Health care premiums vary widely in Florida

1:06 PM, Dec 2, 2013   |    comments
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WASHINGTON (Florida Today) - Some Floridians will pay twice as much as others for similar insurance plans purchased on the federal web site, a USA TODAY/Gannett analysis of federal data shows.

It all depends on where someone lives. But Florida is among the states with the widest range of prices on the federal online exchange.

Map: Health care premiums, county by county

Residents of the Florida Keys will pay the most for the cheapest available option among "bronze" plans, and for the second-cheapest option available among "silver" plans. The federal premium subsidies available on are based on a consumer's income combined with the cost of the second-cheapest silver plan.

Just two counties over, Broward residents will pay the lowest premiums for bronze plans, about half the price that Monroe County residents - including residents of the Keys - will pay. Individuals and families in Gulf County near Panama City, meanwhile, have access to the least expensive silver plans, about 52 percent cheaper than in Monroe.

That 52-percent difference means Florida ties for the fifth-highest price range among the 36 states where the federal government runs or helps to run online exchanges created under the Affordable Care Act, a recent study by the independent Kaiser Health News concluded.

Insurance plans on the exchanges usually come in four categories: bronze (cheapest premiums and priciest cost-sharing), silver, gold and platinum. A fifth - catastrophic - is available only for people under 30. Bronze and silver plans are the levels of coverage expected to be chosen most often.

In Brevard County, a bronze plan for a family of four is $492 a month - one of the cheapest in the state and well below Gilchrist County where it will cost $652, the median in Florida.

The second-cheapest silver plan for the same family costs $721 in Brevard. A similar plan in Volusia County, costs $758, the median price for that plan in Florida.

The reason prices can differ widely in the same state is because some insurers don't offer plans in every county, and insurers can charge different prices for the same coverage based on where a customer lives, experts say.

Other reasons can include how old and sick an area's population is, whether patients and doctors in an area choose higher-cost procedures, and whether there's much competition among insurers and among health care providers, they said.

Wences Troncoso, Florida's deputy insurance commissioner for life and health, attributed the differences to the state's varied demographics and the state's decision to treat each of Florida's 67 counties as a separate insurance "rating area."

"Florida has such unique geography," he said. "The price to administer health care in Putnam County is much different than the price to administer health care in Miami-Dade County."

The differences in premiums could affect more than 2.5 million Floridians who may use to purchase insurance because they don't get coverage from an employer or through a government program like Medicare.

Consumers have until March 31 to sign up for coverage in 2014.

Nearly one-quarter of Floridians under 65 lack health insurance, according to the Kaiser Family Foundation. Only Texas (27 percent) and Nevada (25 percent) have a greater portion of residents without coverage.

Only 3,571 Floridians selected a plan last month opened, according to enrollment figures recently released by the federal government. Nearly 124,000 applied for coverage and were found eligible, but most have yet to choose a plan.

Regional differences in health insurance premium costs are nothing new. But the 2010 Affordable Care Act now makes those price variations transparent to the public.

Still, it's not easy to determine exactly why premiums in one part of the state are more expensive than in another.

When a particular insurer is dominant in an area, it feels less pressure to reduce prices. On the other hand, that insurer may have more leverage to negotiate lower rates from hospitals, doctors and other providers. Conversely, when a particular hospital is dominant in an area, insurers have less power to negotiate lower rates.

Lack of competition among hospitals and other providers is a reason that rural areas, despite their lower cost of living, may not have cheaper health insurance plans.

That may help explain why some of the most expensive premiums can be found in sparsely populated counties such as Monroe, Gadsden and Putnam counties.

"If you're an insurer, and you want to enter a rural market and there's one hospital, the hospital can just tell you to get lost," said Chapin White, a senior researcher at the Center for Studying Health System Change, a nonpartisan think tank in Washington.

Florida is among the more competitive states for insurers. About 90 percent of the state's market is covered by 11 insurers. The largest, Florida Blue, operates in all 67 counties.

But even Florida Blue's prices vary by region for the same coverage on

For example, a 27-year-old Brevard County resident will pay $236 per month for one of Florida Blue's bronze plans - the Blue Options Essential (HAS) Plus 1419P. A similar plan for the same customer runs $209 in Levy County, $219 in Collier County, and $280 in Miami-Dade County, according to data filed with the U.S. Department of Health and Human Services.

Before the Affordable Care Act, insurance premiums varied widely according to other factors. Starting next year, insurers will be barred from charging women more than men, and charging sicker people more than healthy people. And they'll be able to charge older customers no more than three times what younger people pay.

Insurers are still allowed to vary rates by region, but those regions have to be defined by state insurance departments. Several states, including Florida, chose to divide their rating areas by county.

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