Updated 11/1/2017. We will continue to update this blog as specific plan information comes in!
Now that open enrollment has officially kicked off, it is time for Floridians to research their plan options for 2018. Florida has the highest exchange enrollment in the country with 1,760,025 Floridians enrolling through the health insurance marketplace. And 90% of marketplace participants receive premium subsidies that reduce average premiums from $442/month to $118/month.
Obamacare, Trumpcare...what you need to know for open enrollment
Since Trump took office in January, he has been promising to repeal and replace the Affordable Care Act (also known as Obamacare). Congress has not been able to pass a piece of legislation that replaces the ACA so it is still the law of the land. Which means you still need to have health insurance coverage or pay a penalty through your taxes. The penalty is calculated two ways: 2.5% of household income or per person fee ($695/ adult and $347.50. child). You pay whichever is higher!
What Trump has been able to do is reduce the open enrollment period by six weeks. The open enrollment season for 2018 coverage is Nov 1- Dec 15, 2017. He also reduced funding for the marketplace which means there will be less advertising and awareness campaigns about the shorter enrollment window this year. The government health insurance marketplace, healthcare.gov, will also have planned shutdowns this year during open enrollment, making it difficult for consumers to research and purchase plans. The site will be down on Sundays from 12am-12pm (Except Dec 10) during open enrollment and overnight Nov. 1.
Extension for those affected by hurricanes
To ensure those affected by hurricanes have enough time to enroll in coverage for 2018, CMS (Centers for Medicare and Medicaid Services) has announced special enrollment period extensions. Individuals who reside in or move from areas affected by a hurricane in 2017 will be eligible for a special enrollment period that extends the 2018 Annual Open Enrollment Period through December 31, 2017 (an extra 15 days). In order to be eligible for the extension, individuals must contact the Marketplace Call Center at 1-800-318-2596 to request enrollment using this special enrollment period after December 15, 2017. CMS advises that you call prior to December 15, 2017 to ensure you are eligible for the extension.
Plan Types: HMO, PPO, EPO￼￼
HMO, PPO, EPO, POS - what do these network types mean? It sounds confusing, but it mainly comes down to a few key points that distinguish these network types. Understanding the basicsof health insurance helps you make a smart decision! Study up.
Here's an overview:
An HMO (or “health maintenance organization”) is generally the most affordable, but least flexible network type. Here a few key concepts of a HMO:
- You are required to select a primary care physician (or the insurance company can assign one for you) who is your first-stop for health needs. You will need a referral from your primary care physician to see a specialist.
- If you choose to see a doctor outside of the network or without a referral, you will generally have to pay all costs out-of-pocket unless it is a true medical emergency or you have no other options.
- The physician network is local.
A PPO (or “preferred provider organization”) is generally the most flexible, yet most expensive network type. Here a few key concepts of a PPO:
- You do not need to select a primary care physician and you do not need referrals to see a specialist.
- If you see an in-network provider, you will only be responsible for paying a portion of the bill (based on your plan's coverage structure).
- If you choose to see a doctor who is outside the preferred network, you will generally have to pay a larger portion of the bill than you would for an in-network provider.
- You will have access to out-of-state providers that are considered in-network.
An EPO (or “exclusive provider network”) is a hybrid of a HMO and a PPO. Here a few key concepts of an EPO:
- EPOs are more flexible than an HMO, and are typically less expensive than a PPO.
- Like a PPO, you do not need a referral to get care from a specialist.
- Like an HMO, you are responsible for paying out-of-pocket if you seek care from a doctor outside your plan's network.
Participating insurers for Florida market 2018
Six insurers plan to offer coverage in Florida’s exchange for 2018, although participation is localized: 42 of the state’s 67 counties will have just one insurer offering plans in the exchange. All the plans offered on the Florida exchange this year can also be found off the exchange as well for individuals. If you are eligible for a tax credit, purchasing an on-exchange plan is the only way to utilize it.
Use TakeCommandHealth.com to estimate your tax credit, search for your doctors, and compare on-exchange and off-exchange options in your area.
