Understand the basics of health insurance
Understand the basics of health insurance
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What is health insurance?
In simple terms, health insurance is an agreement between you and a health insurance company. When you enroll in a health plan, the insurance company agrees to pay all or part of the cost for certain covered healthcare services, like preventive care, other covered medical services, and prescription drugs.
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What type of health plan is best for me?
There are four common types of health insurance plans: HMO, PPO, EPO, and POS plans. The right plan for you will depend entirely on your specific financial and healthcare needs.
If you expect to have more care needs than just preventive services, the best type of plan for you might have lower out-of-pocket costs.
If you’re healthy and don’t expect to need much care outside of preventive visits, a plan with a higher deductible and a lower monthly payment could help you save money while still giving you the coverage you need.
An exclusive Florida Blue agent can explain the differences between these types of plans and help you determine which one is right for your needs and budget.
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Why is it important to enroll in health insurance during the Open Enrollment Period (OEP)?
Enrolling in health insurance during OEP is important because it ensures that you have coverage for the entire year. If you miss the OEP deadline, you may not be able to enroll in a plan until the next OEP, unless you experience a qualifying life event that triggers a Special Enrollment Period (SEP).
Know the facts
Know the facts
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Health insurance helps keep you healthy! You get checkups, vaccines, yearly bloodwork, and cancer screenings at no extra cost. Plus, it pays part of your medical bills if you get hurt or sick. The average cost of an ER visit at a Florida hospital is $3,1001 and cancer treatments can cost hundreds of thousands of dollars.2
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If you get your health coverage through your job, your family members may qualify for a Marketplace plan with financial assistance.
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Licensed health insurance agents and navigators can walk you through your options and help you enroll in a plan.
Agents will not charge you a fee to help you. Only a Florida Blue agent sells Florida Blue plans. Work with an appointed and licensed Florida Blue agent to find the right plan for your needs and budget.
Key terms you should know
Key terms you should know
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Premium
A premium is money you pay your health insurance company regularly, usually monthly, to have your health insurance plan. Think of it like a membership fee — you’ll pay this amount every month to ensure you have coverage when you need it. If you have a Marketplace plan, you may be able to lower your costs with a premium tax credit (subsidy).
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Deductible
Most plans have an annual deductible — a set dollar amount you must pay toward your costs of covered services before insurance starts to pay. After you’ve paid this amount, you’ll pay a smaller portion of the costs of your care (a copay or coinsurance) until you reach your out-of-pocket maximum.
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Copay
A copay is a flat fee you pay for covered medical care and prescription drugs, usually before you meet your deductible. Often, you’ll have different copays for different types of care and sometimes prescriptions. Some plans require your deductible to be paid first before you pay copays. Some plans have $0 copays for certain services, like office visits. You could be eligible for reduced copays on your plan, based on your income.
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Coinsurance
Coinsurance is the part or percentage of covered medical or prescription drug costs you pay, usually after you meet your deductible.
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Out-of-pocket maximum
Good news! There’s a limit to what you could have to pay for care and prescriptions. Your out-of-pocket maximum is the most you’ll pay in a plan year for covered medical and prescription drug costs. Once you reach this amount, your health plan pays 100% of all covered services for the rest of the plan year.
Types of plans
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HMO: Health Maintenance Organization
Health maintenance organization plans, or HMO plans, offer a wide range of healthcare services through a specific, local network of participating healthcare providers, hospitals, and facilities. Generally speaking, you must have an in-network primary care physician with an HMO plan. Not only is your in-network primary care physician your main point of contact for your healthcare needs, but they also need to provide you with referrals should you need to see an in-network specialist.
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PPO: Preferred Provider Organization
Preferred provider organization plans, or PPO plans networks tend to be larger, so you have more doctors and hospitals to choose from. While you’re able to see out-of-network providers with a PPO plan, you may pay higher out-of-pocket costs than you would with in-network providers. With a PPO plan, you’re not required to have a primary care doctor and can see specialists without a referral.
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EPO: Exclusive Provider Organization
Exclusive provider organization plans, or EPO plans, are like HMO plans in that they have a specific network of providers that members must use, except in the case of an emergency. Outside of emergencies, if you go out-of-network, you will pay more. However, like with PPO plans, most EPO plans don’t require you to have an in-network primary care physician and you do not need a referral from a primary care physician to see a specialist.
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POS: Point of Service
Point of Service plans, or POS plans, are like a combination of HMO plans and PPO plans. An in-network primary care doctor is required however, you do not need a referral to specialists. Like with a PPO plan, you are able to see out-of-network specialists for a higher out-of-pocket cost.
Types of plans
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HMO: Health Maintenance Organization
Health maintenance organization plans, or HMO plans, offer a wide range of healthcare services through a specific, local network of participating healthcare providers, hospitals, and facilities. Generally speaking, you must have an in-network primary care physician with an HMO plan. Not only is your in-network primary care physician your main point of contact for your healthcare needs, but they also need to provide you with referrals should you need to see an in-network specialist.
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PPO: Preferred Provider Organization
Preferred provider organization plans, or PPO plans networks tend to be larger, so you have more doctors and hospitals to choose from. While you’re able to see out-of-network providers with a PPO plan, you may pay higher out-of-pocket costs than you would with in-network providers. With a PPO plan, you’re not required to have a primary care doctor and can see specialists without a referral.
