florida guide to health insurance

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Florida health insurance exchange

FL expects more than 1M to sign up

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Healthcare.gov is working well during the early days of the ACA’s second open enrollment. About 1 million people visited HealthCare.gov and about 200,000 called the call center on the first weekend of open enrollment. About 100,000 people completed applications on Day 1. No major system issues were reported, but some consumers had trouble with user names and passwords.

Technical improvements to HealthCare.gov mean screens load faster, the site can handle more users, and consumers can browse health plan options before creating or logging into their accounts. In addition, HealthCare.gov features a much shorter application for first-time shoppers: 16 screens vs. 76. Daily security tests to protect against hackers have also been implemented.

If you had coverage in 2014, you should actively re-enroll for 2015. Update your financial information and select a health plan by Dec. 15 to make sure your subsidy amount is calculated correctly for the upcoming year.

Dec. 15 is also the deadline to make sure you have coverage starting on Jan. 1, 2015.

Navigators and insurance agents are available to help consumers. Both can help consumers evaluate the available options, but navigators cannot recommend one health plan over another. Agents receive commission from the insurance company for each person they sign up; navigators do not. Use HealthCare.gov to search for a navigator by ZIP code, or see a list Florida’s insurance website.

Florida officials estimate that new signups and re-enrollments will exceed 1 million for 2015.

2015 premiums: up or down?

Differences in calculation methods are leading to conflicting information for 2015 premiums.

Florida insurance regulators say 2015 premiums for individual and family coverage are up 13.2 percent on average. That figure is a weighted average based on projected enrollment in the various plans.

In contrast, the Obama administration said average premiums in Florida are dropping four percent. The decrease is based on an evaluation of the second-lowest silver-level health plan, which is the benchmark for premium subsidies.

An Associated Press/Health News Florida article summarized the 2015 changes for the 11 insurers that were on the exchange in 2014 and are again participating in 2015. Rates for eight insurers are increasing, with a range of 11 to 23 percent. Rates for three insurers are decreasing, with a range of -5 to -12 percent.

2015 participating insurers

Florida residents have an extensive number of health insurers to choose from on the federal marketplace. In total, 14 companies will offer policies through the marketplace for 2015. Four of the insurers are new to the marketplace for 2015, according to Health News Florida.

Participating marketplace insurers for 2015 include Aetna, Blue Cross Blue Shield of Florida, Cigna, Coventry Health Care of FL, Florida Health Care Plan, Health First Health Plans, Health First Insurance, Health Options, Humana, Molina Healthcare of Florida, Preferred Medical Plan, Sunshine State Health Plan, Time Insurance Company, and UnitedHealthcare of Florida.

2014 results: highest enrollment for states using HealthCare.gov

Florida had the highest 2014 enrollment among states using HealthCare.gov and the fourth highest percentage of eligible individuals using the marketplace to purchase affordable health insurance.

With 983,775 people signing up for coverage, 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.

While these are hopeful figures, there is still plenty of room to expand health insurance coverage in the Sunshine State. Although the figures vary among sources, Florida’s uninsured rates in 2013 and mid-2014 are among the highest in the U.S. Gallup puts the figures at 22.1 percent in 2013 and 18.9 percent in mid-2014. A survey by the Commonwealth Fund shows the rates as 30 percent in 2013 and 26 percent in mid-2014.

Florida’s “other exchange”

The state supports Florida Health Choices, which is the state’s own version of an online marketplace. While Florida Health Choices was established by 2008 legislation, it faced many delays and did not go live until March 2014.

Florida Health Choices offers “discount only” plans for some health services, such as 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. 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.

However, with just 30 people signing up between March and August 2014, consumers have rejected Florida Health Choices as a pathway for obtaining meaningful health coverage.

Florida exchange background

Florida staunchly opposed the Affordable Care Act and the development of an ACA-compliant 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.”

Florida health insurance exchange links

HealthCare.gov
800-318-2596

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)