Health insurance in state
- Florida uses the federally facilitated marketplace and enrolls through HealthCare.gov.
- Open enrollment runs from November 1 through December 15.
- Seven insurers offers 2019 coverage through the Florida exchange.
- The average premium increase for 2019 is 5.2 percent.
- About 1.7 million Floridians enrolled in 2018 coverage – the highest exchange enrollment nationwide.
- Florida continues to reject the ACA’s Medicaid expansion.
- Florida defaults to federal rules on short-term health plans.
Florida’s health marketplace
Florida enrollment in qualified health plans
By January 31, 2016, the end of 2016 open enrollment, Florida had enrolled more people than any other state and had the nation’s highest per-capita enrollment rate. As of March 31, 2016, Florida’s effectuated exchange enrollment stood at 1,531,714.
1,760,025 Florida residents enrolled in coverage through the exchange during the open enrollment period for 2017, again far outstripping the rest of the states. And for 2018 coverage, Florida had 1,715,227 enrollees during open enrollment, again well ahead of the rest of the country.
Read more about Florida’s marketplace.
Florida Medicaid expansion
Medicaid expansion was intended as one of the ACA’s main vehicles for reducing the number of people who lacked medical insurance coverage. However, the U.S. Supreme Court ruling in 2012 opened the door to many states, including Florida, to opt out of Medicaid expansion to single adults ages 19 to 64.
Florida’s decision not to expand Medicaid leaves 384,000 people in the coverage gap, meaning they do not qualify for Medicaid nor are they eligible for tax subsidies to help them afford private health insurance. According to the Kaiser Family Foundation, based on current eligibility for coverage, 702,000 people living in Florida would be eligible for Medicaid if the state expanded.
Read more about Medicaid in Florida.
Short-term health insurance in Florida
Because Florida does not have state regulations for short-term plans, so new federal regulations apply in the state. Insurers can offer short-term plans with initial terms up to 364 days and the option to renew for a total duration of up to 36 months.
Read more about short-term health coverage in Florida.
Is Obamacare helping Florida’s uninsured?
Although the Sunshine State has not embraced Obamacare from a legislative standpoint, the healthcare reform law has had some positive impacts there.
Florida’s federally facilitated health insurance exchange has the nation’s largest number of eligible of enrollees and highest enrollment numbers, and according to US Census data, Florida’s uninsured rate was 20 percent in 2013, and had dropped to 12.5 percent by 2016.
The national average uninsured rate was down to 8.6 percent by 2016, but Florida’s rejection of federal funding to expand Medicaid has locked a significant portion of the population out of coverage. If Florida were to expand Medicaid, the uninsured rate would drop substantially.
Florida and the Affordable Care Act
In the 2010 vote on the Affordable Care Act, Florida’s senators split their votes. Democratic Sen. Bill Nelson voted yes, while Republican Sen. George LeMieux voted no. LeMieux briefly held the Senate seat after being appointed by then-Gov. Charlie Crist to serve out the remainder of Republican Sen. Mel Martinez, who retired. LeMieux left the Senate in 2011 and was replaced by Republican Marco Rubio. Rubio is opposed to the Affordable Care Act, and was instrumental in making the ACA’s risk corridor program retroactively budget-neutral, effectively dooming a number of smaller insurers across the country.
Among Florida’s delegation to the U.S. House of Representatives, 9 members voted in favor of the ACA, while 15 voted against the law. Republicans outnumber Democrats in the current delegation, 16 to 10.
The Affordable Care Act was not well received by state-level politicians in Florida. Gov. Rick Scott is vocally opposed to the healthcare reform law, and the state rejected federal loans to evaluate a state-run exchange, was the lead plaintiff in the U.S. Supreme Court case challenging the ACA, and rejected Medicaid expansion.
Other ACA reform provisions
The Consumer Operated and Oriented Plan (CO-OP) Program is a provision of the Affordable Care Act. Through federal loans, the program encouraged start-up, nonprofit health insurers to enter the market and increase choice and competition. While no CO-OP plans were created in Florida, 23 private, nonprofit plans were set up across the country. Heading into 2018, only four were still offering coverage.
Medicare enrollment in the Sunshine State
Florida Medicare enrollment exceeded 4 million in 2015, about 20 percent of its population. Florida’s Medicare enrollment numbers are second only to California and the percentage of Florida residents enrolled in Medicare is higher than the 17 percent the total U.S. population enrolled in Medicare.
About 86 percent of Florida Medicare recipients qualify based on age alone, while the remainder are eligible as the result of a disability.
In 2014, Medicare spent about $10,610 per enrollee. The national average was $8,970 per enrollee. As of 2009, the latest available data, Florida ranked second in overall spending with $39.1 billion per year. California was first with $50.6 billion.
Florida residents who want additional benefits beyond those offered by Original Medicare can enroll in a Medicare Advantage plan. About 40 percent of Florida Medicare beneficiaries select a Medicare Advantage plan – about 32 percent of all U.S. Medicare beneficiaries make that selection. Thirty-five percent of Florida Medicare enrollees also select a Medicare Part D plan for stand-alone prescription drug coverage compared with 43 percent nationwide.
Florida health insurance resources
Florida reform at the state level
Here’s what’s happening legislatively at the state level with healthcare reform in Florida:
- Florida lawmakers passed House Bill 221 on March 11, 2016, and Gov. Scott signed it into law in April, thereby banning the practice of balance billing in situations (including non-emergency care) where the patent 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 required to cover treatment at in-network rates, regardless of whether or not the providers are in-network and regardless of whether or not the patient could choose another provider.