FL Blue (BCBS of Florida)
On and Off exchange
Florida Blue is the State’s largest insurer covering all 67 counties and remains committed to the Florida marketplace. Premium increases are 38.1% over 2017.
Celtic Insurance Company
On and off exchange
Celtic Insurance company includes Centene and Ambetter. Ambetter has 219,053 Floridians enrolled through their marketplace plans in 2017. They currently have coverage in 17 counties in 2017 and plan on expanding coverage in 2018 to 22 counties. The counties where Centene/Celtic/Ambetter is expanding are Alachua, Lake, Marion, Orange, and St. Lucie. Plans are expected to see a 46.1% increase in 2018.
Florida Health Care Plan
On and off exchange
Florida Health Care Plan is available in 4 counties in 2018: Brevard, Flagler, Seminole, and Volusia. Plan premiums are expected to have a 26.5% increase. Florida Health Care Plan Is a subsidiary of Florida Blue.
Health First Commercial plans
On and off exchange
Health First covers four counties in 2017, but will cover five counties in 2018, with expansion into Seminole County. Brevard, Flagler, Indian River, Seminole, and Volusia will all be covered by Health First in 2018. The plans can be purchased both on and off the exchange. Premium increases of 39.3% for 2018.
On and off exchange
Health Options will cover 45 Florida counties in 2018. Plans will have a 36% premium increase over last year.
On and off exchange
Molina will have a 71.2% premium increase. Molina has 336,515 on-exchange members in Florida and will cover 8 counties in 2018 including: Broward, Duval, Hillsborough, Miami-Dade, Osceola, Palm Beach, Polk, and Putnam.
Off exchange only
Available in 3 Florida counties: Broward, Miami-Dade, and Palm-Beach in 2018. Premiums are expected to be 38.7% higher in 2018.
Cigna will cover 17 counties in 2018 including: Brevard, Flagler, Hernando, Hillsborough, Indian River, Lake, Lee, Manatee, Orange, Osceola, Pascal, Pinellas, Polk, Sarasota, Seminole, Sumter, and Volusia. Premium increases are expected to be 68.9% over last year.
Freedom Life Insurance company of America
Freedom Life Insurance is offering the only PPO for Floridians on the individual market. It is available statewide, in all 67 counties. Plan premiums will be 80% higher over last year. As the plans are only available off the health exchange they are ineligible for tax subsidies that would reduce the monthly payment for individuals.
Off-exchange (faith based)
Faith-based Medi-Share has a state-wide PPO network available in 2018 managed by PHCS (Private Healthcare Systems, now owned by Multiplan). It’s smaller than some of the PPO networks in the past, but it does provide flexibility to see your doctors and will cover out-of-network expenses as long as it meets Medi-Share’s faith-based guidelines. Medi-Share won’t be for everyone, but is a worthy option to consider if it fits your personal convictions and lifestyle. Make sure to check out our Medi-Share review and compare it to other major medical plans on our website before you enroll.
Insurers Leaving Florida market 2018
Humana has announced their plan to leave the Florida market, and all markets across the country, in 2018. Last year, Humana had coverage in six Florida counties: Broward, Hillsborough, Miami-Dade, Palm Beach, Pasco, Pinellas, and Volusia. If you reside in one of these counties and had Humana coverage last year, make sure you shop around and compare your options for 2018.
Next Steps: What's my best option?
Hunting down and comparing all of these options can feel overwhelming. However, at TakeCommandHealth.com we help you compare all of your options side-by-side including off-exchange plans, marketplace plans, and faith-based options. You can use our award-winning tools to search for your doctors, check your prescriptions, and even simulate conditions and health needs to make sure you get the most of for your money.
A few other updates we'd like to tell you about:
- We've expanded the capabilities of our doctor search tool to search doctor networks from all of the plans above (no matter if the plan is off-exchange, on the marketplace, or faith-based).
- We've negotiated some pretty awesome deals for our members. Call a doctor 24/7 for $0, medical bill negotiation support, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans.
- We're pretty confident we have the biggest, most complete line-up of plans in Florida this year.
- We've put together a bigger support team ready to help you tackle any issue. You can get started by chatting with us on our website or emailing us at firstname.lastname@example.org.