Florida health insurance
Florida residents have until December 31, 2017 to enroll in coverage for 2018, due to hurricane-related extension
- Louise Norris
- Individual health insurance and health reform authority; broker
- December 27, 2017
Florida 2018 enrollment update
Florida insurance overview
Open enrollment for 2018 coverage ended on December 15, 2017 in Florida, but there’s a special enrollment period for Florida residents due to the hurricanes that hit the state in 2017. People in Florida, as well as those who lived there during the hurricanes, have until December 31 to enroll in a plan through the exchange, with coverage effective January 1, 2018.
Florida has one of the highest uninsured rates in the country (12.5 percent in 2016, as opposed to 8.6 percent for the US as a whole), but it also leads the US in terms of the number of people who sign up for health insurance in the state’s exchange. Nationwide, only a small fraction of the population has coverage in the individual health insurance market — most people get their coverage from employer-sponsored plans or government-sponsored plans. But the percentage of people in Florida with individual market coverage is nearly double the national average, which helps explain why Florida has such high enrollment numbers in the exchange.
For 2017 coverage, 1,760,025 Florida residents enrolled (the second-ranked state was California, with 1,556,676 enrollees). And for 2018, Florida had 1,715,227 enrollees during open enrollment, again coming in far above the rest of the country in terms of enrollments (and nearly reaching 2017’s enrollment total, despite the fact that open enrollment was half as long for 2018). The second-ranked state for 2018 enrollments was again California, with 1,420,000 enrollees as of mid-December — but with the caveat that open enrollment continues until the end of January in California, whereas it ended on December 15 in Florida (with additional enrollments possible through December 31 due to the hurricane-related special enrollment period).
In 2016, Florida lawmakers passed House Bill 221, which bans the practice of balance billing. Florida has been heralded as one of the more progressive states on this issue, as there is no solid federal policy in terms of balance billing.
Florida health ratings
When it comes to public health, various ratings place Florida in the bottom half of the nation. United Health Foundation’s America’s Health Rankings is one of them. In the 2017 edition, Florida ranks 32rd — but that’s up four spots from the previous edition, tied with Utah for the most improved state. From 2016 to 2017, Florida saw a decrease in the percentage of children living in poverty and suffering from frequent mental distress, both of which contributed to the state’s improvement in the overall rankings.
But the 2017 edition of America’s Health Rankings places Florida 46th in terms of the percentage of the population that has health insurance. Despite Florida’s huge enrollment numbers in individual market coverage, the state has refused to accept Federal funding to expand Medicaid under the ACA. As a result, there are an estimated 384,000 Florida residents in the coverage gap — ineligible for Medicaid and also ineligible for premium subsidies, essentially without any realistic options for health insurance coverage.
The 2017 Scorecard on State Health System Performance ranked Florida 39th, the same as it had been in the previous edition of the Scorecard. The Scorecard evaluates a range of health indicators and gives an overall score to each of the 50 states and the District of Columbia. Florida’s scorecard details how the state scored on individual measures within five categories: Access, Prevention & Treatment, Avoidable Hospital Use & Cost, Healthy Lives, and Equity. The state earned its lowest marks for Avoidable Hospital Use & Cost, coming in 45th. But Florida was in the second quintile (20th place) in the Healthy Lives metric.
While it does not include an overall score, the 2016 edition of Trust for America’s Health provides a wealth of public health information; see Key Health Data About Florida. As it does in other rankings, Florida’s percentage of uninsured residents stands out as an area needing much improvement. Based on 2014 data, Trust for America’s Health reports that 16.6 percent of Floridians – adults and children – were uninsured.
Some Florida counties fared far worse than the 16.6 percent average. County-by-county health rankings from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin showed a range of 15 to 33 percent uninsured across the state.
Is Obamacare helping Florida’s uninsured?
Although the Sunshine State has not embraced Obamacare from a legislative standpoint, the healthcare reform law has had some positive impacts there.
Florida’s federally facilitated health insurance exchange has the nation’s largest number of eligible of enrollees and highest enrollment numbers, and according to US Census data, Florida’s uninsured rate was 20 percent in 2013, and had dropped to 12.5 percent by 2016.
