The Affordable Care Act also allows states to extend Medicaid eligibility to people who receive as much as 133 percent of the federal government’s definition of poverty-level income. But Scott has decided against expanding the Medicaid program in Florida. So it’s unclear whether people who would have gained eligibility will automatically get subsidized medical coverage through an insurance exchange, said Linda S. Quick, president of the South Florida Hospital and Healthcare Association in Hollywood. "In states that don’t expand the Medicaid program, will people with 100 to 133 percent of the federal poverty level automatically be given subsidized care through the exchange? It’s one of the questions that the American Hospital Association has pending with" the U.S. Department of Health and Human Services, Quick said.

The exchanges are supposed to serve as shopping tools for individuals and small employers. Insurers that participate in the exchanges would be required to present their medical plan benefits in a standard format for easy comparison. The online exchanges are likely to be "a little bit like Orbitz for health insurance," Quick said. "You’ll put in what it is you want, and a matrix will come up ... You go to the box that meets your needs and see how much it costs."

That is cheaper than marketing individual coverage through storefronts. But face-to-face marketing may become more important as healthcare reform encourages more uninsured individuals to get coverage. A study by professional services firm PricewaterhouseCoopers found that the estimated 30 million uninsured American under age 65 who will get coverage as a result of the Affordable Care Act are less educated and more likely to speak a language other than English than people who already are insured.

Community service could become a more ubiquitous theme in the mass marketing of medical insurance. For example, at the Florida Blue Center in Miami, the insurer stages an open-house event each month, a healthcare fair that is open to the public, and provides attendees, both customers and non-customers, with a free personal health assessment, including measurements of their body fat percentage, blood pressure, blood sugar and cholesterol.

"For several years and continuing now, we also have a health fair program for large employers, where we go on-site and do these same types of activities for large employers," said Thomas, the Florida Blue senior vice president of government and consumer markets. The initiation of monthly health care fairs at the Florida Blue Center in Miami and other cities "was an attempt to make the same services available to members at smaller companies and to individuals."

Florida Blue Centers employ nurses who routinely conduct personal health assessments of policyholders as well as guide their efforts to manage diabetes, lose weight and stop smoking. "It’s an upfront investment in service, but it has a payoff," Thomas said of the storefront concept. The insurer may further expand its network of Florida Blue Centers after it opens the 11th one in Sarasota later this month. "We’re taking a real close look at that right now," he said. "We don’t have specific plans to open more. But we may next year."