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Florida health insurance marketplace: history and news of the state’s exchange

Highest enrollment in the country; highest percentage of residents in the individual market. 5.2% average rate hike for 2019, and Oscar has joined the exchange

Highlights and updates

Florida exchange overview

Florida uses the federally run exchange, so residents enroll through HealthCare.gov. Florida has the highest exchange enrollment of any state in the country.

1,786,679 people enrolled in plans through the Florida exchange during the open enrollment period for 2019 coverage — by far the highest enrollment of any state in the country. Florida’s 2019 enrollment was an increase of about 4 percent over the prior year, when 1,715,227 people enrolled. Florida is one of just nine states where enrollment during the open enrollment period for 2019 plans was higher than it had been for 2018 plans.

Florida has had the highest exchange enrollment in the nation ever since the exchanges debuted in the fall of 2013. About 11.7 million people enrolled in exchange plans nationwide during open enrollment for 2018 plans, and 1.7 million of them (14.6 percent) were in Florida .

Individual market enrollment is particularly high in Florida. Charles Gaba of ACA Signups calculated that nationwide, an average of 6.4 percent of the population was covered by individual market plans, including on and off-exchange policies, in 2017. But in Florida, it was double the national average, at 12.7 percent. And in South Florida, it was nearly 20 percent.

California and New York both have larger populations than Florida, but unlike Florida, they have both expanded Medicaid, which results in fewer enrollments in private plans through the exchange, and New York also debuted a Basic Health Program starting in 2016, which further reduces private plan enrollment. Texas also has a higher population than Florida and has not expanded Medicaid, but exchange enrollment in Florida is far higher than in Texas.

Starting in 2018, premium subsidies in the Florida exchange are much larger than they were in 2017, making coverage for many enrollees more affordable than it was in the past. That’s because the cost of cost-sharing reductions (CSR) is now added to silver plan premiums in Florida, and the subsidies are based on keeping the after-subsidy cost of the second-lowest-cost silver plan affordable. This is described in more detail below.

In December 2016, HHS reported that nearly 1.6 million people gained health insurance in Florida from 2010 to 2015, as a result of the ACA. This is despite the fact that Florida has refused to accept federal funds to expand Medicaid under the ACA. Lawmakers in Florida have shown no signs of moving forward with Medicaid expansion, despite the fact that two-thirds of Florida voters support Medicaid expansion.

Enrollment still by far the nation’s highest; declined in 2018, but increased to a record high for 2019

A record number of people — 1,786,679 — enrolled in plans through the Florida exchange during the open enrollment period for 2019 coverage. Florida’s enrollment was by far the highest of any state in the country, and was an increase of about 4 percent over 2018’s enrollment, when 1,715,227 people signed up for coverage.

2018 enrollment in Florida’s exchange was a drop of about 2.5 percent from 2017, when 1,760,025 people enrolled in private plans through the Florida exchange.

Nationwide, across all states that use HealthCare.gov, there was an average enrollment drop of about 5 percent in 2017, and roughly the same average drop again in 2018. But in Florida, 2017 exchange enrollment was 1 percent higher than it was in 2016, when 1,742,819 people enrolled. And although enrollment dropped in Florida in 2018, the decrease was smaller than the average across other HealthCare.gov states. And it rebounded for 2019 to the highest level it’s ever been.

The enrollment decline in 2018 (and in 2017, in most states) was attributed to confusion about the status of the ACA after a year of GOP repeal efforts, a much shorter open enrollment period (just over six weeks, instead of three months), and the Trump Administration’s decision to drastically reduce funding for exchange marketing and enrollment assistance in the weeks leading up to open enrollment. All of that continued to exist for 2019 — with the individual mandate officially eliminated after the end of 2018, a further reduction in federal funding for outreach and enrollment assistance, and the Trump Administration’s new rules that expand access to short-term plans and association health plans as alternatives to ACA-compliant coverage for healthy enrollees. And yet Florida’s exchange enrollment reached a record high for 2019.