The national average uninsured rate was down to 8.6 percent by 2016, but Florida’s rejection of federal funding to expand Medicaid has locked a significant portion of the population out of coverage. If Florida were to expand Medicaid, the uninsured rate would drop substantially.
2018 Obamacare rates and carriers
Six insurers are offering plans in Florida’s exchange for 2018, with the following average approved rate increases (silver plans rate increases are the largest, because the cost of cost-sharing reductions has been added to silver plan rates for 2018):
- Florida Blue (BCBS of Florida): 38.1 percent
- Florida Blue HMO (Health Options): 36 percent
- Florida Health Care Plan Inc. (a Florida Blue subsidiary): 26.5 percent
- Ambetter (Celtic): 46.1 percent
- Molina: 71.2 percent
- Health First Health Plans: 39.3 percent
Humana exited Florida’s individual market at the end of 2017, but Celtic/Ambetter has expanded to cover 22 counties in 2018, and Health First expanded from four counties to five.
Although rate increases are significant for 2018, premium subsidies are much larger, resulting in after-subsidy rates that are lower for some enrollees than they were in 2017.
FL enrollment in qualified health plans
Despite the ACA’s cold reception among political leaders, Florida residents have taken advantage of the health insurance marketplace, with enrollment leading the nation.
By January 31, 2016, the end of 2016 open enrollment, Florida had enrolled more people than any other state and had the nation’s highest per-capita enrollment rate. As of March 31, 2016, Florida’s effectuated exchange enrollment stood at 1,531,714.
1,760,025 Florida residents enrolled in coverage through the exchange during the open enrollment period for 2017, again far outstripping the rest of the states.
And for 2018 coverage, Florida had 1,715,227 enrollees during open enrollment, again well ahead of the rest of the country. Open enrollment ended December 15, but people in Florida actually have until December 31 to sign up, due to the special enrollment period that was granted in response to the 2017 hurricane season.
Florida and the Affordable Care Act
In the 2010 vote on the Affordable Care Act, Florida’s senators split their votes. Democratic Sen. Bill Nelson voted yes, while Republican Sen. George LeMieux voted no. LeMieux briefly held the Senate seat after being appointed by then-Gov. Charlie Crist to serve out the remainder of Republican Sen. Mel Martinez, who retired. LeMieux left the Senate in 2011 and was replaced by Republican Marco Rubio. Rubio is opposed to the Affordable Care Act, and was instrumental in making the ACA’s risk corridor program retroactively budget-neutral, effectively dooming a number of smaller insurers across the country.
Among Florida’s delegation to the U.S. House of Representatives, 9 members voted in favor of the ACA, while 15 voted against the law. Republicans outnumber Democrats in the current delegation, 16 to 10.
The Affordable Care Act was not well received by state-level politicians in Florida. Gov. Rick Scott is vocally opposed to the healthcare reform law, and the state rejected federal loans to evaluate a state-run exchange, was the lead plaintiff in the U.S. Supreme Court case challenging the ACA, and rejected Medicaid expansion.
Medicaid expansion was intended as one of the ACA’s main vehicles for reducing the number of people who lacked medical insurance coverage. However, the U.S. Supreme Court ruling in 2012 opened the door to many states, including Florida, to opt out of Medicaid expansion to single adults ages 19 to 64.
Florida’s decision not to expand Medicaid leaves 384,000 people in the coverage gap, meaning they do not qualify for Medicaid nor are they eligible for tax subsidies to help them afford private health insurance. According to the Kaiser Family Foundation, based on current eligibility for coverage, 702,000 people living in Florida would be eligible for Medicaid if the state expanded.
Since 2013, monthly Florida Medicaid enrollment as increased slightly by an average of 17 percent despite the state’s decision not to expand.
The Florida Department of Children and Families provides information about Florida’s health insurance assistance programs for low-income individuals and families.
Other ACA reform provisions
The Consumer Operated and Oriented Plan (CO-OP) Program is a provision of the Affordable Care Act. Through federal loans, the program encouraged start-up, nonprofit health insurers to enter the market and increase choice and competition. While no CO-OP plans were created in Florida, 23 private, nonprofit plans were set up across the country. Heading into 2018, only four were still offering coverage.
