florida guide to health insurance

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Florida health insurance exchange

Florida leads nation in enrollment among federally run exchanges

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Obamacare enrollment in Florida has ended for the year. People who get married or divorced, change jobs, have a child or experience another qualifying event may be eligible for a special enrollment period. Enrollment for Medicaid and the Children’s Health Insurance Program (CHIP) continues throughout the year. Individuals who don’t have health insurance that provides minimum essential coverage may have to pay a penalty: $95 or one percent of income, whichever is greater.

Open enrollment for 2015 coverage through the marketplace begins Nov. 15.

Florida led the nation in enrollment among the states using the federal marketplace at 983,775. Florida lagged only California in the number of individuals selecting a qualified health plan (QHP) during the 2014 open enrollment period. In addition to those enrolling in QHPs, 180,479 Florida residents qualified for Medicaid or the Children’s Health Insurance Program (CHIP). Florida is not participating in the Medicaid expansion. However, many people who explored buying private insurance learned they qualified for Medicaid based on the current eligibility criteria.

Ninety-one percent of Floridians who enrolled in a QHP qualified for financial assistance. Nationally, 85 have qualified. Silver plans are far and away the most popular with consumers, in Florida and nationally. In Florida 13 percent selected bronze plans, 73 percent selected silver plans, 6 percent selected gold plans, 7 percent selected platinum plans, and 2 percent selected catastrophic plans.

Florida staunchly opposed the Affordable Care Act and operation of the health insurance marketplace. Florida legislators not only failed to approve legislation to create an exchange in Florida, they returned a $1 million federal planning grant awarded in 2010. And right after the Supreme Court ruling that upheld most of the Affordable Care Act in June 2012, Republican Gov. Rick Scott announced that Florida would not establish a state-based health insurance exchange.

In September 2013, the Florida Department of Health (DOH) banned navigators from all county public health facilities. Florida DOH officials said the move was consistent with its policy of blocking outside groups not doing state business. They have also said the ban helps protects consumers from privacy concerns stemming from the collection of personal information for inclusion in a federal database. The Obama administration strongly criticized the ban on navigators, labeling the order “obstructionist” and “plain absurdity.”

The state supports Florida Health Choices, which is the state’s own version of an online marketplace. Florida Health Choices was established by 2008 legislation. After many delays, the site went live in early March. However, the site does not sell actual health insurance policies. Florida Health Choices offers “discount only” plans for some health services, like dental services and prescription drugs. These plans are not health insurance, and purchasing one of them doesn’t protect you from the individual mandate of the Affordable Care Act — you may still have to pay a penalty for being uninsured.

Florida Health Choices does not comply with the Affordable Care Act. Individuals cannot receive subsidies through Florida Health Choice, nor can businesses access tax credits. Florida Health Choices does not require plans sold on the exchange to cover the ACA’s essential health benefits.

The CEO of Florida Health Choices says the exchange’s target market includes those in the coverage gap — people who make too little to qualify for premium assistance on the federal marketplace and too much to qualify for Medicaid. Because Florida rejected Medicaid expansion, nearly 800,000 people fall into the coverage gap and state health care providers miss out on $1.2 billion annually.

Florida health insurance exchange links


State Exchange Profile: Florida
The Henry J. Kaiser Family Foundation overview of Florida’s progress toward creating a state health insurance exchange.

Florida Health Choices
State exchange, which is not part of the Affordable Care Act

Florida Office of Insurance Regulation
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Florida.
(1-877-693-5236) / Out of State: (850) 413-3089

Subscriber Assistance Program – Agency for Health Care Administration
Serves residents enrolled in managed care; helps resolve grievance between managed care entities and their subscribers.
1-888-419-3456 (toll-free nationwide)