Florida’s exchange has led the nation in enrollment numbers ever since the exchanges began operation. Florida enrollment during previous open enrollment periods was as follows:

Open enrollment for 2019 plans has ended, but plan changes and enrollments can still be completed by people who experience a qualifying event.

Oscar joined the Florida exchange for 2019; average rate increase across Florida’s individual market = 5.2%

Florida insurers that planned to offer coverage in 2019, both on and off-exchange, had to submit their rate and plan filings to the Florida Office of Insurance Regulation by June 20, 2018.

A few days later, the Florida Office of Insurance Regulation (FLOIR) published a list of the insurers that had filed to participate in 2019, and noted that the average proposed rate increase for 2019 was 8.8 percent. But after the rate approval process was completed, FLOIR announced that the final average rate increase would be just 5.2 percent. Blue Cross Blue Shield of Florida offers plans statewide, but all of the other insurers have localized coverage areas (this chart shows where each insurer’s plans are available).

  • Blue Cross Blue Shield of Florida (Florida Blue): 2.4 percent increase (the proposed average rate increase was 10.5 percent)
  • Florida Blue HMO (Health Options): 7.2 percent increase (the proposed average rate increase was 9.5 percent)
  • Florida Health Care Plan Inc. (FHCP is a subsidiary of Florida Blue): 5.6 percent increase (approved as proposed)
  • Ambetter (Celtic): 5.9 percent increase (slightly higher than the proposed 5.8 percent increase)
  • Molina: 1.5 percent DECREASE (Molina had proposed a 9.5 percent average increase)
  • Health First Health Plans: 9.8 percent increase (approved as proposed)
  • Oscar Health: New for 2019, so no applicable rate increase

A 5.2 percent average rate increase is far smaller than the average rate hikes that applied for 2018, but it’s also worth noting that the average increase would be even smaller — or perhaps even a decrease — if the Trump Administration and GOP lawmakers hadn’t acted to destabilize the individual insurance markets (ie, if the individual mandate penalty hadn’t been eliminated as of 2019, and if regulations hadn’t been finalized to expand access to short-term plans and association health plans; over time, these changes will result in fewer healthy people in the ACA-compliant risk pools and premiums that will be higher than they would otherwise have been).

The basic details of the rate filings are available on the federal rate review site and on FLOIR’s rate filing search system. But essentially all of the pertinent documents for each rate filing (ie, details about the rate changes and what’s driving them, as well as enrollment numbers and coverage areas) are marked “trade secret” in Florida, and not available to view.

Six insurers offered plans in the Florida exchange for 2018 (details below). One of them, Molina, was considering whether to continue to offer coverage in the exchange in 2019, after losing a bid to renew their Medicaid managed care contract in Florida. Molina submitted plans for 2019 individual market coverage and simultaneously appealed the state’s decision on the Medicaid contract. In June 2018, the state granted Molina a continued Medicaid contract in two regions of the state, in response to the insurer’s appeal. And Molina’s individual market plans continue to be available both on- and off-exchange coverage in 2019.

So for 2019, there are seven insurers in the Florida exchange, with the addition of Oscar Health. Oscar significantly increased its exchange footprint in 2019, including an expansion into Florida, Arizona, and Michigan, as well as coverage area expansions in some of the states where coverage was already being offered.

The 5.2 percent overall average rate increase for 2019 was calculated before premium subsidies are applied. Subsidies grew to keep pace with premiums (specifically, to keep pace with the premium of the second-lowest-cost silver plan in each area), so subsidized enrollees are generally protected from premium increases, although plan changes are sometimes necessary to avoid a rate increase.

Cigna and Avmed are continuing to only offer plans outside the exchange in Florida. The approved rate increases for both insurers were lower than they had initially proposed — Cigna’s by quite a bit (10 percent, down from 30.2 percent)..

Historically, Florida’s individual market has experienced the following average rate changes each year:

  • 2018: Average increase of 44.8 percent, mostly due to the assumption (which was correct) that cost-sharing reduction funding would end. This is described in more detail below.
  • 2017: Average increase of 19.1 percent.
  • 2016: Average increase of 9.5 percent
  • 2015: Average increase of 13.2 percent (although a Commonwealth Fund analysis shows Florida marketplace premiums increased 7 percent on average compared to 2014 rates).

