Covering Florida, one uninsured person at a time

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— Stephen Estes accidentally fractured his right foot leaving his home early one morning, and so far he’s paid $800 out-of-pocket for his medical expenses.

He works for a local security company but won’t be eligible for health coverage for another two months. Even then the premium is high.

The 37-year-old is leaning toward the “Cover Florida” insurance program for the uninsured that’s debuting Jan. 5. The initiative of Gov. Charlie Crist aims to provide affordable insurance options for people who have been uninsured for six months or are losing coverage.

“It’s something I would definitely do,” Estes said, waiting Wednesday afternoon to see his doctor at The Mike Davis Clinic in East Naples. “I think it’s a great thing. I don’t know how much it will help some of the unemployed.”

On the other side of the country in Oregon, a man considering a move to Florida called a health-care watchdog group seeking insight into the new insurance program.

He has a pre-existing medical condition and the program’s plans at first blush appear not to go far enough, said Laura Goodhue, executive director of Florida CHAIN, the Palm Beach-based group that works to promote health-care access to Floridians.

The man later told Goodhue he decided against the move to Florida, in part because the new insurance program won’t be much of a help.

“We’re not sure if it will cover what people need,” Goodhue said of Cover Florida. “We have not heard a lot from consumers. People need to ask a lot of questions because it’s unsure what is covered. My overall sense is it just stops short of health care reform that is needed. I think our state can do better. We commend the state for trying to do something but I think our state can do better.”

About 3.8 million Florida residents are uninsured for various reasons. The recession is adding to the uninsured ranks like those newly unemployed who lost employer-sponsored coverage and can’t afford temporary coverage through COBRA. Still others can afford individual policies on their own but opt to spend their money elsewhere, compounding the debate about government stepping in to address the uninsured.

Crist’s mission with Cover Florida, approved by the state Legislature this past spring, is guaranteed and affordable private coverage to uninsured Floridians who have been unable to access coverage. Negotiations with private insurers have resulted in six carriers offering 25 plans around the state.

In Southwest Florida, the state has contracts with Blue Cross & Blue Shield and United Healthcare. All carriers are required to offer a “bare bones” plan for preventive coverage and a catastrophic plan covering preventive and hospital care.

Blue Cross’ preventive plan in Lee and Collier counties has an average premium of $51 a month, with variations based on age and gender. The average premium for Blue Cross’ catastrophic coverage is $148 but climbs to $265 a month for a 60-year-old man.

The average premium with United’s preventive-care plan is $65 and averages $171 a month under the catastrophic plan. Again, the premiums are more or less depending on age and gender. For a 60-year-old man, United’s catastrophic premium is $309 a month.

The insurers must guarantee coverage for anyone between the ages of 19 and 64 but the insurers don’t have to cover medical treatment of an enrollee’s pre-existing conditions for one year.

Another eligibility rule is that someone must be uninsured for six months but exceptions can be loss of a job with employer-sponsored insurance, COBRA coverage expiring, and a death or divorce where the spouse provided employer-sponsored insurance.

“I really do think it’s a step in the right direction,” said Dr. Jerry Willamson, with Collier Health Services, adding that after one year of Cover Florida, the state ought to have an idea of its impact. “It will be interesting to see what comes of it. I don’t know. I’m not skeptical. I’m guardedly optimistic but I think it is a good start and I applaud the governor.”

Florida has 59 benefit mandates, more than most states, and such a comprehensive approach has priced many individuals and employers out of the market, said Sam Miller, spokesman for the Florida Insurance Council. The Cover Florida program aims to offer limited insurance without having to comply with the 59 mandates.

“Limited insurance under certain circumstances is better than no insurance,” Miller said. “Who knows whether this will provide a huge dent in the uninsured or not? This is very ambitious and as far as I am concerned, an innovative approach to do something about the uninsured.”

With respect to pre-existing conditions not being covered for one year, Miller said there had to be concessions for insurers to make it work.

“It is only for one year and the reason was price,” he said. “This is not going to work for some folks and some people can’t get insurance now because of pre-existing conditions.”

Other plan components with Blue Cross’ catastrophic coverage is a $3,000 annual deductible and benefits limit of $25,000 annually with a lifetime limit of $50,000. In contrast, United’s catastrophic plan has a $500 annual deductible and $500,000 lifetime benefits’ limit.

The $50,000 lifetime limit with Blue Cross is a concern but for someone who is healthy and young the coverage may be sufficient, said Tony Davis, an independent insurance agent in Naples who sells individual and small-group plans.

“For someone on a limited budget who can’t afford a traditional health care plan, this will give them some coverage but they have got to be aware they are not buying full-blown coverage,” Davis said. “But first they are drawn to price and they don’t pay a lot of attention to what the coverage is.”

For some uninsured residents who are working, the idea of buying a “bare bones” plan is still too far out of reach, said Nancy Lascheid, founder of the Neighborhood Health Clinic in Naples, which serves uninsured employed adults who pay one hour’s wage at each appointment.

“Our patients aren’t talking about what they can do, they are talking about what they can’t do,” she said. “We used to see employees of small businesses and now we are seeing the small business owner. We’re not hearing anything about insurance. Nobody is looking in that direction.”

Cover Florida’s framework is a major change for the insurance industry because it will allow for coverage, after one year, of pre-existing conditions, said Chip Kenyon, senior director of expansion markets for Blue Cross in Jacksonville.

“There’s no set number of people (needed to enroll) to make it worthwhile,” he said. “We are doing this to support the governor and legislators to make it affordable and available to Floridians who were previously locked out of coverage.”

For details about Cover Florida and outlines of the plans, go to Blue Cross & Blue Shield and United Healthcare will have toll-free telephone numbers available on Jan. 5, along with their own Web site details.

© 2008 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Comments » 2

TheVoice writes:

Isnt it crazy how insurance companies are willing to make billions off of perfectly healthy people who pay them thousands of dollars a year and barely even use it unless they get the sniffels, but others who could really use relief by way of insurance due to diabetis or other long term illnesses are givin the shaft, I mean isnt it people with medical conditions that really need medical insurance,if you ask me insurance companies found a loop hole and took advantage of it and basically are being allowed to operate a legal scandel on american people...

TheVoice writes:

Just one more thing if auto insurance operated like med ins. companies, it would be like saying you can have coverage as long as youll never start your vehicle...its nuts...

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