Here for You, Every Step of the Way
Guiding you through complex coverage choices with
expert support and genuine care.
Services
What We Do
We simplify health coverage so you can focus on what matters most
Health Insurance
Personal Health Coverage
Protect you and your family from unexpected medical expenses
Medicare
Medicare Guidance Plan
Helping you find the plan that fits your health needs
Who We Help
Coverage for Everyone
Personalized Insurance Coverage for Diverse Need in Florida
Individuals
Personal health coverage
Flexible plan designed to meet your unique health and budget requirements
Families
Family health protection
Comprehensive coverage that supports your family's health and financial well-being
Small Businesses
Group health solutions
Affordable and comprehensive health plans to support your team's wellness
Why Choose Us
Your Trusted Insurance Partner
The health insurance market is complicated and constantly changing. As a local agency, we stay up to date and
provide expert advices, reliable services, and guidance every step of the way.
Local Expertise
Comprehensive understanding of Florida's health insurance landscape
Reliable Service
Transparent and straightforward insurance solutions
Personalized Support
Dedicated guidance customized to your unique needs
FAQs
Common questions about health insurance and coverage options in Florida
What is ACA health insurance?
ACA health insurance refers to plans available through the Health Insurance Marketplace. These plans cover essential health benefits, provide preventive care at no cost, and guarantee coverage for pre-existing conditions.
Who qualifies for ACA coverage?
Anyone who is a U.S. citizen or legal resident and not eligible for Medicare or certain employer-sponsored coverage can apply. Eligibility for financial help depends on household size and income.
Are pre-existing conditions covered?
Yes. All ACA Marketplace plans must cover pre-existing conditions. Insurance companies cannot deny
coverage or raise premiums based on your health history.
What financial help is available?
Premium Tax Credits lower your monthly premiums. Cost-Sharing Reductions (CSRs) lower
deductibles, copays, and out-of-pocket expenses (available on Silver plans if you qualify).
When can I enroll?
Open Enrollment Period: Usually November 1 – January 15 (dates may vary by state). Special Enrollment Period: Available year-round if you experience a qualifying life event such as losing coverage, marriage, or moving.
What do ACA plans cover?
All plans cover 10 essential health benefits, including preventive care, doctor visits, hospitalization, prescription drugs, maternity and newborn care, mental health services, and pediatric care.
How much does coverage cost?
Costs vary by age, household size, location, and income. Many people qualify for subsidies, and some
clients pay under $50/month for comprehensive coverage.
Will I pay a penalty if I don’t have coverage?
The federal penalty was eliminated in 2019. However, some states (CA, MA, NJ, RI, and DC) may
charge a penalty for being uninsured.
Can I keep my doctor?
It depends on the plan’s network. Before enrolling, we’ll help you check whether your preferred doctors and hospitals are included.
What do ACA plans cover?
All plans cover 10 essential health benefits, including preventive care, doctor visits, hospitalization, prescription drugs, maternity and newborn care, mental health services, and pediatric care.
What’s the difference between Bronze, Silver, Gold, and Platinum plans?
Bronze: Lowest premiums, highest out-of-pocket costs.
Silver: Balanced coverage with extra savings.
Gold: Higher premiums, lower out-of-pocket costs.
Platinum: Highest premiums, very low out-of-pocket
costs.
What is Medicare?
Medicare is a federal health insurance program for people 65 or older, some younger people with
disabilities, and individuals with End-Stage Renal Disease (ESRD) or ALS.
What are the parts of Medicare?
Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing, hospice, and some home
health care.
Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical
supplies.
Part C (Medicare Advantage): Private insurance plans bundling Part A & B, often with extra benefits like
dental, vision, and hearing.
Part D (Prescription Drug Coverage): Helps cover the cost of medications.
What is the difference between Original Medicare and Medicare Advantage?
Original Medicare (Parts A & B): Government-run, lets you see any provider that accepts Medicare
nationwide. Doesn’t include drug coverage (Part D is separate).
Medicare Advantage (Part C): Offered by private insurers, often includes prescription drug coverage
and extra benefits, but may have provider networks.
When can I enroll in Medicare?
Initial Enrollment Period (IEP): 7 months around your 65th birthday (3 months before, your birthday
month, and 3 months after).
General Enrollment Period (GEP): Jan 1 – Mar 31 each year if you missed your IEP. Coverage now
begins the month after you enroll (changed in 2023).
Special Enrollment Periods (SEP): If you delay Medicare due to employer coverage or other qualifying
events.
Annual Election Period (AEP): Oct 15 – Dec 7 each year, when you can change or join Medicare
Advantage or Part D.
Does Medicare cover prescription drugs?
Not under Original Medicare alone. You need either a Part D plan (stand-alone drug coverage) or a
Medicare Advantage plan that includes drug coverage.
Does Medicare cover dental, vision, or hearing?
Original Medicare does not cover routine dental, vision, or hearing services. Many Medicare Advantage
plans include these benefits.
Do I need a Medicare Supplement (Medigap) plan?
If you choose Original Medicare, you may want a Medigap plan to cover costs like copayments,
coinsurance, and deductibles. Medigap is not available if you enroll in a Medicare Advantage plan.