Medicare enrollment in the Sunshine State
Florida Medicare enrollment exceeded 4 million in 2015, about 20 percent of its population. Florida’s Medicare enrollment numbers are second only to California and the percentage of Florida residents enrolled in Medicare is higher than the 17 percent the total U.S. population enrolled in Medicare.
About 86 percent of Florida Medicare recipients qualify based on age alone, while the remainder are eligible as the result of a disability.
In 2014, Medicare spent about $10,610 per enrollee. The national average was $8,970 per enrollee. As of 2009, the latest available data, Florida ranked second in overall spending with $39.1 billion per year. California was first with $50.6 billion.
Florida residents who want additional benefits beyond those offered by Original Medicare can enroll in a Medicare Advantage plan. About 40 percent of Florida Medicare beneficiaries select a Medicare Advantage plan – about 32 percent of all U.S. Medicare beneficiaries make that selection. Thirty-five percent of Florida Medicare enrollees also select a Medicare Part D plan for stand-alone prescription drug coverage compared with 43 percent nationwide.
Florida health insurance resources
Florida reform at the state level
Here’s what’s happening legislatively at the state level with healthcare reform in Florida:
- Florida lawmakers passed House Bill 221 on March 11, 2016, and Gov. Scott signed it into law in April, thereby banning the practice of balance billing in situations (including non-emergency care) where the patent uses an in-network hospital or urgent care facility and “does not have the ability or opportunity to choose a participating provider at the facility.” For emergency care, insurers are required to cover treatment at in-network rates, regardless of whether or not the providers are in-network and regardless of whether or not the patient could choose another provider.
Other state-level health reform legislation:
More Florida coverage
News, history, and enrollment info for your state marketplace
Florida Health Insurance
Learn About Your Health Insurance Options
This guide will walk you through what you need to know for the 2018 Affordable Care Act enrollment. Whether you are enrolling in an insurance plan through Healthcare.gov, a state exchange or a health insurance broker, these FAQs lay out general and Florida-specific information to help you understand your choices.
The official 2018 open enrollment period is from Nov. 1 through Dec. 15.
How to Apply
Healthcare.gov is Florida’s official portal for buying a health exchange plan under the Affordable Care Act, also known as “Obamacare.” Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you will pay the same price for a plan regardless of where you buy it or whether you sign up via phone, online or by filling out paper forms.
When you sign up for coverage on Healthcare.gov, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this information handy:
- Social Security numbers for everyone in your household
- Your employer’s name and address
- Your most recent pay stub or recent records of your wages
- Information about other types of income you receive, such as alimony, unemployment benefits or a pension
Frequently Asked Questions About the Affordable Care Act
Do I have to buy health insurance?
Yes. The Affordable Care Act’s individual mandate requires U.S. citizens to enroll in a health insurance plan or pay a fine.
However, certain factors, like a hardship that prevents you from purchasing coverage, may exempt you from paying the fine. And if you have a plan through your work or coverage through Medicare Part A or C, the Children’s Health Insurance Program or most Medicaid plans, you won’t need to buy additional health coverage.
U.S. News generally recommends getting health insurance of some kind. Many premiums have changed since last year. So, even if your current plan is still available, research whether another plan might be a better value.
What is the penalty if I don’t have insurance?
Not carrying insurance will cost $695 per adult plus $347.50 per child for up to $2,085 per family, or 2.5 percent of your family’s income, above the tax-filing threshold – whichever is more.
What are my options for buying an Affordable Care Act health plan?
You’ll find health plans in as many as four coverage levels, commonly called metal tiers: platinum, gold, silver and bronze. Platinum plans charge high premiums but offer the best cost-sharing benefits, covering an average of 90 percent of health expenses incurred. On the other hand, bronze is the least expensive plan type but only covers an average of 60 percent of incurred health expenses.
Those younger than 30 and those with a hardship or affordability exemption may also purchase catastrophic plans. These plans are the most limited form of health insurance coverage available in the “Obamacare” market.
Am I eligible to buy insurance on the Affordable Care Act marketplace?
You are eligible to buy coverage if you are a U.S. citizen, a U.S. national or an immigrant lawfully living in the U.S.
