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FL Market Boasts 102 Plans

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

The sticker price for a benchmark health plan in Florida's online Marketplace will average $328 a month, far below the price that had been forecast, according to a federal report released early Wednesday.

“We are excited to see that rates in the Florida Marketplace are even lower than originally projected,” said Health and Human Services Secretary Kathleen Sebelius in a press release issued later.

“In the past, consumers were too often denied or priced out of quality health insurance options, but thanks to the Affordable Care Act consumers will be able to choose from a number of new coverage options at a price that is affordable,” she said.

While $328 may not sound affordable to a lot of people, most uninsured Floridians who use the exchange won't have to pay that much, HHS officials said.  Tax credits will reduce the premiums for a majority of those enrolling, often cutting it by half or more.

The report did  not say which companies offered the least-expensive plans. That information will not be available until Tuesday.

The report appears at odds with one produced by Florida’s Office of Insurance Regulation two months ago, based on rates reported to the agency. Nearly all of the rates listed on the OIR chart for the “silver plan,” the benchmark, are much higher than the one in the HHS report. Some are above $400 a month.

Deputy Commissioner Wences Troncoso said at the time that he had made the review an "apples-to-apples" comparison; many plans sold on the individual market until now have covered less than required under the Affordable Care Act.

It was not immediately clear why the state’s figures were higher --- whether there was an apples-to-oranges problem, a math mix-up, or intrusion of politics. State officials have been strictly negative about the Affordable Care Act, while the Obama administration has taken the opposite approach.

In any event, when uninsured Floridians start shopping for a health plan online starting Tuesday, they may be staggered by the sheer number of choices.  

Florida will have an average of 102 health plans available on the federal Marketplace, according to the report from the U.S. Department of Health and Human Services.  It varies by region, but of the five metro areas listed for Florida, the number ranges from 86 in Jacksonville to 137 in Miami-Dade.

One irony, as Kaiser Health News reports, is that states like Florida that have been the most opposed to the Affordable Care Act ended up with the most competitive plans and prices.

The reportby the HHS Assistant Secretary for Planning and Evaluation covers the 36 states that decided to depend on the federal government to create and run the shopping exchange under the Affordable Care Act. Florida is one of them.

While there are scores of plans for each region of Florida, there will be at most 11 companies offering them; the companies are listed on the OIR chart.

One company can provide a variety of plans --bronze, silver, gold and platinum --with premiums increasing according to the percentage of medical services actuaries think they will cover. Plans also differ in the network of doctors and hospitals they offer as well as the list of covered drugs.

Pricing also depends on age, income, family size and geography.  But not gender; women will no longer pay higher rates.

The benchmark plan used to calculate the average premium is the second-lowest-priced silver plan, which covers 70 percent of projected costs.  

Across the 36-states reviewed, the report said, 56 percent of shoppers in the Marketplace will qualify for tax credits that are deducted upfront, so that they resemble discounts.   

With that taken into consideration, a family of four with an income of $50,000 would pay $282 a month for the benchmark plan. That's a $500 discount from the sticker price for that family price.

A 27-year-old with an income of $25,000 would pay $145 a month for the same plan, the report said.

The federal Marketplace will also offer young adults “catastrophic” plans that cover some preventive and primary care but are geared toward protection against high hospital bills.  Providing the lower-cost catastrophic plan is a strategy for bringing young people into the risk pool to help offset the more-expensive  older customers.

The HHS report doesn’t list the prices by company or which insurers are selling in each region of the state. That information won’t be available until the shopping site opens Tuesday.

To qualify for a tax credit, a person must have an income between 100 percent and 400 percent of the poverty level.  That’s anywhere from about $11,500 to about $46,000 for a single person, and anywhere from about $23,500 to $94,000 for a family of four. See income chart here.

Price is important because in 2014, under the Affordable Care Act, Americans who don’t already have health insurance and who are not below the poverty level must buy it. (Those below the poverty level in Florida will not have coverage because the state Legislature voted against expanding Medicaid.)  

Florida’s average of 102 plans is higher than all other states except Arizona, which had an average of 106.

Open enrollment, which begins Oct. 1 on the online Marketplace or exchange, lasts for six months, through March 2014. Those who buy a policy in the fall can be covered as of Jan. 1.

Shoppers can find their choices as of Tuesday – assuming the market opens on time -- at   Help is available online by chat or toll-free at 1-800-318-2596.

A number of health-care facilities and drug stores will have trained personnel to help those who are confused.  “Navigators” who are being trained online, certified upon passing a test and licensed by the state after a background check,  will be deployed through community groups.

The Marketplace shopping site is not for Medicare beneficiaries or those who have adequate coverage through the workplace.

The $328 average premium price for the benchmark plan is about 16 percent below the price that had been projected by the Congressional Budget Office, HHS Secretary Kathleen Sebelius said.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.