Health insurance in Florida
- Florida uses the federally facilitated marketplace and enrolls through HealthCare.gov.
- Open enrollment for 2020 coverage in Florida runs from November 1 to December 15, 2019.
- After December 15, enrollment in 2020 coverage will still be possible for Floridians who have qualifying events.
- Short-term health plans are available in Florida with initial plan terms up to 364 days.
- Nine insurers are offering 2020 coverage through the Florida exchange.
- For individual market plans sold in the Florida exchange, average premiums are unchanged for 2020 (ie, a 0% rate change).
- Nearly 1.7 million Floridians had effectuated coverage in 2019 – the highest exchange enrollment nationwide.
- Florida continues to reject the ACA’s Medicaid expansion.
- Florida’s balance billing protections are among the nation’s strongest, and the state’s health insurance advisory board is recommending that lawmakers consider a provision to add emergency transportation to the balance billing protections.
- More than 21 percent of Floridians are enrolled in Medicare. Of those about 42 percent have Medicare Advantage coverage.
Florida’s health marketplace
Florida uses the federally run health marketplace, so residents enroll through HealthCare.gov.
Open enrollment for 2020 coverage continues through December 15, 2019. After that, enrollment in 2020 coverage will be limited to Floridians who have qualifying events.
Nine insurers are offering 2019 health plans through Florida’s marketplace, including Bright Health, which is new to the state’s market, and Cigna, which rejoined in some areas after exiting the exchange at the end of 2015.
For individual market plans sold in Florida’s exchange, the average rate increase after the state approval process was 0.0 percent. Although there’s variation from one insurer to another, overall premiums (before taking subsidies into account) are flat from 2019 to 2020.
Florida enrollment in qualified health plans
Despite the ACA’s relatively cold reception among the state’s political leaders, Florida residents have taken advantage of the health insurance marketplace, with enrollment leading the nation.
For 2019 coverage, Florida had 1,742,819 enrollees during open enrollment, and Florida’s effectuated exchange enrollment stood at 1,674,948 as of early 2019. California, the state with the second-highest enrollment, had about 1.4 million exchange enrollees.
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 made Medicaid expansion optional for states. And although a growing number of states have since opted to expand coverage, there are 14, including Florida, that have taken no action to expand Medicaid eligibility to include low-income, non-elderly, non-disabled adults without children.
Florida’s decision not to expand Medicaid leaves 445,000 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, 884,000 people living in Florida would be eligible for Medicaid if the state accepted federal funding to expand its eligibility guidelines under the ACA.
Read more about Medicaid in Florida.
Short-term health insurance in Florida
Because Florida does not have state regulations for short-term plans, 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.
The Florida Health Insurance Advisory Board is recommending that lawmakers add a provision to Florida statute to require stronger disclosure language for short-term plans, and a requirement that consumers sign a statement indicating that they have read the disclosure or had it read to them by a salesperson (the recommendation was approved during a December 2019 FHIAB board meeting, and will be forwarded to leaders in the Florida House and Senate).
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 (it had risen slightly, to 13 percent, by 2018, mirroring a nationwide increase in the uninsured rate under the Trump administration).
The national average uninsured rate stood at 8.9 percent as of 2018, 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.
Florida’s junior senator, former Governor Rick Scott, has long opposed the ACA and is part of a team of lawmakers that President Trump has tasked with coming up with a replacement for the ACA.
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.
The Affordable Care Act was not well received by state-level politicians in Florida. The state rejected federal loans to evaluate a state-run exchange, was the lead plaintiff in the 2012 U.S. Supreme Court case challenging the ACA, rejected Medicaid expansion, and is a plaintiff in the ongoing lawsuit that seeks yet again to overturn the ACA.
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 2020, only four were still offering coverage.
Medicare enrollment in the Sunshine State
About 87 percent of Florida Medicare recipients qualify based on age alone, while the rest are eligible as the result of a disability.
In 2016, Medicare spent an average of $11,041 per beneficiary in Florida. The national average was $9,533 per enrollee.
Florida residents who want additional benefits beyond those offered by Original Medicare can enroll in a Medicare Advantage plan, although these plans are subject to more restrictive provider networks than Original Medicare. In 2017, about 42 percent of Florida Medicare beneficiaries select a Medicare Advantage plan. (About 33 percent of all U.S. Medicare beneficiaries make that selection.)
Thirty-three percent of Florida Medicare enrollees selected a Medicare Part D plan for stand-alone prescription drug coverage (compared with 43 percent of Medicare beneficiaries enrolled in the plans nationwide).
Florida health insurance resources
Florida reform at the state level
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.” The legislation was considered among the strongest balance billing protections in the country. 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.
The FHIAB considered numerous legislative recommendations in a December 2019 meeting, approving nearly all of them — including a recommendation that emergency transportation costs be added to the services protected by HB221.
The only recommendations that were not approved by the board were number 4 in the first set of recommendations (it was not discussed at the December meeting) and number 2 in the second set of recommendations (it was eliminated due to confusion over its impact and whether the state would have the authority to implement it.
The FHIAB will pass along the recommendations to the state’s legislative leaders for consideration during the 2020 legislative session.
Scroll to the bottom of the page for a summary of other state-level health reform legislation
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.