florida guide to health insurance

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Florida health insurance exchange

Four insurers join FL marketplace

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

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.

Individuals can sign up for coverage for 2015 when the next open enrollment period begins on Nov. 15. Enrollment is open for three months, ending Feb. 15.

2014 results: more than 1 million Floridians enrolled in private plans or Medicaid

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.

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.

2015 premiums headed up or down?

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

Florida insurance regulators project 2015 premiums for individual and family coverage to increase 13.2 percent on average. The projected increase is a weighted average based on projected enrollment in the various plans, and final rates are still subject to approval at the federal level.

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

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.

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


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)