South Florida insurance rates will be among lowest in state, report says

09/25/2013 7:30 PM

10/10/2013 6:11 PM

Miami-Dade and Broward County residents who buy health insurance through federally run online marketplaces opening Tuesday will be paying some of the cheapest rates available in Florida, according to federal data released Wednesday.

A report from the U.S. Department of Health and Human Services shows how many insurance issuers will be offering plans in each county, what tiers those plans will be on and how much the average resident would pay before tax credits in certain tiers.

For example, in Broward, at least eight insurers will offer a total of 136 plans in platinum, gold, silver, bronze and catastrophic tiers. A 29-year-old resident there would pay an average monthly premium of $91.62 for a catastrophic plan, $136.80 for the lowest-cost bronze plan, $185.62 for the lowest-cost silver plan and $201.31 for the lowest-cost gold plan — all before tax credits that would help cut the costs for some low- and middle-income consumers.

Those are the least-expensive prices for the entire state, with the exception of the silver tier. (Premium amounts for platinum plans were not provided.)

The same 29-year-old living in Miami-Dade will be able to choose from 141 plans from nine different insurers. She would pay $116.36 a month for the lowest-cost catastrophic plan, $173.74 for bronze, $216 for silver and $255.67 for gold before tax credits, according to the report. Those prices also are relatively low compared to other parts of the state, which Obama administration officials credit to the high level of competition in South Florida among insurers on the online marketplaces.

In Monroe County, two insurers will be offering a total of 38 plans. The premiums will be significantly higher than the rest of Florida: That 29-year-old would pay $274.23 a month for catastrophic coverage, and $259.17, $307.11 and $354.30, respectively, for lowest-cost bronze, silver and gold plans.

Not surprisingly, the prices of premiums rise with the age of the insured.

Still, a 55-year-old in Broward would be paying, on average, the least-expensive monthly rates in the state for lowest-cost bronze ($272.62) and lowest-cost gold ($401.18) plans.

The same hypothetical 55-year-old living in Miami-Dade would pay an average of $346.23 a month for lowest-cost bronze, $430.46 for lowest-cost silver and $509.51 for lowest-cost gold, before tax credits.

The very lowest monthly premium a 55-year-old in Monroe would have to pony up is $516.49 for the lowest-cost bronze plan. And it goes up from there: $612.02 a month for the lowest-cost silver plan, and $706.06 for the lowest-cost gold plan – again, before tax credits.

The report did not specify which insurers would offer the low-cost plans or offer any details of the plans such as deductibles. It only offered information on the lowest-priced plans.

Kathleen Sebelius, secretary of Health and Human Services, said competition among insurers has helped drive down costs. In Florida, where there are an estimated 3.8 million uninsured residents, people will have an average of 102 health plans to choose from — the second-most in the country.

“Now there will be more choice and more competition thanks to the marketplace, and most consumers will find they will be able to choose from multiple companies when choosing which plan works best within their budget,” she said at a news conference Tuesday.

Sebelius announced that, nationwide, insurance premiums will be about 16 percent lower than the government projected, with the average individual on a middle-tier plan paying $328 a month before tax credits.

The online marketplaces, or “exchanges,” are a major facet of the Patient Protection and Affordable Care Act – Obamacare. They go live on Oct. 1, with an open enrollment period through March 31, 2014. Consumers must buy insurance by Dec. 15 if they want to be covered starting Jan. 1.

The exchanges will allow individuals and small-business owners to shop for insurance and find out whether they are eligible for Medicaid or for federal subsidies — tax credits — to help pay for coverage. The subsidies, which will be paid by the federal government directly to the insurance companies, will be for low- and middle-income residents who earn between 100 percent and 400 percent of the federal poverty level.

The government estimates that about seven million people will buy health insurance through the online marketplaces in the next year, and about six million of them will receive tax credits. Those who choose not to carry health insurance will face penalties, starting next year at 1 percent of their annual income or $95 per person per year, whichever is greater.

But consumers won’t know until Tuesday the details of specific plans — information like provider networks or co-payments.

That’s where “navigators” like Karen Basha Egozi come in.

Egozi, CEO of the Doral-based Epilepsy Foundation of Florida, and members of her staff are among hundreds of federally funded and trained navigators who will help Floridians in the enrollment process. They are not allowed to recommend specific plans.

“If someone comes to me with epilepsy and says, ‘I need to see a neurologist, and these are the meds I take,’ we would be explaining which plans will let them see a specialist, which ones support their medications and what they cost. Then they can decide what’s best for them,” she said.

Navigators could prove to be particularly helpful, Egozi said, to people with no experience shopping for health insurance.

“We’re particularly concerned with those who have never had health insurance and don’t know what a co-payment is or which medications are covered by a plan and which ones aren’t,” she said.

With all the choices in front of them, especially in South Florida, people may take their time to compare before they buy.

“We expect a lot of inquiries about the exchange, but not many decision-makers until closer to Dec. 15,” Egozi said. “People won’t want to put money out until they have to.”

Miami Herald multimedia analyst Lazaro Gamio contributed to this report. This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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