Health and Dental Insurance

This section of the website contains information on the following:

Affordable Care Act (AKA “Obamacare”)

: These plans apply to individuals under age 65. As an exception, individuals over 65 who are not enrolled in Medicare Parts A and B can also apply for these plans. Please call us at 786-970-0740 (Cell) to learn more concerning eligibility requirements of individuals over age 65 for enrolling in ACA plans.

These plans are sold on what is called the “marketplace” or “exchange,” which is the only place where individuals who qualify for tax subsidies (called “advance premium tax credits”) can purchase insurance. Except for twenty-one jurisdictions [CA, CO, CT, DC, GA, ID, IL (effective January 1, 2026), KY, MA, MD, ME, MN, NJ, NM, NV, NY, PA, RI, VA, VT, and WA] these plans are purchased through www.healthcare.gov. Florida participates on healthcare.gov. See https://www.healthcare.gov/marketplace-in-your-state/ for more information.

Individuals who do not qualify for subsidies can buy EITHER on the marketplace or directly from insurance carriers. Buying directly from an insurance carrier is referred as to buying “off the exchange.” Note that any plan that complies with the Affordable Care Act (either on or off the marketplace) must comply with the law and must include what are called the ten “Essential Health Benefits.”

The Open Enrollment Period for 2026 plans runs between November 1, 2025 and January 15, 2026 on the Federal Facilitated Marketplace (healthcare.gov). Open enrollment is the ONLY time individuals can buy an Affordable Care Act plan without having what is called a “qualifying life event” (examples are moving to a different plan service area, getting married or divorced, birth of a child, losing Medicaid eligibility, etc.). Generally, open enrollment dates for “off-exchange” plans already follow the same dates as “on-exchange” plans, but The One Big Beautiful Bill Act (OBBBA) will require both on- and off-exchange plans in the same jurisdiction to have the exact same dates.

NOTE: Until January 1, 2019 there was a federal tax penalty for individuals who did not purchase an Affordable Care Act plan or who qualified for another type of plan (such as Medicaid or healthcare/medical cost sharing) that was either recognized as meeting Affordable Care Act requirements or was exempted under the Act. CA, DC, MA, NJ, and RI have state tax penalties. VT statute requires state residents to enroll in Affordable Care Act-compliant plans, but there is presently no penalty for non-compliance.

The following are alternatives to Affordable Care Act coverage:

Short-Term Health Insurance

: The Administration announced on August 7, 2025 they are not prioritizing enforcement of regulations issued by the Biden Administration effective September 1, 2024 limiting the duration of short-term health-insurance plans to three months plus one renewal month. Accordingly, carriers now offer plans with the same durations they were offering prior to the effective date of the Biden regulations. These plans do not provide all the essential health benefits required for ACA plans (e.g., preventive care, prescription drug coverage, and maternity benefits) but are considerably less expensive than non-subsidized or lowly-subsidized Affordable Care Act plans. These plans are regulated by State Insurance Commissions. and provisions vary between states. Florida permits these plans to be bought for up to three years (with three one-year plans). However, states are permitted to mandate shorter durations, make these plans available only at certain times of the year, or, like California, not offer these plans at all.

Health (Hospital-Surgical) Defined Benefit Indemnity Plans

: In today's market where health insurance is often unavailable or not affordable, a Health (Hospital-Surgical) Defined Benefit Indemnity plan can help families budget and pay for health care expenditures. By providing a choice between different levels of hospital, medical and outpatient coverage, individuals and families can choose a plan according to their health care needs.

Note: these are not major medical plans and are legally referred to as Limited Benefit plans. They do not comply with the Affordable Care Act (for example they do not include all the minimum essential benefits).

Eligibility for these plans is based on medical underwriting and not all those who apply will be eligible for coverage. The plans have a 12-month pre-existing condition limitation, and pre-existing conditions are not covered until the policy has been in effect for 12 consecutive months.

Association Plans Available To Individuals And Families

: We offer four major medical PPO plans provided through the AFI Association and several limited day benefits plans offered through the BMI Association. These plans permit enrollment on a year-round basis and require successfully answering health questions to qualify. The plans utilize Cigna’s largest national network. They permit continuous enrollment (i.e., annual re-enrollment is not required), and members can remain enrolled with no age limit. They’re a very attractive option for those who desire more comprehensive coverage but either seek lower premiums than they would pay with an Affordable Care Act plan or who want to apply outside of open enrollment but don’t have a qualifying life event that would permit them to enroll in an ACA plan. None of these plans are available in Washington state. These programs require answering medical questions to qualify. Enrollment must occur by the 20th of the month for coverage to begin the first of the following month; future payments (first payment is made with the application) and succeeding months’ payments are taken out as of the 15th of each month.

SunCARE

: We’ve recently introduced four programs offered by SunCARE which are exclusive to Sunshine Life & Health Advisors, LLC. These programs are designed to be lower-cost alternatives to Affordable Care Act plans for those who either receive no tax subsidies or want to find lower-cost alternatives to Affordable Care Act plans. Here are links to information and pricing for these four programs, listed in order of highest price and benefit level to lowest price and coverage level (the MedMax plan is the most popular of these four plans) :

• MedAccess
• MedMax
• MedValue
• America’s Health and Wellness

The first plan utilizes a Cigna network, whereas the others use the First Health Network, which is owned by Aetna. With the exception of America’s Health and Wellness plan, which has one health question, all of these plans require successfully answering health questions to qualify.

Enrollment must occur by the 25th of the month for coverage to begin the first of the following month, but during Open Enrollment individuals can enroll up to the 28th of the month. Payment for the first month of coverage is made with the application, and payments for succeeding months are made as of the 15th of the month.

Performance Health is the third party administrator for these plans.

Plans For Employees

: We offer programs of two different companies that offer contributory healthcare coverage to part-time employees who agree to participate in monthly health questionnaires as a condition of employment and are paid for these activities. Depending on the company, these individuals receive either 1099’s or K-2’s and must report this as income on their tax returns.

Medical Cost Sharing

: We also offer medical cost sharing programs offered by Zion Health Share and One Share in Florida. We also offer these programs, as well as programs offered by Sedera, in most other states, and availability differs by state and program. These programs aren’t regulated by state departments of insurance but some states don’t permit offering these programs in their jurisdiction. These are not insurance programs but, instead, members participate in a community of like-minded people that share medical expenses. These programs can be up to 50% or more less expensive than traditional health insurance.

Supplemental Plans

:  These plans do not include all the ten Essential Health Benefits and do not otherwise comply with the Affordable Care Act. They include supplemental benefit plans like critical illness; cancer; accident medical expense, hospital illness indemnity plans. and hospital sickness plans. Plans can be bought up to age 65 in almost every state and some can be bought after age 65 depending on the carrier and the state. Except for accident medical expense most of these types of plans require answering health questions to qualify.

Dental, Vision, and Hearing Plans

: Dental, vision, and/or hearing plans can be bought on either an insured basis or as discount plans. They can be purchased any time during the year, and in most cases are available to persons of all ages.

Please contact us at 786-970-0740 (Cell) if you’d like more information about any of alternatives or for help enrolling in any of these options.