For most of the country, Affordable Care Act open enrollment ended Dec. 15. Due to a damaging hurricane season, Florida residents have until Dec. 31 to sign up for health coverage in 2018. For Florida families, that’s extra time well spent to review their coverage and choose the plan that works best for them.
But there’s a secret lurking inside many of those health plans.
In Florida, there are no statutes preventing your health insurer from reducing your prescription coverage at any point during the policy year, while you’re locked into a plan. Insurers are free to raise your out-of-pocket costs, place more restrictions on your treatments, or even remove coverage for them altogether.
These midyear policy changes are commonly known as “non-medical switching” and can have life-threatening consequences for patients.
A survey of Floridians living with chronic conditions found that 68 percent had experienced changes that reduced their medical coverage. As a result, 74 percent were forced to switch to an entirely different medication — and 88 percent of those who switched reported negative physical health effects.
For patients with epilepsy, a non-medical switch — even a small change in the amount or formula of a medication — can cause them to experience breakthrough seizures and other serious side effects.
Fortunately, there’s a fix on the horizon for these unscrupulous tactics.
Senate Bill 360 and House Bill 229 — known as the “Bait and Switch Bill” — would protect Floridians from unfair midyear prescription coverage changes by requiring that health insurers maintain consistent coverage for the full year a plan is offered. The bill also prevents insurance providers from increasing out-of-pocket costs or reducing coverage during the policy year, and still allows them to add generic medications to their plans or remove treatments due to safety concerns.
Most importantly, the bill would give Floridians assurance that the plan they pick will be the plan they actually receive.
The Epilepsy Foundation of Florida’s certified Navigators are here to provide free, in-person enrollment assistance through the December 31 deadline. Consumers can make an appointment by calling 1-877-553-7453 or visiting efof.org/acanavigation.
But Florida’s consumers also need to know their benefits may not be guaranteed in 2018 — unless Florida’s lawmakers pass a solution that ends the bait and switch.
Karen Basha Egozi is CEO of the Epilepsy Foundation of Florida. She lives in Miami.