For 2014 and 2015, Florida’s Insurance Commissioner was powerless to regulate proposed health insurance premiums, due to legislation signed into law by Governor Scott in 2013. But in 2015, for the first time since ACA-compliant plans debuted, Insurance Commissioner Kevin McCarty had the ability to challenge rates proposed by health insurance carriers. Since then, Florida’s Insurance Commissioner has continued to regulate premiums in the state.

Humana exited individual market at the end of 2017, other insurers remained in the exchange

Of the six insurers that offered coverage in Florida’s exchange in 2017 — seven if you count the two separate Florida Blue entities — only Humana opted to exit the exchange at the end of 2017 (this was true in every state where Humana still offered coverage in 2017). But Human only offered plans in seven of Florida’s 67 counties in 2017.

Although there were six insurers offering plans in the Florida exchange in 2017, most of them had limited coverage areas (2017 coverage areas for each insurer are listed here). Florida Blue was the only insurer offering plans in 67 counties in Florida, including most of the northern part of the state, so their commitment to remaining in the exchange for 2018 was particularly important.

Celtic and Health First expanded coverage areas for 2018; Celtic expanded again for 2019 but Health First dropped back to four counties for 2019

Centene/Celtic/Ambetter already offered plans in the Florida exchange in 2017, but they expanded their coverage area for 2018. They offered plans in 17 counties in 2017, and that increased to 22 counties for 2018, with expansion into Alachua, Lake, Marion, Orange, and St. Lucie counties. And for 2019, Celtic is offering plans in 26 counties.

Health First offered plans in four counties in 2017, but covered five counties in 2018, with expansion into Seminole County. For 2019, they are back to four counties, offering coverage in Brevard, Flagler, Seminole, and Volusia counties (but no longer in Indian River County).

2018 rates: State approved 44.7% average rate increases, mostly due to assumption that feds wouldn’t fund CSR

In June 2017, FLOIR announced that six insurers planned to offer coverage in the Florida exchange for 2018, and that their combined proposed average rate increase was 17.8 percent. At that point, the rates that each insurer had filed were not yet publicly available, but it’s important to note that those initial filings were based on the assumption that cost-sharing reductions (CSRs) would continue to be funded by the federal government in 2018.

Rate filings became available on August 1 on ratereview.healthcare.gov. The actuarial memos with the Florida filings were much less comprehensive than the filings available in many other states, but one insurer’s filing memo noted that “due to the exit of Aetna/Coventry from the [off-exchange] ACA market, FLOIR has required all carriers to increase rates by 3% so that rates are adequate to accommodate the migrating members.”

The initial rates that insurers filed for 2018 were based on the assumption that funding would continue for CSRs. Insurers are obligated to provide CSRs regardless of whether the federal government funds them or not. If that funding is not forthcoming, insurers have to increase their prices to account for the lack of federal funding.

So Florida regulators asked insurers to file backup rates that would apply if CSR funding were to be eliminated, as rates needed to be considerably higher in that case. The backup rates are the ones that were ultimately approved by state regulators, as there had been no resolution to the CSR funding issue at the federal level by the time rates had to be finalized (in October, the Trump Administration eventually did officially cut off CSR funding, so it was fortunate that Florida regulators had already approved the rates based on the assumption that would happen).

Overall, the rates that Florida regulators approved represented an average increase of 44.7 percent (details below for each insurer). But FLOIR noted that 31 percentage points of that was “directly attributable” to on-exchange silver plans, which bear the increased premiums necessary to cover the cost of CSR. Not counting on-exchange silver plans, the average premium increase was 18 percent — still a significant increase, but not nearly as eye-popping as 44.7 percent.

People who have silver plans and who receive premium subsidies do not have to bear the burden of the CSR load on the silver plans, as premium subsidies are based on keeping the second-lowest-cost silver plan affordable, so they grew in 2018 to keep pace with the premium increases. 91 percent of Florida exchange enrollees were receiving premium subsidies in 2018, versus the nationwide average of 83 percent.