Those who are incarcerated or who are living in the U.S. illegally are not eligible to purchase coverage. You may purchase insurance through the exchanges if you are eligible for employer-sponsored coverage, though you likely wouldn’t be eligible for subsidies.
Do I qualify for a health insurance subsidy?
Your expected income and household size determine whether you can receive subsidies.
If you qualify for the premium tax credit, you can use it to reduce the cost of your monthly premium upfront, receive the amount when you file your taxes or opt for a mix of the two. When you enroll in a marketplace insurance plan, you can choose what you’d prefer. The lower your income is, the larger your credit will be. Read the IRS’ Q&A on the premium tax credit to learn more.
Cost-sharing subsidies, which reduce what you pay for deductibles, copayments and coinsurance, are still available in 2018. Those who are eligible for cost-sharing subsidies must pick a marketplace silver plan to use them. In October 2017, the Trump administration announced it would end cost-sharing subsidy reimbursements to insurers, but insurers expected the move and many have raised 2018 premiums, particularly for silver plans, to compensate, according to the Kaiser Family Foundation.
Even if you don’t qualify for a subsidy, you can still purchase a plan on Healthcare.gov.
I hardly ever get sick. Can I opt for a catastrophic plan to save money?
It depends on your age and your financial situation. Catastrophic plans, which have cheaper premiums but high deductibles, are only available to adults younger than 30 and those who qualify for a hardship or affordability exemption.
If I am a smoker, are my rates higher?
It depends where you live. In most states, an insurer can charge policyholders who use tobacco as much as 50 percent more. Some states, including California, the District of Columbia, Massachusetts and Rhode Island, have prohibited tobacco penalties. Visit Healthcare.gov to learn how tobacco surcharges work in your state.
I had a stroke last year. Can I still get covered?
Under the Affordable Care Act, insurers are not allowed to deny coverage based on pre-existing medical conditions.
I’m unemployed. Where do I get coverage?
If you are unemployed, you might qualify for Medicaid or a subsidy to help cover the expense of a private health insurance plan. You could also apply for an exemption. Which programs or subsidies you are eligible for depend on your household size and income, not your employment status. If you are receiving unemployment compensation, you will need to report the expected amount when applying for coverage.
Do I have to be on the same plan as my spouse?
No. The Affordable Care Act does not require that spouses be on the same plan. However, if you are looking to qualify for tax credits to help you pay for your insurance, your total household income will be considered.
The Florida Office of the Insurance Consumer Advocate exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers.
10 Best and Worst States for Health Insurance Costs
Health insurance costs are up for 2016. Monthly premiums for the most popular plans offered on Affordable Care Act state exchanges in 2016 are 10.1 percent higher on average than they were in 2015, according to the Kaiser Family Foundation. The tax penalty for those without health insurance is also set to increase in 2016 from $325 per adult or 2 percent of household income to $695 or 2.5 percent of household income, reported the The New York Times.
GOBankingRates conducted a study of popular health plans offered on ACA exchanges in each state and the District of Columbia to see which states’ residents are paying less for health insurance and what they’re getting for their money. Click through to see if your state is among the best or worst for health insurance costs.
The 10 States With the Highest Health Insurance Costs
To find the states with the highest costs, GOBankingRates compared the lowest-cost plan at the ACA’s silver tier in each state. Comparing monthly premiums, deductibles and copays based on a single, 40-year-old, non-smoking male with an annual income of $40,000, the study highlighted the 10 states with the highest health insurance costs.
If you live in one of these states, you should expect to pay more each month for your insurance. Unfortunately, you’ll also be paying more for each doctor or emergency room visit, as the worst plans charge higher co-insurance rates and copays. Starting with the 10th-worst to the No. 1 worst state for health insurance costs, these are the states where residents pay more for coverage.
Colorado residents enrolled in the state’s cheapest silver plan, the CO Silver 2750 option from Kaiser Permanente, will pay a $266 monthly premium that’s right in line with the national median. The deductible is also relatively reasonable at $2,750.
This plan’s unfavorable co-insurance charges put Colorado in the bottom 10 of this list. A 20 percent co-insurance charge will apply for all visits to a primary physician as well as for emergency care, which means that the policyholder might still face high out-of-pocket costs even after they’ve met the deductible.
