shows-impact-of-skyrocketing-drug-prices-on-floridians-with-new-data-and-infographic

Total Diabetes Deaths by Race/Ethnicity | KFF. (2023, May 15). KFF. https://www.kff.org/other/state-indicator/diabetes-death-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Total Heart Disease Deaths by Race/Ethnicity | KFF. (2023, May 15). KFF. https://www.kff.org/other/state-indicator/number-of-heart-disease-deaths-per-100000-population-by-raceethnicity-2/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

Van Sant, J. (2023, August 28). Officials work to improve Florida’s mental health care system. Spectrum Bay News 9. https://baynews9.com/fl/tampa/news/2023/08/28/florida-ranks-49th-in-the-nation-for-mental-healthcare-