Keys residents face highest rates posted [Florida Keys Keynoter, (Marathon, Fla.)]

Sept. 28--Florida Keys residents may pay higher premiums than much of South Florida for health insurance offered through the Affordable Care Act.

A report from the U.S. Department of Health and Human Services indicates that a Monroe County resident 24 years old could pay $274 in monthly costs for the lowest "silver" grade policy, 42 percent more than a Miami-Dade resident ($193).

Exact details will be unveiled Tuesday when online health-insurance marketplaces, created as part of the Act also known as Obamacare, open for the first time.

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

Reasons for the higher costs in the Keys were uncertain.

Health-care professionals point to possible factors: Studies show Monroe residents overall tend to have more unhealthy behaviors like smoking and heavy drinking, an older population, and fewer insurance companies willing to write policies in Monroe County.

"Basically, insurance companies determine their rates based on how much they expect to pay out," said Sheila Konczewski, spokeswoman for Tavernier'sMariners Hospital, part of the Baptist Health South Florida.

"If you look at the statistics, we have a high percentage of heavy or binge drinking, and a high level of adult smokers," Konczewski said. "They look at this and say they have to charge more in Monroe County."

Nicki Will, chief executive of the Lower Keys Medical Center, agreed, "The adult behavioral risk factors are a lot higher than in Miami-Dade and Florida, so the insurers coming into Monroe feel they are writing somewhat riskier policies."

Keys residents also have a lower percentage of people who seek early diagnostic screening tests for cancer and other diseases, she said.

According to the federal report, two insurers writing Monroe County policies under the ACA will offer a total of 38 plans. The policies are graded bronze, silver, gold and platinum.

Bronze policies have lower premium costs but require more out-of-pocket payments for treatments. A gold plan has a higher premium with lower out-of-pocket costs. Few people are expected to purchase the platinum plan, the most costly.

The most likely <location value="LU/us.fl.monroe" idsrc="xmltag.org">Monroe County providers are Florida Blue and Cigna, with a possible third company. Those details will be released this coming week.

In contrast, Broward County is expected to have at least eight insurers offering a total of 136 plans. In Monroe, a 29-year-old would pay $259.17 monthly for a low-cost bronze plan, $307.11 for silver and $354.30 for the gold.

The very lowest monthly premium a 55-year-old in Monroe would pay for a bronze plan is $516. It goes up from there: $612.02 a month for the lowest-cost silver plan, and $706.06 for the lowest-cost gold. Rates are the same for men and women.

People under age 30 or those with very low incomes can buy "catastrophic" plans, intended to cover a serious illness or accident.

Dixie Humelsine, an independent insurance broker in the Keys, noted that actual costs could be much lower than the estimates, once tax credits and subsidies for eligible residents are calculated.

"The reality is that people are going to need help wading through this," Humelsine said. "It's not like buying health insurance used to be."

Most people in government or employer-based health plans are not expected to see significant changes under the ACA. The health-insurance marketplaces primarily are aimed at those who purchase their own individual or family plans.

The online marketplaces open Tuesday but people using them have until Dec. 15 to obtain a heath policy that takes effect Jan. 1.

"People shouldn't get frustrated if the system isn't working perfectly from the start," Humelsine said. Civic groups are planning forums on the new ACA system, and efforts are being made to have "navigators" available in the Keys to help buyers sort through the plans. Details are pending.

- With reports from the Miami Herald

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