Florida Insurers Compete With 'Cost-Share' Plans

Dec 10, 2015
Originally published on December 10, 2015 2:21 pm

The latest numbers from federal health officials show Florida is continuing to lead in enrollment on HealthCare.gov, with nearly 600,000 who have signed up so far.

"We're so pleased with the reduction in uninsured,” U.S. Department of Health and Human Services Secretary Sylvia Burwell said after enrollment numbers were released Wednesday afternoon. “We also know there are still many folks in Florida who don't have coverage.”

As a key deadline for the third season of open enrollment nears, health insurance companies in Florida are stepping up their marketing efforts to enroll consumers who are eligible for health plans that are heavily subsidized by the federal government.

"The two key concerns that people are really always asking about is how much is it going to cost me, and where can I go,” said Katherine Skube, who works at the Florida Blue Retail Center across the street from the WestShore Plaza Mall in Tampa.   “Those are the two driving factors for health care for most people."

Florida Blue is among the health insurance companies in Florida trying to appeal to the estimated 825,000 people who are eligible for financial assistance for a health plan, but still haven't enrolled. According to the Kaiser Family Foundation, many of them haven’t signed up because they don’t know they could get tax credits for monthly premiums or additional financial help through cost-sharing.

As part of the Affordable Care Act, all insurance companies are required to offer silver plans that incorporate cost-sharing dollars from the federal government. Customers who qualify for cost-sharing plans have incomes between 100 percent and 250 percent of the federal poverty level, or about $24,000 to $60,000 a year for a family of four. Under these plans, the actuarial value of the plan is increased for the consumer.

“To put it in the most common language, it's how much they're going to have to spend themselves,” Skube said.

The Congressional Budget Office estimates it will cost about $147 billion over the next decade to fund cost-sharing under the Affordable Care Act. Different companies use the cost sharing dollars in different ways, to reduce what customers spend on co-pays, deductibles and co-insurance.

The new product from Florida Blue, called MyBlue, features a $0 deductible and low co-pays. It’s available only in Duval, Osceola, Orange, Seminole, Pinellas, Pasco, Hillsborough, Palm Beach, Broward and Miami-Dade counties.

"It's pretty exciting that somebody could have the potential of paying $1 to go see a specialist,” Skube said. “That can be something that's very interesting to a person who says, I don't have a lot of disposable income that I can spend for this."

But there's a tradeoff. They're in a Health Maintenance Organization, or HMO, meaning they have a very specific list of providers they can see. Sometimes, it's a short list.

  The issue of provider networks came up recently in Tampa, when HealthCare.gov CEO Kevin Counihan met with some of Florida's Affordable Care Act navigators, or in-person assisters. He said consumers should call the doctor's office to confirm they accept a certain plan.

“Not just the company, like, do you take Florida Blue? Because you guys know, it's not that simple,” Counihan said.  “The doctor's office will say sure, right? But is it Florida Blue HMO X Y Z? That's what the question has to be."

Humana is among the health insurance companies in Florida selling a variety of plans on HealthCare.gov, including a cost-sharing plan.  

"This year, we did lower the prescription co-pays, the doctor co-pays, and the overall maximum out-of-pocket,” said Abbie Hundt, who oversees sales representatives who sell Humana plans in Tampa Bay, Central Florida and South Florida. “For those people that fall in the lower levels of the federal poverty level, we really want to help those consumers out so they do have access to care. We want them to be able to go a primary care physician.”   

She said part of Humana’s marketing strategy includes setting up kiosks in malls this weekend around Tampa Bay, Central Florida and South Florida. She said when they set up shop last year during open enrollment, they were met by lines of people waiting.

“We were thrilled, obviously, because we do want to help everyone purchase health insurance,” Hundt said.

Amid the crowds of people doing holiday gift buying this year, Humana -- and other insurance companies  -- are hoping for long lines of people who are shopping for health insurance.  

Dec. 15 is the deadline to enroll for coverage that kicks in by Jan. 1. Under the federal health law, the penalty for going without insurance in 2016 is increasing to $695, or 2.5 percent of household income, whichever is greater.

Lottie Watts is a reporter and producer with WUSF in Tampa. Health News Florida receives support from the Corporation for Public Broadcasting.

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