The lowest-cost silver plan offered in Wyoming, BlueSelect Silver ValueTwo, carries a premium of $315 a month, 18.4 percent more than the national median of $266 for this type of plan, as found by this study. That’s with a substantial tax credit of $105 a month, without which the premium is $420. The plan has an average deductible of just $3,000, but plan participants pay co-insurance charges at 20 percent even after the deductible is met, meaning costs could be high for people who require healthcare services more frequently.
Wyoming residents and legislators are currently debating whether to expand Medicaid in the state under Obamacare, which would bring the state $268 million in additional funding over two years and enable it to help approximately 20,000 uninsured residents get coverage. Wyoming Gov. Matt Mead expressed support for the expansion, reported the Wyoming Tribune Eagle.
The lowest-cost silver health insurance plan offered on the ACA exchange in Delaware is the Health Savings Embedded Blue EPO 3400 plan from Highmark Blue Cross Blue Shield Delaware. Priced at $320 a month after tax credits ($3,840 annually), it costs well above the $266 national median identified by the survey and has a higher-than-median deductible of $3,400; however, the plan offers 100 percent coverage after this deductible is met.
These costs are higher than this state’s residents paid last year. Delaware’s ACA exchange premiums rose 22.1 percent on average for 2016 compared with insurance costs for 2015 plans, according to DelawareOnline.com. Deductibles and out-of-pocket costs also rose year over year. Similarly, Delaware state employees might be facing higher health insurance costs or lowered benefits due to a spending gap anticipated in 2017, reported Delaware Public Media.
The number of Indiana residents enrolled in insurance plans through the ACA marketplace doubled in 2015 to close to 180,000, reported The Journal Gazette, and the state expanded its Medicaid through the ACA in 2015. Despite these changes, Indiana still has some of the highest health insurance costs in the nation.
The lowest-cost silver plan, the MDWise Marketplace Silver Basic, costs $3,432 a year with its higher-than-average monthly premium of $286. The plan also has a high deductible of $5,000, and even after the deductible is met, the policyholder can expect a $200 copay for urgent or emergency care visits. Out-of-pocket costs are capped at $6,600.
The cheapest silver health insurance plan offered to Oklahoma residents, Blue Advantage Silver PPO 103, has a monthly premium of $283, totaling $3,396 annually. This cost is higher than the median, and the plan’s high deductible of $4,000 and higher copays, such as $15 per visit to a primary doctor and 20 percent co-insurance even after the deductible is met, contribute to making this one of the most expensive plans in this study. The plan’s out-of-pocket maximum is $6,850.
Insurance options offered to Oklahomans through the ACA exchange are more limited for 2016, down from five providers to just two — and one of the remaining insurers has further limited its offerings in the past year, reported local outlet NewsOK. With fewer choices, Oklahoma insurance shoppers have fewer chances to get a deal on health insurance in 2016.
Mississippi’s lowest-cost silver plan, Ambetter Balanced Care 2 from Magnolia Health, is $278 per month, or $3,336 annually. It’s the plan’s high deductibles, however, that make it one of the most expensive. The insured party under this plan needs to meet a deductible of $6,500, the second-highest deductible cost of the health plans surveyed in this study, and each visit to a primary doctor has a copay of $30.
Mississippi also has the worst health system of any state, according to a 2015 study on state health system performance by the CommonWealth Fund. The state had the third-worst score for accessible and affordable healthcare, largely due to its high rates of uninsured adults and failure to expand Medicaid. As the state with the highest poverty rate of nearly a quarter of its residents — 24.3 percent, according to The Stanford Center on Poverty and Inequality — health insurance is still outside the financial reach of many Mississippians.
4. New Jersey
New Jersey’s lowest-cost silver plan, Oscar Market Silver, landed among the worst in the U.S. because of its high co-insurance costs of 50 percent. While it has a lower-than-average deductible of $2,500, a plan participant will still be responsible for half of the healthcare costs after this deductible is met. Additionally, the plan’s monthly premium of $317, or $3,804 annually, is higher than average.
The combination of a high monthly premium, high deductible and high copays make Alabama the third-worst state for health insurance costs. The state’s lowest-cost silver plan, the Silver Compass 5000 plan offered by UnitedHealthcare, has a high deductible of $5,000, after which the enrollee is still responsible for 20 percent of care costs and a $20 copay for primary doctor visits. These lackluster benefits come at an above-median cost of $288 a month, or $3,456 a year.
