The price of health plans sold on and off Florida's insurance exchange will go up an average of 9.5% next year, Florida's Office of Insurance Regulation said Wednesday. The final rates vary widely by insurer and type of plan.
In addition, the average highest-priced exchange plan for 2016 costs less than the highest-priced plan for 2015, data show. Florida did not break down plans by their bronze, silver, gold and platinum tiers.
Eleven health insurance companies will sell policies on Florida's exchange in 2016. Another eight will sell off the exchanges. Florida's federally operated exchange has the largest enrollment in the country with more than 1.4 million members as of March 31. More than 93% of Florida exchange consumers receive premium subsidies and another 71% receive cost-sharing subsidies to help pay down copayments, coinsurance and deductibles.
Florida has also been hostile to the Affordable Care Act. The state has refused to expand Medicaid to include more low-income people, and the state's insurance department was criticized last year for skewing information on the exchange rate increases.
This year, the 9.5% average rate hike is weighted, meaning the average accounts for health plans that have larger market shares. Modern Healthcare requested the most recent exchange enrollment by plan, but the state did not provide the information by deadline. Nor did it provide separate weighted averages for on- and off-exchange plans.
Laura Brennaman, policy and research director at consumer group Florida Community Health Action Information Network, said it was good that the state provided weighted averages but the overall process still lacked transparency. “We can't see the submissions because (insurers) claim trade secret,” she said. “So we don't know exactly what the Office of Insurance Regulation reviewed.”
The 9.5% rate increase was actually higher than the cumulative 8.6% boost that plans requested. Brennaman speculates Florida did not want major insurers undercutting competitors with much lower premiums.
For example, Blue Cross and Blue Shield of Florida, the state's largest health insurer, asked the state for a modest 4.3% increase. Florida insurance regulators ultimately approved a premium rate increase more than double that, 8.9%. The average monthly premium for someone who selects a Florida Blue plan next year will be $472 before subsidies, the highest total of all exchange-selling insurers. Florida also more than doubled Humana's proposed rate increase.
Several insurers made corrections or were approved for much smaller premium increases. Florida Health Care Plan will lower ACA premiums by 9.7% on average next year after it was by far the most expensive exchange plan in 2015. Molina Healthcare will be the cheapest exchange plan next year, costing $331 per month on average before subsidies.
Even though the average premium increase is above medical inflation, the range of premiums for exchange plans next year ($331 to $472) is tighter than it was in 2015 ($314 to $496). Further, people in parts of Florida with high levels of ACA sign-ups will actually see their premiums decrease next year. The average monthly premium for a silver-level plan for someone making $27,000 per year and living in Miami-Dade County is decreasing 5%, from $308 in 2015 to $293 next year. Miami-Dade County has by far the highest total number of ACA plan selections in the country compared with other counties.
Narrow provider networks also appear to be the standard for exchange plans in Florida. Each of the 11 exchange offerings, according to the state filing, is either an HMO or a similar exclusive provider organization plan. Research has shown that people who buy ACA plans usually have fewer choices of doctors and hospitals than those with employer-based plans.
Monthly premiums for off-exchange plans in Florida will cost anywhere from $247 to $543. Some people buy plans off the exchange if they don't qualify for subsidies, fall in the Affordable Care Act's “family glitch” or are politically opposed to the healthcare law.