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Need health insurance? Open enrollment starts Nov. 1 for Affordable Care Act plans

Liz Freeman
Naples Daily News

Southwest Florida residents enrolling or switching health insurance through the Affordable Care Act will have more plan options next year but may pay more.

Premiums among plans statewide offered by 10 insurers under the health law, commonly called Obamacare, will be 3.1% higher in 2021, according to the Florida Office of Insurance Regulation.

The increase takes into account cost projections for COVID-19 care.

What’s not factored is premium assistance, or subsidies, that enrollees may be eligible for based on income.

Affordable Care Act plans are popular in Florida. Enrollment is the highest of any state with 1.9 million Floridians insured this year, according to healthinsurance.org.

In Southwest Florida, 61,569 people in Lee County and 33,814 in Collier County are enrolled in plans.

When the law was passed in 2010, Florida opted not to establish its own “marketplace exchange” where people shop and compare plans. Instead Florida residents rely on a federal exchange at healthcare.gov.

The tax penalty for not having insurance, known as the individual mandate under the Affordable Care Act, was eliminated in 2019.

In both Lee and Collier next year, residents have plan options from Florida Blue, Celtic Insurance, and Health Options.

In addition, Cigna Health is offering coverage in Collier while Lee residents have a fourth option for coverage from AvMed Inc.

That's more than last year's one choice in Lee with Florida Blue and two in Collier with Florida Blue and Cigna.

Open enrollment runs from Nov. 1 to Dec. 15 for coverage beginning Jan. 1.

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People can qualify for coverage outside of open enrollment when they face life changes like losing employment-based insurance, moving or getting married.

The government is allowing qualification due to the COVID-19 pandemic, said Jodi Ray, director of Florida Covering Kids & Families, the organization overseeing enrollment assistance in Florida.

“Based on what we are seeing, I think it’s going to be very busy,” Ray said. “The need is really high. It’s indicative of the current situations changing.”

The average statewide monthly premium for 2019-20 coverage is $597 and will be $616 next year.

Ray said enrollees might qualify for premium subsidies that might bring down their share of cost.

A single person earning $27,000 a year in Collier would pay an average premium of $205 after a subsidy of $272 against an average premium of $477, according to the state insurance office.

In Lee County, the same individual would pay $207 a month.

A family of four earning $58,000 a year in Collier would pay $536 a month after the subsidy; the same family in Lee would pay $544 a month.

Out of the 1.9 million Floridians covered in Affordable Care Act plans, 1 million are covered by Florida Blue, spokesman Paul Kluding said.

"We remain the only insurer in the state that has offered ACA plans in every Florida county, as we have done in every year of the ACA and will continue to do in 2021," he said.

Florida Blue is offering a wellness rewards program where members can earn up to $500 next year toward health care services, which is a $400 increase over what was previously offered, he said.

COVID-19 impact on enrollment

Florida Covering Kids & Families received $1.6 million from the federal government this year for “navigators” at the local level to help people get enrolled, Ray said.

This year’s funding was more than last year's $1.3 million so this year she can bring back navigators in Northwest and Central Florida that had to be cut last year.

Ray said it is possible the state will see a new high in enrollment numbers for next year because of COVID-19.

“I don’t see any reason why enrollment will go down, particularly now more than ever,” she said. “People want to be insured so they can go to the doctor. I think it’s quite simple.”

Kluding, with Florida Blue, said it is difficult to predict the impact COVID-19 has had and will continue to have on the economy and industry segments like health care.

"Our hope is that Floridians will take time to explore their coverage options, particularly with subsidies available for the majority of them to help offset health care costs," he said.

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Florida is one of 14 states as of January that has not expanded Medicaid for people with incomes up to 138% of federal poverty, or $17,236 for an individual in 2019.

The U.S. Supreme Court in 2012 struck down Medicaid expansion under the Affordable Care Act and made it optional to states.

Half a dozen states since the court decision have expanded Medicaid coverage, but Florida has not despite a push from Florida Voice for Health, a coalition of social service and health care advocacy groups.

Roughly 846,000 uninsured non-elderly residents in Florida would gain coverage if the state expanded Medicaid, according to the Kaiser Family Foundation.

Maria Gomez, 47, a secretary for a farm produce business in LaBelle, said she can’t get Medicaid and lost premium assistance two years ago with an Affordable Care Act plan when her income changed.

She’s been uninsured since and relies on home remedies to keep her blood sugar under control for diabetes. She loves her job and is grateful to have it even though she gets no benefits.

In mid-July, she was infected with COVID-19 and had no choice but to go to the hospital. After being discharged, she kept testing positive and was off the job for nearly two months.

The hospital bills from Gulf Coast Medical Center in Fort Myers for her COVID-19 treatment are piling up. In the past with other illnesses, she’s made payments to the hospitals and that’s all she can do now.

“I know I need a doctor, but when you don’t have what you need (to make) you can’t get it,” she said.

The Neighborhood Health Clinic in Naples, which provides medical care to uninsured employed adults in Collier, said clients laid off during the pandemic are still being seen so their care is not disrupted, according to Nancy Lascheid, co-founder of the clinic with her late husband, Dr. William Lascheid.

The clinic does not see patients covered by government insurance, and most of the clinic’s patients would not be able to afford premiums through an Affordable Care Act plan, she said. 

The $20 a month patients contribute to support the clinic is waived if they have faced job losses, she said.

More recently about 50% of clinic patients who were laid off are back at work but part-time working in restaurants, hotels, housekeeping and other service industries, she said.

“As we’ve navigated this crisis, we’ve continued to focus on the humanitarian aspect,” Lascheid said.

(For assistance with Affordable Care Act plans, visit www.coveringflorida.org or call 1-877-813-9115.)