Obamacare enrollment runs through Dec. 15. Here’s what you need to know

South Florida health insurance consumers have more choices for 2020 on the Affordable Health Care marketplace as enrollment gets underway from Nov. 1 through Dec. 15.

With six years of cost and revenue data under their belts, long-established insurers like Blue Cross Blue Shield have figured out how to remain profitable, while leaner, narrow-network insurers have carved out sizable segments for themselves.

Three companies that offered 2019 plans in Broward and Miami-Dade counties are returning next year -- market leader Florida Blue, along with Molina Healthcare and Ambetter, owned by Centene.

They are joined by a fourth provider -- Oscar Health. Backed by $1.2 billion from investors including Google parent company Alphabet, Oscar debuted in Central Florida last year and in 2020 is expanding into 10 additional Florida counties, including South Florida’s tri-county region and the Tampa area. The tech-savvy company has expanded to six new states, for a total of 14.

Palm Beach County consumers can choose from all four of those companies plus two others -- Bright Health and Cigna Healthcare.

Is the ACA’s future still uncertain?

Yes it is. But that won’t affect consumers’ ability to purchase coverage for 2020. A federal appellate court is expected to rule any day on a Texas judge’s declaration last year that the Affordable Care Act is unconstitutional. But if the appellate court agrees, its decision will be appealed to the U.S. Supreme Court, which wouldn’t be expected to rule on the question until next year.

What’s happening with premiums?

Nationwide, premiums are set to decline 4% for one of the most popular 2020 plans, the Centers for Medicare and Medicaid Services reported. In Florida, the cumulative change for plans offered by 10 companies is 0%, according to the Florida Office of Insurance Regulation. Last year, premiums rose a cumulative 5.2%, and for 2018 they rose 44.7%.

What’s the difference between on- and off-exchange policies?

First, it’s necessary to know that there are two different types of individual health insurance policies -- those purchased “on-exchange” and those purchased “off-exchange.” Since Jan. 1, 2014, both types have been required to cover 10 essential benefits with no lifetime or annual benefit maximums, and provide consumer protections such as ending exclusions for preexisting conditions.

The key difference is on-exchange plans are eligible for government tax credits and additional cost-sharing revenue. To be eligible, these must be purchased through the government-created marketplace Healthcare.gov. This is why more than 90% of “on-exchange" buyers receive some government subsidies.

Off-exchange plans are not eligible for government help, but are also available from more insurers with a wider range of costs and benefits. Typically, consumers whose incomes are too high to qualify for government subsidies purchase off-exchange plans.

But costs of these unsubsidized plans remain high, forcing an increasing number of higher-income workers to forego insurance, the New York Times reported Oct. 22.

For example, the cheapest plan that a 50-year-old Broward County non-smoking single male or female earning $55,000 a year can buy on-exchange in 2020 costs $438 a month, and that’s with a $5,500 deductible and $8,150 out-of-pocket maximum. The same plan would cost a 27-year-old with the same salary $257 a year.

High costs have also prompted expansion of so-called “short term” plans that are exempt from many of the ACA’s consumer protections and minimum coverage requirements.

Who can buy an ACA policy?

Subsidy-eligible plans can be purchased by consumers who don’t have access to employer-based plans or Medicare. Also, immigrants who are in the country illegally cannot qualify, nor can people who are incarcerated.

Typical ACA purchasers are low-income parents with children, people who are self-employed, workers whose employers don’t offer affordable health insurance, and early retirees who don’t yet qualify for Medicare.

Who qualifies for tax credits?

Households earning between 100% and 400% of the federal poverty level qualify for tax credits that can lower their monthly premiums.

To be eligible for tax credits, a single-household consumer would need an adjusted gross income between $12,490 and $49,960. For a family of four, the range is $25,750 to $103,000.

Why is Obamacare so important in Florida?

Because of the state’s low wage base and high percentage of service jobs, many households qualify for government subsidies and would otherwise go without coverage.

Florida is Obamacare’s biggest success story. Enrollment for 2019 plans increased by 73,329 to 1.67 million while it declined in the 38 other states that use the federal exchange.

Nearly half of Florida’s enrollees -- about 800,000 -- live in Broward, Miami-Dade and Palm Beach counties, according to federal data.

Prices are confusing. Why?

Prices vary widely, even with the maximum monthly tax credit.

Generally, the lower the deductible, co-pay and co-insurance and out-of-pocket maximum offered, the higher the monthly premium.

For example, a 55-year-old man living alone in Palm Beach County making $25,000 a year qualifies for a $634 monthly tax credit.

If he opted for the highest-benefit “platinum” coverage, he would pay $598 a month for a Blue Select Platinum 1457 plan from Florida Blue with $0 deductible and a maximum $2,000 out-of-pocket cost. He would also pay $75 per emergency room visit, $10 for a generic drug prescription, $10 to visit his primary care physician and $20 to visit his specialist.

But because of the high monthly premium, that plan would end up costing $7,783 over the year if he’s a “medium" health care user with regular doctor visits and prescriptions and no hospital stay.

Opting for the highest-deductible plan, Oscar Simple Bronze, would cost the same consumer nothing for monthly premiums but he would have to pay full price for emergency room visits, primary physician and specialist visits until reaching the $8,150 deductible. Generic prescriptions would cost $20 each.

Assuming “medium” health care usage, Healthcare.gov estimates this plan would cost the consumer $2,183 over the coverage year.

Additional benefits:

In addition to eligibility for premium tax credits for households earning between 100% and 400% of the federal poverty level, households earning between 100% and 250% of the federal poverty level are also eligible for special “modified” Silver plans with additional cost-sharing reductions that will bring down the deductibles, copays, coinsurance and out-of-pocket limits.

For example, the 55-year-old in our example above who opts for the Ambetter Balanced Care 15 plan would pay $237 a month after receiving his $633.53 monthly tax credit. That plan comes with a $2,875 deductible and $6,500 out-of-pocket maximum. He would pay 40% of the cost of any emergency room visit up to his out-of-pocket maximum, $25 for for a primary physician visit, $60 to see a specialist and $25 for a generic prescriptions. His estimate total yearly costs for “medium” usage would be $3,491.

With additional cost-sharing reductions, a couple in their 30s with three children under 10 would get the same plan for $135 a month, a $1,900 deductible and $3,700 out-of-pocket maximum. Primary doctor visits and generic prescriptions would be $10 each. A specialist would cost $30 per visit, and estimated “medium” usage would cost $3,643.

Where can I get more information and sign up?

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