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Florida health insurance

Florida residents have until December 31, 2017 to enroll in coverage for 2018, due to hurricane-related extension

Florida 2018 enrollment update

Florida insurance overview

Open enrollment for 2018 coverage ended on December 15, 2017 in Florida, but there’s a special enrollment period for Florida residents due to the hurricanes that hit the state in 2017. People in Florida, as well as those who lived there during the hurricanes, have until December 31 to enroll in a plan through the exchange, with coverage effective January 1, 2018.

Florida has one of the highest uninsured rates in the country (12.5 percent in 2016, as opposed to 8.6 percent for the US as a whole), but it also leads the US in terms of the number of people who sign up for health insurance in the state’s exchange. Nationwide, only a small fraction of the population has coverage in the individual health insurance market — most people get their coverage from employer-sponsored plans or government-sponsored plans. But the percentage of people in Florida with individual market coverage is nearly double the national average, which helps explain why Florida has such high enrollment numbers in the exchange.

For 2017 coverage, 1,760,025 Florida residents enrolled (the second-ranked state was California, with 1,556,676 enrollees). And for 2018, Florida had 1,715,227 enrollees during open enrollment, again coming in far above the rest of the country in terms of enrollments (and nearly reaching 2017’s enrollment total, despite the fact that open enrollment was half as long for 2018). The second-ranked state for 2018 enrollments was again California, with 1,420,000 enrollees as of mid-December — but with the caveat that open enrollment continues until the end of January in California, whereas it ended on December 15 in Florida (with additional enrollments possible through December 31 due to the hurricane-related special enrollment period).

In 2016, Florida lawmakers passed House Bill 221, which bans the practice of balance billing. Florida has been heralded as one of the more progressive states on this issue, as there is no solid federal policy in terms of balance billing.

Florida health ratings

When it comes to public health, various ratings place Florida in the bottom half of the nation. United Health Foundation’s America’s Health Rankings is one of them. In the 2017 edition, Florida ranks 32rd — but that’s up four spots from the previous edition, tied with Utah for the most improved state. From 2016 to 2017, Florida saw a decrease in the percentage of children living in poverty and suffering from frequent mental distress, both of which contributed to the state’s improvement in the overall rankings.

But the 2017 edition of America’s Health Rankings places Florida 46th in terms of the percentage of the population that has health insurance. Despite Florida’s huge enrollment numbers in individual market coverage, the state has refused to accept Federal funding to expand Medicaid under the ACA. As a result, there are an estimated 384,000 Florida residents in the coverage gap — ineligible for Medicaid and also ineligible for premium subsidies, essentially without any realistic options for health insurance coverage.

The 2017 Scorecard on State Health System Performance ranked Florida 39th, the same as it had been in the previous edition of the Scorecard. The Scorecard evaluates a range of health indicators and gives an overall score to each of the 50 states and the District of Columbia. Florida’s scorecard details how the state scored on individual measures within five categories: Access, Prevention & Treatment, Avoidable Hospital Use & Cost, Healthy Lives, and Equity. The state earned its lowest marks for Avoidable Hospital Use & Cost, coming in 45th. But Florida was in the second quintile (20th place) in the Healthy Lives metric.

While it does not include an overall score, the 2016 edition of Trust for America’s Health provides a wealth of public health information; see Key Health Data About Florida. As it does in other rankings, Florida’s percentage of uninsured residents stands out as an area needing much improvement. Based on 2014 data, Trust for America’s Health reports that 16.6 percent of Floridians – adults and children – were uninsured.

Some Florida counties fared far worse than the 16.6 percent average. County-by-county health rankings from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin showed a range of 15 to 33 percent uninsured across the state.

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.

2018 Obamacare rates and carriers

Six insurers are offering plans in Florida’s exchange for 2018, with the following average approved rate increases (silver plans rate increases are the largest, because the cost of cost-sharing reductions has been added to silver plan rates for 2018):

  • Florida Blue (BCBS of Florida): 38.1 percent
  • Florida Blue HMO (Health Options): 36 percent
  • Florida Health Care Plan Inc. (a Florida Blue subsidiary): 26.5 percent
  • Ambetter (Celtic): 46.1 percent
  • Molina: 71.2 percent
  • Health First Health Plans: 39.3 percent

Humana exited Florida’s individual market at the end of 2017, but Celtic/Ambetter has expanded to cover 22 counties in 2018, and Health First expanded from four counties to five.

Although rate increases are significant for 2018, premium subsidies are much larger, resulting in after-subsidy rates that are lower for some enrollees than they were in 2017.

FL enrollment in qualified health plans

Despite the ACA’s cold reception among political leaders, Florida residents have taken advantage of the health insurance marketplace, with enrollment leading the nation.

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. Open enrollment ended December 15, but people in Florida actually have until December 31 to sign up, due to the special enrollment period that was granted in response to the 2017 hurricane season.

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.

Florida Medicaid

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.

Since 2013, monthly Florida Medicaid enrollment as increased slightly by an average of 17 percent despite the state’s decision not to expand.

The Florida Department of Children and Families provides information about Florida’s health insurance assistance programs for low-income individuals and families.

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.

Other state-level health reform legislation:

More Florida coverage

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