Florida Health Insurance Rates

[golfing eagles]

Here's a question I could use some help with:
I recently retired and am under 65. I have had Blue Cross for the last 30+ years, now on a COBRA plan, and have been happy with the insurance. My wife is covered by something else, the terms of which prohibit me from "latching on" to it, so as I plan to move shortly, I need to pick up a Florida based individual plan.
I was however surprised to find out, after checking Florida Blue plans, that the rate for my exact same policy is 53% higher in the Sunshine State. So, has anyone else out there found themselves in a similar situation? I realize it may be a better question for the insurance agent as I move forward, but I suspect I'll get a stock answer such as "Rates are determined by the claims experience in the applicable cohort". Of course this would mean Florida residents UNDER 65 are 50% sicker than in NY, which I doubt.
I could go shopping for other insurers, but I'll never get within 10 miles of Healthcare.gov, so please don't suggest it. Thank you everyone

[Villager Joyce]

Equally important to me is what insurance will the doctors take. Our doctor said they are having a hard time with referring patients to specialists because of insurance.

[golfing eagles]

Equally important to me is what insurance will the doctors take. Our doctor said they are having a hard time with referring patients to specialists because of insurance.

I'm aware of that more than most. Just about all providers accept BC/BS. But your advice is excellent, especially for anyone doing bargain shopping for obscure plans. Many have narrow panels of participating physicians, and even more so for specialists. These plans generally have lower rates because they lowball reimbursement rates. Most providers will not participate in a plan that pays 30-40% less than their competition, and the ones who do, well.....another case of res ipsa loquitur

[Ohiogirl]

rates are determined by community and are age-banded, I believe. Perhaps the reason Florida is more expensive (my rates were higher than Ohio also, but not close to 50% plus) is that there are lots of retirees in Florida under 65, and also that Florida did not do the expanded Medicaid.

Now that I'm about to go on Medicare, I also found that the same applies - more expensive if I am a Florida resident for same plan.

Have a good friend who sells Medicare policies in Ohio. She says Florida medical fraud is among highest in nation and that also affects premiums.

[golfing eagles]

rates are determined by community and are age-banded, I believe. Perhaps the reason Florida is more expensive (my rates were higher than Ohio also, but not close to 50% plus) is that there are lots of retirees in Florida under 65, and also that Florida did not do the expanded Medicaid.

Now that I'm about to go on Medicare, I also found that the same applies - more expensive if I am a Florida resident for same plan.

Have a good friend who sells Medicare policies in Ohio. She says Florida medical fraud is among highest in nation and that also affects premiums.

You might be right on some of that. Retired or not, the rate of illness in the under age 65 group should not be extremely different state to state. However, the claims experience could be. Having seen a lot of snowbirds, I have found that in general ( in general, so don't jump down my throat lol), Florida physicians order A LOT more tests and consults than their counterparts up north. The conspiracy theory part of me also suspects that they are using creative accounting to subsidize other cohorts as a result of ACA, but good luck proving it

[blueash]

Was your policy in wherever you come from a group or individual policy? Group policies are much less expensive than individual policies as the average age of the group is certainly lower than your age. Was it age rated only or also grandfathered and rated based on your pre-existing conditions or more importantly, lack of pre-existing conditions. The rate of rise of insurance premiums has slowed dramatically year over year in the last few years.
Average Monthly Premiums Per Person in the Individual Market | The Henry J. Kaiser Family Foundation (http://kff.org/other/state-indicator/individual-premiums/)
Here you can see the average monthly premium by state in 2013 from Kaiser Family Foundation. No data there for 2014 or 2015. But Florida and that includes the higher priced areas of Dade County, has an average rate a couple dollars BELOW the national average. This is for all ages not for those nearing medicare and includes policies that would no longer qualify as adequate.
https://www.ehealthinsurance.com/resource-center/ehealth-price-index
Here you can see the average quarterly premium for 2015 for individual coverage, again all ages and smoking status lumped together.
As you indicate you are from New York State, you will see that for 2015 the data is divided into three types of coverage, low, average and high or bronze, silver, gold/Platinum plan
Low NY 153 FL 70 OH 84 TX 78
Ave NY 365 FL 313 OH 301 TX 280
High NY 736 FL 1094 OH 1061 TX 1111

These are all without any subsidy and reflect the self pay cost of coverage. As you can see the only plan higher here is the gold/platinum plan compared to NY and that Florida rates are right in line with most other states.

