Florida Health Insurance

 Health insurance in Florida

● Florida uses the federally subsidized marketplace and enrolls through HealthCare.gov.

● Open enrollment for 2021 health plans runs from November 1 to December 15, 2020. Florida residents with qualified events can still sign up or make changes to their coverage for 2020.

● Short-term health plans can be sold in Florida with initial plan terms of up to 364 days.

● Ten insurers offering 2021 coverage through the Florida exchange, including newcomer AvMed.

● For plans sold in Florida's individual marketplace, insurers have proposed an overall average rate increase of 1.8% for 2021.

● Nearly 1.9 million Floridians have signed up for exchange plans for 2020, the highest enrollment in the exchange nationwide.

● Florida continues to reject the ACA's Medicaid expansion.

● Florida's balance billing protections are among the strongest in the nation, and the state's health insurance advisory board recommends lawmakers consider a provision to add emergency transportation to balance billing protections.

● Nearly 4.66 million Floridians are enrolled in Medicare.

We've created this page to help consumers find information about various types of health insurance in Florida. We covered the basics of Florida health insurance exchange (marketplace) and upcoming open enrollment period; a brief overview of Medicaid coverage in Florida and the state's refusal - so far - to expand Medicaid; a quick look at the availability and rules of short-term health insurance in the state; details about Medicare in Florida, including state rules for Medicare plans, and a variety of health coverage-related resources in Florida.

Florida's health insurance marketplaceplace

Florida uses the federally managed health marketplace (exchange), so individuals and families who need to buy their own health coverage use HealthCare.gov to enroll. The marketplace is used by individuals and families who do not have a coverage option from an employer or Medicare. Individual/family health plans are purchased by people who are self-employed, people who have retired before the age of 65, and must purchase their own coverage until they become eligible for Medicare, and by people employed by small businesses that do not provide health benefits. The marketplace is also the only place Florida residents can get income-based financial assistance with their individual medical coverage.

Florida open enrollment period and dates

Open enrollment for 2021 health plans will start on November 1, 2020 and continue until December 15, 2020. Outside of that window, Florida residents with qualified events can sign up or make changes to their coverage.

The open enrollment period applies both on the stock exchange and outside the exchange (i.e., directly through insurance companies). Open enrollment is an opportunity to sign up for coverage recently and is an opportunity for existing subscribers to renew or change coverage for 2021. Existing subscribers should ensure that their financial information on file with the exchange is accurate, so that eligibility for the grant is calculated correctly.

Ten insurers will offer plans for 2021 in Florida's individual marketplace, all of which will offer plans in the exchange. This includes AvMed, which joins the exchange for the first time (in past years, AvMed has offered plans outside the exchange). Insurers' participation in the Florida stock exchange also grew by 2020, with Bright Health entering the marketplace and Cigna reuniting in some areas after exiting the exchange in late 2015. By 2021, Cigna is expanding again, adding Leon, Lake, Seminole, Orange, Osceola, Broward, Indian River, Martin, and St. Lucie counties to its Florida service area.

For individual marketplace plans sold in the Florida exchange, the average rate increase after the state approval process was 0.0% for 2020. Although there was a variation from one insurer to another, overall premiums (before considering subsidies) were flat-rate from 2019 to 2020.

For 2021, insurers proposed an overall (unweighted) average rate increase of 1.8%.

1,913,975 people enrolled in individual marketplace plans through Florida's health insurance marketplace during the open enrollment period for 2020 coverage. This was a 7.3% increase over the previous year, which was the third largest percentage increase in the country (most states saw a drop in enrollment from 2019 to 2020).

Still no Medicaid expansion in Florida

The Medicaid expansion was intended as one of the ACA's major vehicles to reduce 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 chosen to expand coverage, there are 14, including Florida, that have taken no action to expand Medicaid eligibility to include low-income, non-elderly, and non-disabled adults without children.

Florida's decision not to expand Medicaid leaves about 391,000 people in the coverage gap, meaning they don't qualify for Medicaid or are eligible for tax benefits to help them afford private health insurance. According to an analysis by the Robert Wood Johnson Foundation, more than 1.3 million people in Florida would earn Medicaid coverage if the state expanded coverage, and the uninsured rate would drop by 30 percent.