FLOIR noted that “consumers enrolled in a Silver on-Exchange plan that do not receive a premium subsidy will have the option of purchasing a similar off-Exchange Silver plan without this extra cost [of the added premium to pay for CSR].” On- and off-exchange plans have to have the same premium if they’re identical, but if a slightly different off-exchange plan is offered, it wouldn’t have to have the same premium, and could thus avoid the CSR load.

To fill in the backstory, CSRs are part of the ACA, and they allow low-income enrollees to have coverage with lower out-of-pocket costs if they pick silver plans. 64 percent of Florida exchange enrollees are receiving CSRs in 2018 (versus 54 percent of exchange enrollees nationwide). But the ACA didn’t specifically allocate funding for them, and House Republicans sued the Obama Administration in 2014 over the funding issue. The court sided with House Republicans in 2016, but the Obama Administration appealed and the money continued to flow to insurers until late 2017 (to the tune of about $7 billion in fiscal year 2017). The case was pended throughout 2017, but President Trump repeatedly threatened to cut off funding for CSRs, and his threats took on new urgency when the Senate failed to pass any version of their ACA repeal/replace legislation in late July (Nicholas Bagley has written an excellent explainer of how this all works).

Ultimately, the Trump Administration cut off CSR funding in October 2017. Insurers in most states, including Florida, added the cost of CSR to premiums (in most cases, only to silver plan premiums, as was the case in Florida). The result is larger premium subsidies for the 91 percent of Florida exchange enrollees who qualify for premium subsidies. For the 9 percent who aren’t eligible for premium subsidies, the added cost of CSR could be avoided by selecting a non-silver plan for 2018.

Rates and plans for 2018

FLOIR approved the following average rate increases for 2018 — keeping in mind that the bulk of these increases are attributable to silver plans, and the overall average rate increases would have been much lower if CSR funding had been committed for 2018 (the proposed rates, in parentheses, are what the insurers originally filed with the assumption that CSR funding would continue).

  • Florida Blue (BCBS of Florida): 38.1 percent (BCBS of Florida had originally proposed average rate increases of 9.3 percent to 24.7 percent, depending on the plan).
  • Florida Blue HMO (Health Options): 36 percent (Health Options had originally proposed average rate increases of 6.3 percent to 11.3 percent, depending on the plan).
  • Florida Health Care Plan Inc. (FHCP is a subsidiary of Florida Blue): 26.5 percent (FHCP had originally proposed average rate increases of 1.7 percent to 15.4 percent, depending on the plan)
  • Ambetter (Celtic): 46.1 percent (Celtic/Ambetter had originally proposed an average rate increase of 12.4 percent; Ambetter had 219,053 members in 2017, and expanded to a larger coverage area in 2018, described above).
  • Molina: 71.2 percent (Molina has 336,515 on-exchange members. The insurer had originally proposed a 37.5 percent average rate increase. Molina executives noted over the summer that their average rate increase across all states where they offer exchange plans would increase to 55 percent if cost-sharing reduction funding is eliminated; in Florida, their final rate increase was 33 percentage points higher—nearly double—than their original filing, due to the new assumption that CSR funding won’t continue in 2018).
  • Health First Health Plans: 39.3 percent (Health First offered plans in Brevard, Indian River, Flagler and Volusia counties in 2017; they expanded to also offer coverage in Seminole County in 2018. In 2017, they had 17,591 on-exchange members, plus 3,057 off-exchange. Filings didn’t show up on ratereview.healthcare.gov, but Health First plans were included in the approved plans that FLOIR announced in late September.

Premium subsidies became much larger in 2018, making after-subsidy rates lower for some enrollees

Because the cost of CSR has been added to silver plan premiums, premium subsidies are much larger in Florida (starting in 2018) than they were in previous years. Consider a family of four (parents are 45, kids are 15 and 13) living in Miami. If they earn $70,000, they can get a premium subsidy of $1,051 per month in 2019. After that subsidy is applied, the cheapest plan available to them in the exchange is $116/moth in total premiums for the family.

