Premium prices for a popular type of health coverage under the Affordable Care Act have increased dramatically in Monroe County this year.
The news is especially important for consumers who signed up for coverage in 2014 because they will be automatically re-enrolled in their current plans on Dec.15 — but maybe not at the same price. Insurers are allowed to adjust premiums and benefits from year to year.
Consumers have the option of browsing healthcare.gov for a new, more affordable plan or seeking in-person help from a federally licensed nonprofit group or insurance agency.
“If you signed up last year, you may be happy with how your plan looks going forward, but you could save money by going back to the exchange,” said Jonathan Wu, CEO of ValuePenguin.com, a consumer finance site that created a national map showing county-level changes in federal subsidies and in premiums for “silver” level, or mid-range, plans, the most popular type.
In major metropolitan areas around the nation, lower-income consumers will generally pay a similar or slightly lower price for silver plans next year, according to an analysis by the Kaiser Family Foundation.
Premiums and subsidies are staying relatively stable in Miami-Dade and Broward but not in Monroe, which includes the Florida Keys.
Frank Gerlando, 52, of Marathon, signed up for a policy with Florida Blue last year. He chose a “gold” level plan, which is more expensive but offers greater financial protection in case of illness or injury.
Gerlando takes asthma and high blood pressure medications and said he was extremely satisfied with the plan.
In 2014, Gerlando said he paid $645 per month for his insurance. But next year Florida Blue is raising his monthly premium to $879 per month.
“That means my health coverage is 25 percent of my take home [pay]. I obviously cannot afford this once you include my car payment and housing and living expenses,” Gerlando wrote in an email.
Federal subsidies are also rising in counties like Monroe to help eligible residents pay for higher premiums, but Gerlando’s income is too high to qualify. He’ll have to pay the new price or pick a different plan that may not offer comparable benefits.
“I’ve lived in the Keys for almost 30 years,” said Gerlando, who manages two restaurants in Islamorada and Key Largo. “I know the cost of living is high here and I was prepared for maybe a 20 percent hike. But this is unbelievable. I thought it was a typo.”
“I need to make sure I can afford my medicine,” he added.
Maura Shiffman of the Health Council of South Florida, a nonprofit that received a federal grant to advise consumers in Miami-Dade and Monroe counties, said it’s important for consumers to think about benefits like provider networks, cost sharing and prescription drug access in addition to premiums.
“Sometimes the bottom-line price looks wonderful, but when you actually start utilizing the services, you realize the out-of-pocket costs are very high,” Shiffman said.
Plan prices change based on the consumer’s age, marital status and number of children. Federal subsidies are calculated using the second-cheapest silver plan in each county, which is called the benchmark plan.
About three of four Floridians chose silver plans for 2014.
In 2014, the benchmark plan for a 40-year-old with no children in Monroe County cost $352.88 per month, according to federal data. In 2015, the price will rise to $404.76.
Meanwhile, prices for benchmark plans in Miami-Dade and Broward are staying stable, increasing by about $4 in Dade to $274.10 and dropping by about 30 cents in Broward to $241.84.
Market forces are driving the price increases in Monroe, said Steven Ullmann, director of the Center for Health Sector Management and Policy at the University of Miami.
“One factor is that there are fewer insurers in the market in Monroe than there are in the other two counties,” Ullmann said. Miami-Dade and Broward each have nine insurers offering plans in their market. Monroe has only three.
That means insurers have less incentive to compete for consumers by offering lower premiums. “You don’t see much as much pressure to bring prices down in that kind of market,” Ullmann said.
Paul Kluding, a spokesman for Florida Blue, said price increases also had to do with the makeup of the people being insured, the so-called risk pool.
Kluding said that technical glitches during the previous enrollment window discouraged many healthy people who weren’t desperate for coverage from signing up, “leaving mostly the sickest members to endure the process of enrollment.”
Kluding added that the Obama administration’s decision to let about 465,000 Floridians keep their previous plans allowed healthier consumers to stay with their existing coverage while sicker people flocked to the exchanges.
In Monroe, residents also tend to be older and drink more alcohol than other residents of other Florida counties. Between 2000 and 2010, the number of people under age 54 in the county declined by about 12 percent while the number of people over 54 increased by almost 18 percent, according to a report by the Florida Department of Health.
And more than 25 percent of Monroe residents are considered “binge” drinkers compared to a statewide average of 15 percent, according to the same report.
Chronic illnesses from aging and alcohol abuse can be expensive to treat, said Dr. Mark Whiteside, medical director for the Florida Department of Health in Monroe County.
And it can be difficult to recruit healthcare providers to Monroe because of the county’s steep cost of living and high rate of uninsured residents, Whiteside said. About one in five people in Monroe are uninsured.
“Maybe that will change as more people sign up [for coverage],” Whiteside said. “We’re certainly poised to gain from more people getting insurance.”
But Gerlando says that for the moment he is stuck. He said he’s looked at the cheaper plans on offer and the out-of-pocket costs are too high.
“I’m stuck paying for this new policy and it’s going to take a big chunk out of my retirement,” Gerlando said.
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This article was produced in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.