By Tom Scherberger
Jo Bertloff, a 59-year-old Tampa sign language interpreter, hasn’t had health insurance in a decade. Since she is an independent contractor, her monthly income is uncertain, and private health insurance unaffordable.
Bertloff considers herself fortunate to not have serious health issues but says it sometimes feels like she’s gambling, aware of how costly a simple fall could be.
“It’s always there in the back of my mind,” she said. “You’re extra careful.”
Getting coverage through the Affordable Care Act (ACA), sounds promising, she said, but she is still seeking answers to basic questions.
Beginning this month, an estimated 3.5 million Floridians like Bertloff who now lack coverage are able to shop for coverage from 12 private companies through the insurance marketplace—sometimes called an exchange. The marketplace offers one-stop shopping where consumers and businesses with up to 50 employees can compare prices and coverage among the plans.
Of those uninsured, 334,000 low-income residents ages 50 to 64 could have been covered at federal expense if the state had expanded Medicaid, according to an AARP Public Policy Institute report. After three years, the state would have gradually paid up to 10 percent of their Medicaid cost.
To help people like Bertloff figure out the process, AARP Florida will host a tele-town hall Oct. 10 to explain the ACA and answer questions. About 70,000 people will be invited to join the call.
In addition, dozens of trained AARP volunteers are going around the state making presentations to community groups. Statewide AARP radio ads are expected to reach more than 1 million Floridians, and information is available from AARP Florida on Facebook and Twitter.
“People … have been confused by the intense political debate,” said Leslie Spencer, AARP Florida associate state director for advocacy. “We are trying to reach out to people who may be in this position.”
Basic health care covered
The plans offered through the exchange must cover basic health care such as doctor visits, hospital stays and prescription drugs. They can’t charge a copayment for preventive care such as mammograms, Pap smears and blood pressure or cancer screenings.
The plans come in four levels—bronze, silver, gold and platinum—with bronze considered basic coverage, silver standard and gold and platinum higher coverage with higher premiums.
The ACA prohibits insurers from denying coverage or charging higher premiums based on preexisting medical conditions, a person’s gender or occupation. It also eventually will eliminate most annual and lifetime coverage caps. Adult children are able to stay on their parents’ insurance until age 26.
Older people who buy private insurance before they are eligible for Medicare at 65 can’t be charged more than three times the rate of younger customers’ premiums.
For those covered by Medicare, the ACA gradually closes the “doughnut hole” in Medicare Part D prescription drug coverage.
24-hour hotline available
Consumers can call a telephone hotline—800-318-2596—24 hours a day for more information or visit HealthCare.gov to learn about the enrollment process and the insurance plans. Trained “navigators” and certified counselors will provide one-on-one assistance.
People who enroll by Dec. 15 will have coverage on Jan. 1. People who enroll later will receive coverage about a month after they sign up.
Low- and middle-income people—with incomes of less than about $46,000 for a single person and about $94,000 for a family of four—may qualify for a subsidy that can be used to lower the monthly premium or can be taken as a tax credit on their federal income tax return.
The ACA requires most Americans to have health insurance beginning next year or pay a penalty of at least $95 on their federal tax return.
Go to healthlawanswers.org for more information about how the ACA can affect you.
Tom Scherberger is a writer living in Treasure Island, Fla.