The state has not opted to expand Medicaid. In November 2015, a task force appointed by Gov. Robert Bentley recommended that the state government work to extend coverage to the hundreds of thousands of Alabamans who currently earn too much to qualify for Medicaid but don’t make enough to reasonably afford health insurance, according to AL.com. Opting into a federally funded expansion of Medicaid could help the state’s low-income residents get better access to healthcare.
2. South Carolina
In South Carolina, the cheapest silver plan is the Blue Option Silver 6850 offered by BlueChoice HealthPlan, which ranked as the second-costliest because of its $6,850 deductible, the highest of any silver plan in this study. This high deductible is the plan’s maximum out-of-pocket cost, and no co-insurance is required once this is met; however, a primary care doctor visit will incur a $25 copay.
People in South Carolina also get poorer quality healthcare, according to CommonWealth Fund’s study of state health systems, which ranked South Carolina in 40th place. The study reported that South Carolina is among the worst states for accessible and affordable care, has less equitable healthcare and is home to residents with overall poorer health and lifestyles.
1. New York
New York has the most expensive health insurance, with factors scoring poorly across the board. The state’s cheapest silver plan, offered by CareConnect, has a higher $3,000 deductible and the highest monthly premium at $366 ($4,392 annually). The insured party will pay some co-insurance charges, such as 25 percent on emergency care. The plan’s maximum out-of-pocket costs are capped at $6,850 per individual.
Although New York is featured here for its high costs, it made healthcare news in late December 2015 when Gov. Andrew Cuomo signed a bill that adds pregnancy as a qualifying event, which enables pregnant women to enroll in an insurance plan at any time, including outside of typical enrollment periods. With this law, New York is the first and only state that requires health insurers to accept pregnant women as new policyholders at any time.
The 10 States With the Lowest Health Insurance Costs
In the study of states’ health insurance plans, some plans stood out as offering higher value while charging lower premiums — the lowest is less than half of the cost of the most expensive health plan identified in this study. Lower premiums enable plan participants to save money in their monthly budgets, and lower deductibles and copays mean residents of these 10 states are also more likely to pay less when they need to use their insurance. Click through to see the 10 states where health insurance providers give customers better deals.
Idaho is one of the worst states for accessible and affordable healthcare, with 22 percent of people experiencing high out-of-pocket costs relative to income and rates of uninsured adults remaining high near 20 percent, according to data from the Commonwealth Fund. Because the state has opted not to expand Medicaid through federal funding, the state also has 78,000 residents who have incomes too high to qualify for subsidies or Medicaid but too low to afford monthly premiums, reported the Associated Press. Idaho’s Gov. C. L. Otter, however, has introduced a new $30 million legislative plan that would use state funds to address the issue.
The good news for Idaho residents is that their health insurance costs are already relatively low. The lowest-cost silver plan in the state, Mountain Health Co-Op Link Silver, has a monthly premium of $266, which is the national median, and it has a lower deductible of $2,150. Flat fees for visits to emergency rooms and primary doctors also keep costs low.
Several new healthcare laws went into effect Jan. 1, 2016, in Oregon that expand many residents’ insurance coverage. The provisions require health insurance providers serving Oregon residents to cover a full year of birth control, 90 days’ worth of most prescription medicines, and medical services provided via videoconference, reported Portland Business Journal.
Despite the expansions to health insurance coverage for Oregonians in 2016, the costs are still some of the lowest in the nation. Silver plans start at $230 a month with the Connect 2000 Silver plan from Providence Health Plan. Its deductible is a low $2,000. Plan participants should expect to be responsible for some of the costs beyond the deductible, however; emergency services carry a $250 copay after the deductible is met, and the copay for care from a primary doctor is $25, with out-of-pocket costs capped at $6,850.
Despite having one of the nations’ highest costs of living, Hawaii’s health insurance costs are some of the most reasonable. Along with one of the better low-cost silver plans, Hawaii also has one of the best health systems in the nation, ranked as the third best in the nation by the CommonWealth Fund’s study.