For the same scenario in 2017, the premium subsidy would have been $452 per month, and the cheapest plan available to them would have cost $447/month in after-subsidy premiums (it’s worth noting, however, that the lowest-cost plan would have been just $21/month for this family in 2018; although the premium subsidy amount is slightly larger for 2019 than it was for 2018, the lowest-cost plan is more expensive (pre-subsidies) than it was in 2018).

Premium subsidies are available to households with income up to 400 percent of the poverty level. And it’s important to understand what counts as income — don’t give up on eligibility for a subsidy until you talk with a tax adviser, because contributions to an HSA and/or retirement plans might bring your income into the subsidy-eligible range, even if it initially seems too high.

Unfortunately, Florida has a Medicaid coverage gap because the state has rejected federal funding to expand Medicaid. As a result, households with income below the poverty level are not automatically eligible for Medicaid (very low-income parents are eligible, but non-disabled childless adults are not, regardless of how low their income is). People with income below the poverty level are also ineligible for premium subsidies. Florida could fix the coverage gap at any time by accepting federal funding to expand Medicaid, but they have not yet done so.

7 carriers offered plans in 2017; others exited at the end of 2016

UnitedHealthcare exited the individual market in Florida at the end of 2016, as was the case in many of the states where they offered exchange plans in 2016.

Aetna also left the exchange in Florida at the end of 2016, as was the case in all but four of the states where they offered exchange plans in 2016. Aetna continued to offer off-exchange coverage in Florida’s individual market in 2017, but exited the entire individual market at the end of 2017.

Cigna was planning to re-enter the Flordia exchange after pulling out at the end of 2015 (details below), and they did file rates for on-exchange plans. But ultimately, they did not re-enter the exchange, and a Florida Office of Insurance Regulation (FLOIR) chart showed Cigna only offering two off-exchange plans in Florida for 2017. FLOIR also confirmed via email that Cigna did not have any on-exchange plans for 2017. Cigna continues to only offer plans outside the exchange as of 2019.

Humana scaled back their exchange participation across the country for 2017. They remained in the Florida exchange, but with a much smaller footprint. As of September 2016, Humana was planning to offer 16 plans in the Florida exchange, but no off-exchange plans. They exited 31 of the 38 counties where they offered plans in 2016, but continued to offer exchange plans in the other seven counties in 2017. Humana exited the individual market altogether, nationwide, at the end of 2017, however. Those seven counties in Florida no longer had Humana coverage available in the exchange in 2018.

Harken Health — a subsidiary of UnitedHealthcare — had planned to enter the exchange for 2017, in the Miami and Fort Lauderdale areas. Harken began offering coverage in the Chicago and Atlanta areas in 2016, and their plan was to expand into Florida for 2017. In August 2016 they reversed course, saying that they would not offer plans in Florida in 2017. But they left the door open for a future expansion into Florida, saying “Harken believes people in South Florida could benefit greatly from our innovative model, and we look forward to offering access to those services as part of future expansion.

Grandmothered and grandfathered plans

Florida is one of the states that has allowed grandmothered/transitional health plans to remain in force through 2019. In October 2016, the Florida Office of Insurance Regulation (FLOIR) published a report showing how many people were enrolled in various types of coverage during the 2015 coverage year:

  • 236,701 people were enrolled in grandmothered individual market plans (including some in association plans that were governed by another state’s regulations)
  • 1,999 people were enrolled in grandmothered “group of one” sole proprietor plans (coverage for self-employed people in the small group market)

The continuation of grandmothered plans is one of the factors that results in a less healthy risk pool for the ACA-compliant market. This is because everyone on grandmothered plans passed medical underwriting between 2010 and 2013, meaning it’s a relatively healthy book of business. Since these individuals are allowed to remain on their medically underwritten (and thus less expensive) coverage, they don’t enter the ACA-compliant market, resulting in the latter being more skewed towards sicker, older enrollees.

Grandfathered plans can remain in force as long as the insurance company wants to continue to maintain them (some insurers have opted to terminate grandfathered plans, but they are not required to do so at any point, unlike grandmothered plans, which must terminate by the end of 2019, unless the federal government allows another extension).

