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Florida charts individual health PPACA worlds

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In Florida, holders of individual major medical coverage now come in four Patient Protection and Affordable Care (PPACA) flavors.

About 65 percent of all individual coverage holders have PPACA-compliant coverage — but only 18 percent of the holders who bought their policies outside the PPACA public exchange system have PPACA-compliant coverage.

Officials in the Florida Office of Insurance Regulation have shed some light on how Florida’s individual market is working with a report based on enrollment data from insurers’ rate filings. The officials created a chart that shows how many residents bought individual coverage through the state’s PPACA exchange, which was run by the U.S. Department of Health and Human Services (HHS).

Officials also included figures for the state’s off-exchange market. Their chart shows whether people bought PPACA-compliant policies outside of the exchange, or whether they have hung on to “transitional coverage” or “grandfathered plans.”

A grandfathered plan is a plan that a consumer bought before March 23, 2010, when PPACA and her sister, the Health Care and Education Reconciliation Act (HCERA), came to life, and has changed little since. Those plans are exempt from most PPACA rules.

A transitional plan is a plan from an issuer in a state that lets insurers renew newer, non-PPACA-compliant individual coverage, or requires insurers to do so. Those plans are exempt from the PPACA rules that took effect Jan. 1, 2014.

In Florida, in June, 1.3 million people had some kind of individual coverage. Fifty-seven percent — about 763,000 people — bought qualified health plan (QHP) coverage through the public exchange. 

Outside the exchange, officials found about 104,000 holders of PPACA-compliant policies; 141,000 holders of grandfathered individual policies; and 325,000 holders of transitional individual policies.

Fifty-seven percent of the holders of off-exchange individual coverage have transitional coverage.