Last Modified: Tuesday, March 31, 2009 at 10:01 p.m.
Gov. Charlie Crist has been touring the state promoting his new health plan “Cover Florida” as a solution for the state’s nearly 4 million uninsured residents.
Two insurers, United Healthcare and Blue Cross Blue Shield, are offering insurance statewide through a new plan backed by Gov. Charlie Crist called Cover Florida.
Residents qualify if they are between 19 and 64, do not qualify for Medicaid and have been without health insurance for six months.
For complete details see the Cover Florida Web site or call the insurers directly.
Here is a sampling of what the plans offer for individuals:
Preventive: The average rate of this plan is $50.75, with a range from about $23 to $69 based on age and gender. The patient pays $50 for doctor visits. The insurer pays $15 for each prescription and the patient pays the remainder. Mammograms and osteoporosis screening are free for the patient.
Catastrophic: The average premium is $148 per month, with a range from about $57 to $323. Deductible is $3,000 with a $50,000 lifetime cap. For hospital services the patient pays the deductible plus 20 percent of the charges.
Preventive: The average cost of the plan is $131.71 a month, with a range from about $77 to $180. The patient pays $10 for doctor’s visits up to $450 per year. Free annual exams and screenings. Up to $600 a year for hospital outpatient services. Patient pays $10 for generic drugs, for up to $500 worth of drugs per year.
Catastrophic: The average cost is $343.63 a month, ranging from about $200 to $472. Deductible is $500, with benefits up to $500,000 over a lifetime. Up to 10 days of hospital stays are allowed per year, at up to $2,000 per day. Up to $600 per year is allowed in hospital outpatient preventive services, and $400 per year in non-preventive services.
But enrollment figures show the program is unpopular. Fewer than 2,000 people have purchased policies since they became available in January.
Crist blames insufficient advertising. Critics say the problem is the plan itself.
“If it were such a wonderful thing people would be knocking down the doors to get it,” said Dave Sherrill, director of the Florida Association of Health Underwriters. “It isn’t going to hurt anything but it really isn’t going to help anything, either.”
Crist heralds the program’s low cost — the average premium is $155 a month — and the fact that people with pre-existing conditions can qualify, so long as they satisfy the other requirements of being without insurance for six months and being between the ages of 19 to 64. Plus, no taxpayer dollars are used.
But the policies are still too expensive for the working poor, who comprise two-thirds of the state’s uninsured. For those who can pay, the plans offer limited value. Prescription drug coverage is capped, as are hospital stays and the amount of money the insurance company will pay out in a lifetime.
One of the plans, offered by Blue Cross Blue Shield, is essentially the same plan the company has been selling on the private market since 2007.
Sherrill, who represents insurers across the state, said Cover Florida’s plans are so flawed he wouldn’t personally sell one. “Honestly, we don’t see a place for them,” he said.
To convince insurance companies to participate in the plan and offer low-cost coverage, the state waived some of its owns requirements, including cancer drugs or bone marrow transplants. That means under the plans the insurance companies can avoid paying for treatments that the law otherwise requires in Florida.
Six private insurers signed on, with Blue Cross Blue Shield and United Healthcare offering the only plans statewide. Two types of plans are offered, those offering only preventive coverage, such as doctors visits, and those that also include catastrophic insurance.
Scott Anderson, 47, lost his job last April and is newly self-employed recruiting nurses for hospitals.
He is paying $480 a month in COBRA for health insurance, which is about twice what he would pay in monthly premiums if he were enrolled in Cover Florida.
Anderson said he is reluctant to make the switch before his COBRA runs out in six months because he reviewed the state plans and determined an accident or chronic illness could throw him into debt. He was hit by a car while riding his bike last year, and his hospital bills would have used up the state coverage maximums in a month, he said.
“You would end up paying a premium for something that only gives you some coverage,” Anderson said.
Where Cover Florida offers a unique benefit is for people with pre-existing conditions without access to a group health plans – so-called “uninsurables” who have been locked out of the market to buy insurance. But that group makes up only about 5 percent of the total uninsured in the state.
For the poor, getting the right coverage with premiums that range up to $470 a month could mean forgoing rent or food.
“Affordability remains a huge barrier, more than ever in the current recession, especially because subsidies to assist low-income people with premiums have never been part of the mix,” said Greg Mellowe, policy director for Florida Community Health Action Network.
With Cover Florida failing to live up to the governor’s predictions and no other major programs being seriously considered in this year’s legislative session, the number of uninsured Floridians will likely continue to climb as the economy worsens.
The only states that have come close to insuring everyone are those that have offered government subsides to expand Medicaid, the tax-funded health care program for the poor, or buy private insurance for residents who cannot afford it.
Florida has done neither, and meanwhile has the third highest rate of uninsured residents behind Texas and New Mexico.