  • 84,149 people were enrolled in grandfathered individual market plans in Florida in 2015, including those governed by another state’s regulations.
  • 620 people were enrolled in grandfathered sole proprietor group plans.

Legislation to end surprise balance bills

On March 11, 2016, lawmakers in Florida passed House Bill 221, and Governor Scott signed it into law in April. HB221 bans the practice of balance billing in situations (including non-emergency care) where the patient uses an in-network hospital or urgent care facility and “does not have the ability or opportunity to choose a participating provider at the facility” (for emergency care, insurers are simply required to cover treatment at in-network rates, regardless of whether the providers are in-network, and there’s no requirement that the patient not have been able to pick a different provider). The new rules took effect July 1, 2016, and HB221 is being called a model for other states that want to implement similar consumer protections.

Florida already prohibited balance billing for HMO members who receive emergency care or treatment at an in-network facility, but HB221 provides similar protections for insureds who have PPO and EPO plans. HB221 was sponsored by six Republicans and two Democrats. Rep. Carlos Trujillo, a Miami Republican and one of the bill’s sponsors, said that their goal was to “remove the consumer from the middle” of the billing process when hospitals contract with providers who aren’t in the same networks as the hospital.

Balance billing has become increasingly common as health insurance plans offer narrower networks, and it puts patients in the often impossible situation of needing to verify that every provider who will be treating them is in-network. Without HB221, it’s not enough to verify that the facility and primary doctor are in-network; assistant surgeons, radiologists, anesthesiologists, and durable medical equipment suppliers may be out-of-network, and the patients may not even realize that those providers are treating them.

Not surprisingly, radiologists and anesthesiologists were among those fighting against HB221 in Florida, claiming that it would force them to accept whatever payment the insurance companies wanted to offer them, despite the fact that they don’t have a contract with the carrier in question. But the legislation passed with support from both the Florida Association of Health Plans and the Florida Medical Association.

HB221 also requires hospitals to post names and links for providers who are in-network, and explain that the patient should take steps to ensure that treatment is being provided by in-network providers in order to avoid balance billing (note that HB221’s ban on balance billing in non-emergency situations only applies when a patient is treated by a non-network provider at an in-network facility, AND the patient wasn’t able to choose an in-network provider instead).

Cigna pulled out of exchange for 2016, planned to re-enter for 2017 but didn’t; Time and Preferred Medical also exited

Two weeks before the start of the third open enrollment period, Cigna announced that they would not offer plans in the exchange in Florida in 2016. At that point, they had about 30,000 enrollees in the Florida exchange, all of whom had to select coverage from a different carrier if they wanted to continue to be insured in the exchange in 2016. Cigna continued to offer plans outside the exchange (and that’s still the case as of 2019), but no subsidies are available outside the exchange.

In the weeks leading up to the start of open enrollment, there were carriers in several states that announced they would not participate in the exchanges for 2016. In most cases, the risk corridor payment shortfall was cited as a reason, but Cigna’s justification for leaving the exchange was somewhat unique: the carrier cited fraudulent billing by substance abuse clinics and labs in Florida. Cigna has said they didn’t realize how significant the fraudulent claims were until after the deadline to submit plans for 2016. Once they determined the scope of the problem, they made their decision to pull out of the exchange market for a year.

Cigna planned to re-enter the Florida exchange in 2017 with a new suite of plans available. They filed rates in the spring of 2016, but ultimately withdrew their on-exchange plans, are have since only offered plans outside the exchange in Florida.

Time announced in June 2015 that they would exit the health insurance market nationwide and did not offer plans for 2016 or any subsequent years.

Preferred Medical Plan exited the Florida exchange at the end of 2016, due to the risk corridor shortfalls that were announced in October 2015. With the lower-than-anticipated payments that carriers received through the risk corridors program, Preferred Medical Plan’s was forced to pull out of the exchange. In December 2015, the carrier noted that “CMS has maintained its position that Preferred Medical Plan not be allowed to participate on the [ACA exchange] due to the funding shortfall created by CMS not paying the Risk Corridor payment.” Preferred Medical Plan had about 75,000 Obamacare enrollees in 2015 in Miami-Dade and Broward counties, but they had to select new coverage for 2016.

