Health insurance in Florida
- Florida uses the federally facilitated marketplace and enrolls through HealthCare.gov.
- Open enrollment for 2019 coverage in Florida ended on December 15, but people in counties hit by Hurricane Michael have until February 16, 2019 to enroll.
- Enrollment is still possible for Floridians who have qualifying events.
- Short-term health plans are available in Florida with initial plan terms up to 364 days.
- Seven insurers offers 2019 coverage through the Florida exchange.
- The average premium increase for 2019 is 5.2 percent.
- About 1.5 million Floridians had effectuated coverage in 2018 – 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.
- More than 20 percent of Floridians are enrolled in Medicare. Of those about 42 percent have Medicare Advantage coverage.
Florida’s health marketplace
Open enrollment for 2019 coverage ended on December 15, but enrollment is still possible for Floridians who have qualifying events.
In addition, there’s a special enrollment period through February 16, 2019 for people in 18 counties in the Florida panhandle that were deemed eligible for FEMA assistance as a result of October’s Hurricane Michael. CMS initially granted affected residents in those counties a special enrollment period that continued for only a few days after the end of the regular open enrollment period. But new guidance was issued in December that allows affected residents in those counties another 60 days to enroll in a health plan for 2019.
Affected individuals must call the exchange at 1-800-318-2596 or TTY at 1-855-889-4325 and attest that they were affected by the hurricane and were unable to enroll during open enrollment as a result.
In addition, outside the exchange, some Florida insurers have chosen to extend enrollment for 2019 coverage. AvMed, Florida Blue, Health First, and Florida Health Care Plans have all extended open enrollment until December 31, 2018.
Florida enrollment in qualified health plans
For 2018 coverage, Florida had 1,715,227 enrollees during open enrollment, and Florida’s effectuated exchange enrollment stood at 1,529,385 as of mid-2018. 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 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, 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.
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 2019, 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.
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.