You can still get a nationwide PPO in Florida. Here is how investors and property managers here are choosing coverage in a market where prices climbed and vary sharply by county.
Hi, I'm Sam Jaber. I'm a Tampa health insurance broker, and I help real estate investors and property managers who have to buy their own coverage. I'm licensed in 36 states and I do everything over the phone.
Florida investors face an odd combination this year. The income side is lumpy: monthly rents, the occasional sale, and expenses that can make a portfolio look small on paper. The insurance side got more expensive, and how expensive depends heavily on which county you call home. Here's how investors are making sense of both.
First, the good news: you can still get a nationwide PPO in Florida, through me, and for a healthy investor it's often priced well below what the marketplace charges for its own PPO.
The marketplace version comes from a single insurer in every county, and its markup over other plans swings widely depending on the county. In Lee County it costs 122% more than the least expensive silver plan on another network. In Collier the gap is 101%, and in Sarasota 78%. Across all 67 counties it ranges from 31% to 191%.
The alternative is a medically underwritten private plan built on a national PPO network. It's priced on your health rather than your county's marketplace rates, and it travels with you when you're checking on properties elsewhere.
HealthCare.gov sets the premium tax credit using your household's modified adjusted gross income for the coverage year. For an investor, that's a moving number. Rental income and expenses are generally reported on Schedule E, where repairs, management, interest and depreciation can shrink what's left. A sale can add a large gain in one year. Wages and a spouse's income count too.
This year the answer matters more in Florida. The regulator's figure is an average approved increase of 34.1% on individual plans, before any subsidy, weighted by enrollment. The credit absorbs a good part of that for those who qualify. The rest pay the full increase.
Choose the scenario that fits your year.
A closing that adds a big gain can put you far past the credit range for that year, and then you see Florida's new full prices with nothing to soften them. If the household is healthy, this is the year to price an underwritten nationwide PPO.
You'll complete health questions on the application, and the insurer can approve, decline, or approve with a condition excluded. When the answers are good, the price can come in under the marketplace's full rate. Benefits differ between plans, so we compare them carefully before you commit.
Next step: Call me before the sale closes, and I'll price a nationwide PPO against the marketplace plans in your county for the year you're about to have.
In a year without sales, your income may land in the credit range, and then a marketplace plan is generally the less expensive choice, because the credit only applies on HealthCare.gov.
Two Florida points to watch. Most of the marketplace is HMO coverage, 316 of 410 plans, so check that your doctors are in network before deciding on price. And if you do sell partway through the year, update your estimate, because a gain you didn't report can turn part of the credit into a tax bill.
Next step: Send me your expected rents and any possible sales, and we'll choose a plan that fits the year and your doctors.
A year of major repairs, new purchases and depreciation can leave very little taxable income. In Florida that can backfire. The state has not expanded Medicaid, and the marketplace credit generally starts at 100% of the federal poverty level. A household that lands below that line may qualify for neither one.
Your tax preparer decides how the year is reported. My job is to make sure you know what that number means for your coverage before you enroll.
Next step: Call me once you and your preparer have a sense of the year, and we'll see what you qualify for before you apply.
If you or a family member manages a chronic condition, stay on the marketplace even when the credit is gone. It can't decline anyone or price by health, and underwritten plans can.
In Florida that usually means deciding whether your county's HMO or EPO plans cover your specialists, or whether the marketplace PPO's higher price is worth paying for access to a particular doctor.
Next step: Tell me your doctors and medications, and I'll show you which plans in your county keep them in network.
Some investors live in one county and own property in several others. Your coverage options and prices are set by where you live, and in Florida the gap between the marketplace PPO and everything else depends a great deal on that county. Add the full-price increase and the lack of a Medicaid expansion, and an investor's health insurance decision in Florida rests on two things: an honest read of the year's income and a clear look at your health.
Straight answers, no sales pitch.
Yes. HealthCare.gov uses modified adjusted gross income, and a gain from a sale adds to it for that year, which can move you past the credit range.
That one belongs with your tax preparer. The deduction for self-employed people draws on business profit, while rent usually lands on Schedule E instead, so whether it works for you depends on how your income is set up.
No. Compared with the least expensive plan on another network in the same county, its markup ranges widely from county to county. A nationwide PPO priced on your health is the other route for a healthy investor.
Plan before you enroll. Florida hasn't expanded Medicaid, and the credit generally isn't available under the poverty level, so a very low year can leave a gap.
Your home county, last year's return, any sales you expect, and who needs coverage. I'll show you which route fits and price it where you live, and if your current plan already makes sense, I'll tell you so.
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