Florida health insurance marketplace: history and
news of the state’s exchange

BCBS of Florida and Bright Health offering plans for 2018; cost of CSR added to silver premiums,making other
metal levels particularly affordable

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Louise Norris
Individual health insurance and health reform authority; broker
March 22, 2018

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    • Insurance for those over 64

Highlights and updates

  • 2018 enrollment down 4.6% from 2017
  • One insurer in 2017, but Bright Health joined in 2018
  • Average rate increase 15.6%, including added premiums to cover CSR cost
  • Cost of CSR added to silver exchange, other metal levels particularly cheap for some
  • 2018 rates and new insurer indicate death spiral no longer a danger

Florida exchange overview

The state of Florida currently has one of the highest numbers of uninsured residents at a whopping 12.5% (the national average is only 8.6%). Nationally, most people get their health coverage through their employers. Florida, however, leads the nation when it comes to residents getting insured via the individual health insurance market. In 2018, Florida ranked second in number of individual enrolling, just behind California, with 1,715,227 enrollees. A big factor in this is Florida refusing to accept federal funding to expand Medicaid. This results in a hefty coverage gap of about 384,000 people who are ineligible for Medicaid but also ineligible for premium subsidies. Furthermore, Florida has a special enrollment period due to hurricanes that push open enrollment until December 31st.

Health Ratings in Florida

In 2017, Florida ranked 23rd by United Health Foundation’s America’s Health Rankings. From 2016 to 2017, Florida saw a decrease in children’s poverty and mental illness. Additionally, Florida ranked 39th on the 2017 Scorecard on State Health System Performance. The Scorecard is ranked by force categories:

  • Access to Healthcare
  • Prevention and Treatment
  • Avoidable Hospital Use and Cost
  • Healthy Lives
  • Equity

Florida ranked lowest, 45th, in the ‘Avoidable Hospital Use and Cost’ category. On a brighter note, Florida ranked 20th place in the Healthy Lives metric.

Rates and Carriers

Six insurers offer plans for Florida residents in 2018,

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


Affordable Care Act and Florida

The Affordable Care Act was not welcomed in the state of Florida. Governor Rick Scott speaks against it and the state itself turned down federal loans to expand Medicaid expansion. In the House, nine members voted for the Affordable Care Act, while 15 members voted against it. The Consumer Operated and Oriented Plan (CO-OP) Program is a provision of the Affordable Care Act. This program helps nonprofit health insurers to come into the market to increase competition. As a result of this, 23 private, nonprofit plans were created across the country. In 2018, only four are offering coverage.


In 2015, Florida’s Medicare enrollment was above 4 million—about 20% of the state’s population. About 86% of Florida resident Medicare enrollees qualified based on their age. For those Florida Medicare enrollees who prefer a more advanced plan with more benefits, they can enroll in a Medicare Advantage plan. About 40% of Florida Medicare recipients opted for a Medicare Advantage plan. Additionally, about 35% of Florida Medicare enrollees opted for a Medicare Part D plan which covers prescription drugs.

Healthcare Reform

For emergency care, insurers are required to cover treatment—regardless if the providers are in-network. In March of 2016, lawmakers passed House Bill 221 which banned balance billing where patients used in-network hospitals or emergency care facilities when the patients doesn’t have the ability to choose a provider at that specific facility.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.