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EPO: Exclusive Provider Organization
Exclusive provider organization plans, or EPO plans, are like HMO plans in that they have a specific network of providers that members must use, except in the case of an emergency. Outside of emergencies, if you go out-of-network, you will pay more. However, like with PPO plans, most EPO plans don’t require you to have an in-network primary care physician and you do not need a referral from a primary care physician to see a specialist.
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POS: Point of Service
Point of Service plans, or POS plans, are like a combination of HMO plans and PPO plans. An in-network primary care doctor is required however, you do not need a referral to specialists. Like with a PPO plan, you are able to see out-of-network specialists for a higher out-of-pocket cost.
More than just medical coverage
- Embedded adult dental and vision coverage on some health plans
- Pediatric dental and vision on most health plans
- Standalone dental plans available
Which health plan category is right for you?
Which health plan category is right for you?
Bronze
Lowest monthly premium
Highest costs when you need care
Bronze plan deductibles can be thousands of dollars a year
Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself
Silver
Moderate monthly premium
Moderate costs when you need care
Silver plan deductibles are usually lower than those of Bronze plans
Good choice if: You qualify for cost-sharing reductions — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered
Gold
Higher monthly premium
Lower costs when you need care
Gold plan deductibles are usually low
Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value
Platinum
Highest monthly premium
Lowest costs when you need care
Platinum plan deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans
Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered
Bronze
Lowest monthly premium
Highest costs when you need care
Bronze plan deductibles can be thousands of dollars a year
Good choice if: You want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself
Silver
Moderate monthly premium
Moderate costs when you need care
Silver plan deductibles are usually lower than those of Bronze plans
Good choice if: You qualify for cost-sharing reductions — or, if not, if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered
Gold
Higher monthly premium
Lower costs when you need care
Gold plan deductibles are usually low
Good choice if: You’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value
Platinum
Highest monthly premium
Lowest costs when you need care
Platinum plan deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans
Good choice if: You usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered
The Florida Blue difference
The Florida Blue difference
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Earn rewards toward healthcare costs.3
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As a Florida Blue member, you can save up to 50% on healthy lifestyle products with Blue365©, a health and wellness discount program.4 Enjoy year-round savings on gym memberships, fitness gear, eyewear, and more.
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Adult dental coverage and vision benefits included on select plans.
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Local Florida Blue Centers with in-person fitness and wellness classes, customer support, community resources to help with transportation, food, finances, and more.
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Wide network with thousands of doctors, hospitals, and specialists to choose from.
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Plus, you get an exclusive Florida Blue agent to work with — no obligation. Our agents are specially trained and are the only agents who can show you the savings and perks offered by Florida Blue.
Important dates for 2027 Open Enrollment period
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October 1, 2026
Open Enrollment for Off-Exchange members begins. This is the first day to enroll or change your insurance plan for 2027 if you enrolled directly with Florida Blue. -
November 1, 2026
Open Enrollment for On-Exchange members begins. This is the first day to enroll or change your insurance plan for 2027 coverage. -
December 15, 2026
The last day to enroll in a health plan for coverage that starts on January 1, 2027.
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January 1, 2027
If you’ve enrolled by December 15, 2026, this is when your 2027 coverage starts. -
January 15, 2027
This is the last day to sign up for a new health plan under the Open Enrollment Period.
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February 1, 2027
If you enroll between December 16, 2026 and January 15, 2027, your coverage is effective February 1, 2027.
Important dates for 2027 Open Enrollment period
-
October 1, 2026
Open Enrollment for Off-Exchange members begins. This is the first day to enroll or change your insurance plan for 2027 if you enrolled directly with Florida Blue. -
November 1, 2026
Open Enrollment for On-Exchange members begins. This is the first day to enroll or change your insurance plan for 2027 coverage. -
December 15, 2026
The last day to enroll in a health plan for coverage that starts on January 1, 2027. -
January 1, 2027
If you’ve enrolled by December 15, 2026, this is when your 2027 coverage starts. -
January 15, 2027
This is the last day to sign up for a new health plan under the Open Enrollment Period. -
February 1, 2027
If you enroll between December 16, 2026 and January 15, 2027, your coverage is effective February 1, 2027.
1www.debt.org/medical/emergency-room-urgent-care-costs
2www.healthcare.gov/why-coverage-is-important/protection-from-high-medical-costs
3Reward amounts available for individual ACA members 18 years or older. Excess amounts may be redeemed subject to the reward program,s terms and conditions.
4Blue365® offers access to savings on items that Florida Blue members may purchase directly from independent vendors. Blue365 does not include items covered under your policies with Florida Blue or any applicable federal healthcare program. Blue Cross and Blue Shield Association (BCBSA) and Florida Blue may receive payments from Blue365 vendors. Neither BCBSA nor Florida Blue recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. For more information about Blue365, go to FloridaBlue.com/disclaimer/blue365.
Policies have limitations and exclusions. Premiums may vary with the amount of benefits selected. Florida Blue and Florida Blue HMO are independent licensees of the Blue Cross and Blue Shield Association. Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc. an Independent Licensee of the Blue Cross and Blue Shield Association.
Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue and HMO coverage is offered by Health Options, Inc. DBA Florida Blue HMO. Both companies are Independent Licensees of the Blue Cross and Blue Shield Association.
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