The state’s lowest-cost silver plan, HMSA Silver HMO, has a monthly premium of $260, which is slightly better than the $266 median, and it has a relatively low deductible of $2,500. It also charges flat copays for emergency care and visits to primary physicians, which help to limit plan holders’ costs when they need to use their insurance.
7. District of Columbia
The District of Columbia has some of the best health insurance costs. The District’s cheapest silver plan, BlueChoice HMO HSA Silver, has a monthly premium of $229, or $2,748 annually.
The deductible is just $1,350 — one of the lowest of any of the plans reviewed for this study — which also helps limit out-of-pocket costs for policyholders, such as the $300 emergency room copay.
Michigan is another state with low a monthly premium — just $210 a month, or $2,520 annually. The low-cost silver plan with this premium, Humana Silver 3800/Detroit HMOx, does have a $3,800 deductible, however, which is higher than most states’ silver plan deductibles, but costs are kept low with other fees, such as the $20 primary doctor visit fee and the $250 emergency room copay before deductible.
These low costs are offset somewhat by Michigan’s 0.75 percent tax on health insurance, which funds Medicaid coverage for low-income residents of the state. Even with this tax, however, health insurance is relatively affordable in Michigan, and 311,000 state residents have signed up for health plans through the ACA exchange since Nov. 1, 2015, according to the Associated Press.
Competition between Pennsylvania’s 19 health insurers selling individual plans on the ACA exchange has led to better prices and plans for residents. The state’s lowest-cost silver plan from Independence Blue Cross, for example, has one of the lowest deductibles in this study: $1,500.
This deductible, paired with flat copays that make it easier to predict and control costs, are the top factors that put Pennsylvania at No. 5 among states with the lowest health insurance costs, even with the plan’s monthly premium of $276.
Health insurance plans offered on the healthcare exchange in Texas are some of the best in the nation. The state’s cheapest silver plan, Molina Marketplace Choice Silver Plan, offers a low $2,000 deductible with a competitive $253 monthly premium for an annual premium total of $3,036. Flat fees on health services also reduce the overall cost.
Despite its low healthcare costs, Texas still has some catching up to do. Texas is one of the most populous states that opted not to expand Medicaid, according to the Kaiser Family Foundation, and although its uninsured rates have dropped since ACA took effect, 20.8 percent of residents were still without insurance in the first half of 2015, according to Gallup data — the highest of any state.
In the nation’s most populous state, more than 238,000 California residents joined the Covered California health exchange, reported The Orange County Register. The state’s cheapest silver plan, Silver 70, costs $360 less a year than the national median because of its lower $236 monthly premium. The plan also has other affordable features, such as a low $2,250 deductible and flat fees on many health services.
These low costs might soon be increased by a tax on all health insurance plans proposed by California Gov. Jerry Brown, according to the San Jose Mercury News. The tax would raise an estimated $1.35 billion each year, which Gov. Brown hopes to use to expand programs and services such as those for Californians with developmental disabilities.
For Utah residents, low-cost health insurance is within reach even though the state has not adopted the federal Medicaid expansion. The state’s least expensive silver plan, Molina Marketplace Silver Plan, has a premium of just $214 a month ($2,568 annually). Utah residents on this plan can also look forward to more affordable out-of-pocket costs. The plan has a low $2,000 deductible and flat fees for many health services. It also caps out-of-pocket expenses at $6,850.
1. New Mexico
With the lowest monthly premium for a silver plan of any state, New Mexico residents can get covered for just $181 a month, or $2,172 annually, on the Molina Marktplace Silver Plan. Along with a low premium, this plan also offers a low $2,000 deductible and flat-fee copays for many health services.
Despite low costs, many New Mexico residents have encountered issues getting their health coverage. Due to a high volume of health insurance applications, many applications submitted in December 2015 remained unprocessed even past the date when insurance coverage should have kicked in, reported the Santa Fe New Mexican. Enrollees whose applications weren’t processed quickly enough experienced problems such as being unable to visit a doctor or receive care using their new policy.
50 States and D.C. Ranked by Health Insurance Costs
Here is the full ranking of the 50 states and the District of Columbia from best to worst, according to their health insurance costs for the silver plan with the lowest monthly premium in each state.