Florida Healthy Kids

Full-Pay Program

Current Costs

Aetna Better Health of Florida and Simply Healthcare Plans provide full-pay coverage statewide and Community Care Plan provides full-pay coverage in the following eight Southeastern Florida counties: Broward, Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach, and St. Lucie.

The Florida Healthy Kids full-pay plan provides health and dental insurance for Florida children who do not qualify for subsidized coverage because of their household size and income.

Florida Healthy Kids remains committed to continuing the full-pay plan and works hard to offer high quality and competitively priced health insurance that is child-centered, including comprehensive medical, dental and the services children need at each stage of growth and development.

Benefits and Cost Comparison

Hospital Inpatient Medical and Surgical Care

Semi-private room, Pre-authorized, includes 15 day rehabilitation stay for non-acute confinement

$0

Primary Care Provider (PCP) Office Visit

Offices visits for minor illness, accident care

$5 copay/visit

Well-Child Care (PCP) Office Visit

$0

Routine Vision and Hearing Screening performed by your Primary Care Provider

$0

Diagnostic Testing

i.e. Laboratory, X-rays, etc

$0

Specialist Office Visit

Must be referred by your PCP

$5 copay/visit

Prenatal Care and Delivery

Up to 3 days maximum – limited to vaginal delivery

$0

Rehabilitative Services

Physical, Occupational, Respiratory and Speech Therapies. Limited to 24 treatment sessions within a 60-day period per episode or injury)

$5 copay/ visit

Chiropractic Visit

Shall be provided in the same manner as in the Florida Medicaid program – 24 visits/year

$5 copay/visit

Podiatry Visit

Limited to 1 visit per day, totaling 2 visits per month for specific foot disorders.

$5 copay/visit

The Emergency Room

Copayment is waived if authorized by Primary Care or patient is admitted

$10 copay/visit

Emergency Ambulance Services

$10 copay

Behavioral Health Services - Outpatient Visits

$5 copay/visit

Behavioral Health Services - Inpatient

$0

Substance Abuse Services - Outpatient

$5 copay/visit

Substance Abuse Services - Inpatient

$0

Refractions (Vision Testing)

$5 copay/visit

Corrective lenses or frames

After failing vision screening by PCP – 1 pair every 2 years or when head size or prescription changes warrant. Coverage is limited to Medicaid frames with plastic or SYL non-tinted lenses.

$10 copay/visit

Hearing Aids

$0

Organ Transplants

Includes pre-transplant, transplant and post–transplant services and treatment when authorized by insurer at approved facility.

$0

Prescription Drugs - Up to a 31 day supply

Coverage includes all drugs available under the Florida Medicaid program. Generic or brand name when generic is not available.

$5 copay

Durable Medical Equipment and Prosthetic Devices

Pre-authorized medically necessary equipment

$0

Skilled Nursing Facility Service

Must meet Skilled Care criteria - Limited to 100 days per contract year

$0

Home Health Services

Must meet Skilled Care criteria

$5 copay/visit

Hospice Services

Must meet Skilled Care criteria

$5 copay/visit

Frequently Asked Questions

  1. What are my alternative options for coverage?
    You may apply for private health insurance through the federal health insurance marketplace at healthcare.gov between November 1, 2019 and December 15, 2019. For working parents and guardians, coverage for your child may be available through an employer-sponsored health insurance plan during their open enrollment period. You may consider contacting a licensed insurance agent to learn about other private health insurance options. Your county health department may also offer low-cost health care services for your child and may be able to refer you to other affordable health care service providers in your local community.