Turmoil in the South Florida marketplace, particularly from insurance companies renegotiating contracts with major providers, is driving up health insurance costs, healthcare insurers say.
Ongoing disputes between providers like Florida Blue with Memorial Healthcare System and Broward Health are contributing to increased cost uncertainty and contract pricing, said Raymond Mateo, employee benefits leader at NSI Insurance
“Local insurers such as Avnet losing business may also contribute to possible price increases,” he said. “These contract disputes and market fluctuations are making insurance in Miami-Dade more expensive compared to other parts of South Florida – more contentious negotiations than other regions, like Tampa, where deals such as with BayCare have been smoother.”
The ongoing federal government shutdown has not yet impacted healthcare plan prices in South Florida. However, if the shutdown continues, there may be delays for people enrolling in Medicare, Mr. Mateo said.
“The more significant concern is regarding Obamacare (ACA) plans where subsidies are currently off the table in Congress, and if the situation isn’t resolved soon, there is a risk that premiums for these plans could double or triple,” he added. “This could make it harder for people to enroll or receive correct invoices unless the issue is addressed before year-end.”
Mr. Mateo advised people to be hopeful that the situation will be resolved, but also to be prepared by considering alternative options such as enrolling in an employer-sponsored plan or adjusting their existing healthcare plans by selecting higher deductibles or co-pays to offset possible cost increases.
“People should have backup options and stay informed, especially for those heavily enrolled in Obamacare programs in high-enrollment areas like Miami-Dade County,” he said.
The county is part of Medicare Locality 4. This designation is tied to a higher Medicare reimbursement rate compared to the rest of Florida, said Doug Wolfe, co-founder and managing partner of Wolfe Pincavage, a healthcare law firm that works exclusively with healthcare providers.
“A substantial portion of commercial provider reimbursement rates in the market are benchmarked or tied to these higher Medicare rates. When the base cost of care is higher, the ultimate cost reflected in insurance premiums tends to be higher as well,” he said. “The higher rate structure could mean that the overall cost of delivering healthcare services – including facility fees, professional services, and labor – is elevated in the Miami-Dade market.”
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