[golfing eagles]

Was your policy in wherever you come from a group or individual policy? Group policies are much less expensive than individual policies as the average age of the group is certainly lower than your age. Was it age rated only or also grandfathered and rated based on your pre-existing conditions or more importantly, lack of pre-existing conditions. The rate of rise of insurance premiums has slowed dramatically year over year in the last few years.
Average Monthly Premiums Per Person in the Individual Market | The Henry J. Kaiser Family Foundation (http://kff.org/other/state-indicator/individual-premiums/)
Here you can see the average monthly premium by state in 2013 from Kaiser Family Foundation. No data there for 2014 or 2015. But Florida and that includes the higher priced areas of Dade County, has an average rate a couple dollars BELOW the national average. This is for all ages not for those nearing medicare and includes policies that would no longer qualify as adequate.
https://www.ehealthinsurance.com/resource-center/ehealth-price-index
Here you can see the average quarterly premium for 2015 for individual coverage, again all ages and smoking status lumped together.
As you indicate you are from New York State, you will see that for 2015 the data is divided into three types of coverage, low, average and high or bronze, silver, gold/Platinum plan
Low NY 153 FL 70 OH 84 TX 78
Ave NY 365 FL 313 OH 301 TX 280
High NY 736 FL 1094 OH 1061 TX 1111

These are all without any subsidy and reflect the self pay cost of coverage. As you can see the only plan higher here is the gold/platinum plan compared to NY and that Florida rates are right in line with most other states.

Thank you, very informative
yes, I am getting a group rate, and I'm probably a bit above average age. I have the high deductible HSA bronze plan from BC/BS, which you list as a NY average of $365/month and I pay $358.19. However, right next to it lists FL average at $313 for this plan. The FL BC/BS website quoted me $528/month for the same coverage. I wonder if this was some generic rate and I need to talk to an agent to get the real quote. It doesn't look like our group rate was substantially below the individual average, so I don't see a big jump in premium can be on that basis.

[Ohiogirl]

since the ACA (Obamacare) went into effect, premiums can no longer be based on pre-existing conditions, or lack of. Age and community banded only. Even different parts of Florida have different rates, possibly based on fraud or # of claims - and also possibly because yes, I agree that Florida doctors, or at least those around here, order more tests - as a new patient, I think that's partly because they don't know you and don't trust the medical records, or don't read them, and also older people (yes, us) have more stuff wrong with them - after all, we are aging, and everybody eventually gets something.

[golfing eagles]

since the ACA (Obamacare) went into effect, premiums can no longer be based on pre-existing conditions, or lack of. Age and community banded only. Even different parts of Florida have different rates, possibly based on fraud or # of claims - and also possibly because yes, I agree that Florida doctors, or at least those around here, order more tests - as a new patient, I think that's partly because they don't know you and don't trust the medical records, or don't read them, and also older people (yes, us) have more stuff wrong with them - after all, we are aging, and everybody eventually gets something.

Well said, all pretty much true. Fraud is a minor issue in private insurance, they're pretty good at weeding it out, unlike the government which is totally inept at it, but that's another issue. I've found that different states, and even different areas within a state tend to have their own "medical culture". A lot depends on the prevalence of litigation, which is higher in Florida, especially southeast FL. A lot depends on what your colleague down the street is doing. Also, believe it or not, patients LIKE tests. They tend to have more faith in a lab number or a smudge on an MRI than they do in physician's judgment . This is compounded by all the self-diagnosis promulgated by the internet. You're also right to point out aging populations have more health issues, and patient's with multiple problems that overlap as well as the polypharmacy that results are a challenge to even the best of us. Despite all that, the rate differential seemed excessive, especially in light of the plan averages so graciously presented by another poster

[2BNTV]

I am not familiar with getting insurance if one is less than 65 but it seems to be very expensive.

In general, one must be there own health advocate and select a doctor who will think as you do. I for one will not have any unnecessary tests performed and don't like doctors who try to over medicate to resolve problems, but that's me.

Be leery of dentists as they seem to want to charge large sums of money for any work performed. I've been to two places and they both wanted to charge me approximately two thousand dollars, of unecessary work. They give you the line they need to perform an exam and then seem to find a lot of things wrong.

Went back to my old dentists in CT and he perform work on a broken bridge, for $500. I'm sure the dentists down here would have charged me thousands, to do the same work. IMHO

[rubicon]

Last year because of ObamaCare , no longer concerned about the insurability issue, my former employer relinquished control of their retiree group plan and provided an opportunity for selection of individual health insurance. My former employer did and does still provide a contribution to which I am very grateful.

According to third party administrator's handbook individual health plans offer the same or less in costs than group plans because individual plans cover more people than any specific group plan.

The initial process was time consuming (spoiled since the employer was did all the chosing). However we followed my employer's blueprint and secured the same coverage as did the employer. However we choose a different RX plan and we chose poorly.

So this time around will continue our Blue Cross Blue Shield and Delta Dental plan but will change RX plans and I will drop my vision coverage. My wife may retain hers

As to costs there was not an appreciable difference.

Of course the health Insurance industry is in constant state of flux and God only knows what that will mean from the time of enrollment and/or when the policies of insurance come into effect ?