How much does Medicare cost?
Part A: Usually free if you or your spouse paid Medicare taxes for at least 10 years.
Part B: Standard premium applies (set annually by Medicare, often deducted from Social Security).
Part C & D: Costs vary by plan, insurer, and coverage.
Will Medicare cover me if I travel?
Original Medicare: Covers you anywhere in the U.S. (not abroad).
Medicare Advantage: Coverage depends on your plan’s network and rules.
Travel Coverage: Some Medigap plans include limited foreign travel benefits.
How do I choose the right Medicare plan?
Choosing depends on your preferred doctors/hospitals, prescription needs, desired extras (dental,
vision, fitness), and budget (premiums vs. out-of-pocket costs). At Forge Health Insurance, we’ll guide
you step-by-step to compare options and make the choice that’s best for you.
Why should my small business offer health insurance?
Offering health insurance helps attract and retain employees, improve satisfaction and productivity, and
may provide tax advantages while keeping your business competitive.
What options do small businesses have for health insurance?
Group Health Insurance Plans: Traditional employer-sponsored coverage for employees.
ICHRA (Individual Coverage HRA): Employer sets a budget; employees pick their own ACA plan and
get reimbursed.
QSEHRA (Qualified Small Employer HRA): For businesses with fewer than 50 employees, allows
tax-free reimbursements for individual coverage.
ACA Marketplace Coverage: Employers may guide employees to individual plans, though this is less
common if you want to contribute financially.
How many employees do I need to offer a group plan?
Generally, you need at least one full-time W-2 employee (not including the owner or spouse) to offer a
group health plan.
Am I required to offer health insurance as a small business?
Businesses with fewer than 50 full-time equivalent employees are not required to offer insurance.
Those with 50 or more may face penalties if affordable coverage is not provided.
What are the tax benefits for my business?
Employer contributions for coverage are typically tax-deductible. ICHRA and QSEHRA contributions
are also tax-free for employees. Small businesses may qualify for the Small Business Health Care Tax
Credit.
Can I include myself as the owner in coverage?
C-Corp Owners: Yes, you’re considered an employee.
S-Corp Owners (2%+ ownership): Generally not eligible for tax-free reimbursements.
Sole Proprietors/Partnerships: Owners can’t directly use tax-advantaged plans but may offer coverage
to employees.
How much does small business health insurance cost?
Costs depend on the number of employees, their ages, location, and the type of plan. Employers can
set their contribution levels, especially with ICHRA and QSEHRA.
What’s the difference between ICHRA and QSEHRA?
ICHRA: Available to businesses of any size, no contribution limits, very flexible.
QSEHRA: Only for businesses with fewer than 50 employees, with IRS-set annual contribution limits
Will Medicare cover me if I travel?
Original Medicare: Covers you anywhere in the U.S. (not abroad).
Medicare Advantage: Coverage depends on your plan’s network and rules.
Travel Coverage: Some Medigap plans include limited foreign travel benefits.
How do I decide which option is right for my business?
It depends on your goals:
- Predictable costs → ICHRA or QSEHRA
- Traditional benefits → Group plan
- Employee flexibility → ICHRA
- Very small team → QSEHRA might be simplest
What is a Health Savings Account (HSA)?
An HSA is a tax-advantaged savings account that allows you to set aside pre-tax money to pay for
qualified medical expenses. You must be enrolled in a High Deductible Health Plan (HDHP) to open
and contribute to an HSA.
What are the benefits of an HSA?
HSAs have a triple tax advantage:
- Contributions are tax-deductible (or pre-tax through payroll).
- Growth (interest and investments) is tax-free.
- Withdrawals for qualified medical expenses are tax-free.
Funds roll over year to year, accounts are portable, and balances can be invested.
Who is eligible for an HSA?
You must be enrolled in a High Deductible Health Plan (HDHP), not enrolled in Medicare, not be
claimed as a dependent on someone else’s tax return, and not have other disqualifying health coverage
(like certain FSAs).
How much can I contribute to an HSA (2025 limits)?
Individuals: $4,300 per year
Families: $8,550 per year
Catch-up contribution: Extra $1,000 if age 55 or older
These limits are adjusted annually by the IRS.
What expenses can I use HSA funds for?
Qualified medical expenses include doctor visits, hospital bills, prescriptions, dental and vision care,
mental health services, some over-the-counter medications, long-term care premiums, and COBRA
premiums.
Can I invest the money in my HSA?
Yes. Once your balance reaches a minimum threshold (varies by bank), you can invest HSA funds in
mutual funds, stocks, or other investments. Growth is tax-free.
What happens if I use my HSA for non-medical expenses?
Before age 65: Non-qualified withdrawals are taxed and subject to a 20% penalty.
After age 65: You can withdraw for any reason without penalty, but non-medical withdrawals are taxed
as income.
How is an HSA different from an FSA?
HSA: Owned by you, rolls over year to year, portable, higher contribution limits, tied to HDHPs.
FSA: Employer-owned, usually ‘use it or lose it,’ lower contribution limits.
Can employers contribute to an HSA?
Yes. Employer contributions are also tax-free and count toward the annual IRS contribution limit.