Florida’s other exchange: 712 customers by 2016, no longer state-funded by 2017

Florida Health Choices is the state’s own version of an online marketplace, but it does not offer any premium subsidies. While Florida Health Choices was established by 2008 legislation sponsored by Marco Rubio, who was the Florida House Speaker at that point, it faced many delays and did not go live until March 2014. The state’s pseudo-exchange was engaged in a legal battle with HHS over efforts to trademark “Healthchoices, The Health Insurance Marketplace.”

Florida Health Choices initially offered discount-only plans for some health services, such as dental services and prescription drugs. These plans were not true health insurance, and consumers largely ignored the state-sponsored exchange. Just 49 people purchased plans through Florida Health Choice during 2014 (by 2016, Florida Health Choices was no longer offering prescription discount plans, due to lack of consumer interest).

In early January 2015, Florida Health Choices began offering health plans that were compliant with the ACA and covered the ACA s ten essential health benefits. Policies from four insurers were available in 2015: Assurant, Cigna, Humana, and UnitedHealthCare.

For 2016, Assurant exited the health insurance market nationwide, but Cigna, Humana, and UnitedHeathcare continued to offer plans through Florida Health Choices (Cigna exited the Healthcare.gov exchange for 2016, but continued to participate in Florida Health Choices, which is technically “off-exchange”).

For 2017, UnitedHealthcare exited the individual market in Florida, and their plans are no longer available on or off-exchange. Humana remained in some counties in Florida on HealthCare.gov, but dropped out of the Florida off-exchange market altogether, which means their plans were no longer available via Florida Health Choices.

Consumers who shop on Florida Health Choices can NOT obtain subsidies to help them pay for coverage. Those subsidies are available only through HealthCare.gov, the federally facilitated marketplace. As of 2018, 91 percent of Florida residents who had coverage through Healthcare.gov were receiving premium subsidies.

The Florida Health Choices board of directors approved an $852,000 budget for 2015. Heading into the year, Naff was quoted in the Miami Herald saying, “I’d be tickled pink if we got 1,000 people.”

During the 2015 open enrollment period, 42 people bought health insurance plans through Florida Health Choices. By mid-April, it had 80 paying customers. During his unsuccessful 2016 presidential campaign, Marco Rubio distanced himself somewhat from Florida Health Choices, not mentioning it in his plans for repealing and replacing Obamacare.

By August 2015, Florida Health Choices had enrolled 150 people, and was reaching out to Realtors and professionals licensed by the state of Florida, offering them coverage through dedicated private exchanges. Naff noted that Florida Health Choices was aimed at people who earn too much money to qualify for premium subsidies, since those can only be obtained through Healthcare.gov in Florida. But Naff explained that Florida Health Choices could also help people enroll in Healthcare.gov if their income made them subsidy-eligible.

By mid-2016, Florida Health Choices had 712 customers, according to the Jacksonville Times Union. In order to be self-sustainable, they needed at least 3,000 customers, so they were still reliant on state funding. However, Governor Scott vetoed $250,000 in state funding for Florida Health Choices in the 2017-2018 budget, and Florida Health Choices is no longer supported by state funding. The state was working to sell the domain name in 2017, but it was still up as of 2018, with Florida Blue plans available. By 2019, the website was still up, but no plans appeared to be directly for sale through it.

2015 participating insurers

In total, 14 companies offered policies through the marketplace for 2015. Four of the insurers were new to the marketplace for 2015, according to Health News Florida.

Participating marketplace insurers for 2015 included 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 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.

Florida also made it more difficult for navigators to assist consumers in using the marketplace. In 2013, Florida passed a law requiring fingerprinting and background checks for anyone who wanted to serve as a navigator. The state requirements were in addition to federal requirements for 20 hours of training and a qualification test. Also in 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 established independent 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)


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.