Since 2013, monthly enrollment in FLORIDA CHIP/Medicaid has increased by only 3%, compared to a national average increase of 28%.

Short-term health insurance in Florida

Because Florida has no state regulations for short-term plans, federal regulations apply in the state. Insurers can offer short-term plans with initial terms of up to 364 days and the ability to renew for a total duration of up to 36 months.

The Florida Health Insurance Advisory Board recommended that lawmakers add a provision to Florida's statute to require stronger disclosure language for short-term plans and the requirement that consumers sign a statement indicating that they read the disclosure or read it from a seller (the recommendation was approved at a December 2019 FHIAB board meeting, to be forwarded to Florida House and Senate leaders. But so far, lawmakers have taken no action.

How did Obamacare help Florida?

Although the Sunshine State has not embraced Obamacare from a legislative point of view, the health care reform law has had some positive impacts.

Florida's federally subsidized health insurance exchange has the highest enrollment numbers in the nation, all with coverage for the ACA's essential health benefits. And more than 1.7 million of them subsidies for premiums, which make monthly health insurance premiums much cheaper than they would otherwise be.

According to U.S. Census data, Florida's uninsured rate was 20% in 2013 and had fallen to 12.5% in 2016 (it had slightly increased, to 13%, by 2018, and to 13.2% by 2019, reflecting a nationwide increase in the uninsured rate under the Trump administration).

The average uninsured national rate stood at 9.2% in December 2019, but Florida's rejection of federal funding to expand Medicaid has blocked a significant portion of the population out of coverage. If Florida expanded Medicaid, the uninsured rate would drop substantially.

Affordable Care Act

In the 2010 vote on the Affordable Care Act, Florida senators split their votes. Democratic Senator Bill Nelson voted yes, while Republican Senator George Lemieux voted No. Lemieux briefly held the Senate seat after being appointed by the then governor. Charlie Crist is serving the rest of Republican Senator 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 has been instrumental in making the ACA's risk corridor program retroactively budget-neutral, increasingly condemning 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 instructed to come 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 has not been well received by state politicians in Florida. The state turned down federal loans to evaluate a state-run exchange, was the lead plaintiff in the 2012 U.S. Supreme Court case that challenged the ACA, rejected Medicaid expansion, and signed on as an plaintiff in the ongoing lawsuit that seeks once again to overturn the ACA.

Medicare coverage and enrollment in Florida

Medicare is a health coverage provided by the federal government for elderly and disabled Americans. As of August 2020, there were nearly 4.66 million Florida residents enrolled in Medicare. Most are eligible because they are at least 65 years old. But 13 percent of Florida Medicare beneficiaries are under the age of 65, and are eligible for it because of a disability that lasted at least two years, or SRIA, or end-stage kidney disease.

Health insurance resources in Florida

● Florida Consumer Action Network (FCAN)

● Florida Kid Care

● FloridaHealthFinder.gov

● Florida Office of Insurance Regulation - Licenses and regulates health insurance companies, brokers, and agents. It provides information and assistance to consumers who have questions or complaints.

● Medicare Rights Center - A national service (call center and website) that can provide advice and information for Medicare beneficiaries.

Florida reform at the state level

Florida lawmakers approved House Bill 221 on March 11, 2016, and Governor Scott signed it in April, thus prohibiting the practice of billing balance in situations (including non-emergency care) where the patent uses a networked hospital or urgent care facility, and "does not have the ability or opportunity to choose a participating supplier at the facility." The legislation has been considered among the strongest billing protections in the country. For emergency care, insurers are required to cover treatment at online rates, regardless of whether providers are less networked and whether or not the patient can choose another provider.

The FHIAB reviewed numerous legislative recommendations at a December 2019 meeting, approving almost all of them, including a recommendation to add emergency transport costs to services protected by HB221. The FHIAB sends suggestions to the legislature, but it is then up to the legislators to decide whether to act on them.