LAKELAND — In Polk County, the rest of Florida and nationwide, people are signing up for health insurance under the Marketplace at numbers similar to previous years, seemingly undeterred by the Trump Administration’s efforts to repeal and replace the Affordable Care Act.
However, there is a big difference in the enrollment period. It has been halved from 90 days to 45 days. Signup started Nov. 1 and ends Dec. 15.
There is no massive marketing campaign informing people about the sign-up period, requiring more reliance on social media and news accounts to inform the public, said Melanie Hall, executive director of the Family Healthcare Foundation. The foundation is the lead agency in a four-county area (Polk, Pinellas, Pasco and Hillsborough) to train navigators, counselors and assisters to help people through the online maze of signing up for insurance.
In Polk County, three insurance companies are offering policies through the Marketplace — Blue Cross Blue Shield, Molina and Ambetter, Hall said. All three companies offer the same basic plans — the least expensive bronze, the benchmark silver plan, and the gold plan, Hall said. In addition, Blue Cross Blue Shield is offering a platinum plan.
The biggest difference among the companies and their various levels of plans is which doctors and facilities are in their particular networks. Sometimes specialty physicians they list are out of county.
“It is very important that people go back to the Marketplace and actively shop,” Hall said. “They may do better than they are expecting in terms of finding an affordable plan.”
Keri Eisenbeis, director of government relations and community outreach for BayCare Health System, said in a news release, “Some people may be uncertain about whether the Marketplace still exists after various efforts by Congress this year to repeal and replace the Affordable Care Act. We can assure our communities that the Marketplace is still here.”
People who are computer savvy can go to healthcare.gov to sign up on their own. The website also lists private companies in most Polk County communities that provide assistance. There is also free, unbiased help from navigators or certified application counselors and certified assisters, including through BayCare, Central Florida Health Care, Heart of Florida Regional Medical Center and Lake Wales Medical Center.
Whether it is costing individuals less, the same or more than last year depends on individual circumstances, said Ermelinda Centeno, director of enabling services for Central Florida Health Care, which operates federally qualified community health clinics in communities across Polk County.
“Some people come in to their appointment upset,” but leave relieved, Centeno said. People who currently are insured through the Marketplace receive a letter in the mail that gives a premium rate, which is the amount before tax credits and cost sharing is applied.
For example, somebody who was paying $35 a month received a letter saying their cost was going up to $492 in 2018, she said. But by the time the tax credits and cost sharing are applied, the monthly out-of-pocket cost was about the same as this year, she said.
The certified application counselors who help clients at the community health clinics are finding that many people are paying premiums as low as $20 a month with $600 deductibles, Centeno said. However, she added, the clientele at the community health clinics tend to be lower-income, so people with higher incomes would not be eligible for such large cost-sharing amounts.
"We are encouraging everyone to sign up,” Centeno said. There are many variables, including age, smoker or nonsmoker, and area of residence, she said. The only way to know what is available, what level of subsidies and tax credits a person is eligible for or to obtain a tax-exemption status is to go through the process, she said.
Federal statistics indicate that 90 percent of those who signed up in Florida this year qualified for a tax credit and 72 percent of those qualified for cost-share reductions, further reducing their premiums.
Generally, premiums have gone up by quite a bit (40 percent in the four-county area) but so have the amounts given for tax credits and subsidies, according to an analysis by the federal Office of Health Policy. As a result, most people will pay less out of pocket in 2018 than they did this year.
As in years past, those whose incomes fall between 100 percent and 250 percent of poverty level qualify for sliding-scale tax credits and cost-sharing subsidies. Those whose income is 251 percent to 400 percent of the federal poverty level qualify for sliding-scale tax credits.
In 2018, 100 percent of poverty level is $12,060 for a single person and $24,600 for a four-person household. The cost-sharing subsidies end at 250 percent of poverty level or $30,150 for a single person; $61,500 for a family of four.
But the tax credits continue up to the 400 percent of poverty level, which is $48,240 for a single person, $98,480 for a four-person household.
The people most likely to pay big hikes in cost this year are those in a small percentage of high earners who don't qualify for any subsidies but must purchase through the Marketplace because their workplace does not offer health-insurance coverage.
Here are examples the Office of Health Policy offered in a research brief released Oct. 30.
• For a 27-year-old in Florida with an income of $25,000 buying the benchmark silver plan: In 2018, the average monthly premium would be $382 (compared with $272 this year) but the person would qualify for subsidies amounting to $245 a month (compared with $130 in subsidies this year). The person would end up with a monthly cost of $137 for health insurance in 2018, which is $5 lower than this year’s cost.
• For a family of four in Florida with a household income of $60,000, buying the benchmark silver plan: In 2018, the average monthly premium would cost $1,381 (compared with $983 this year) but the family would qualify for subsidies amounting to $991 (compared with $579 in subsidies this year). The family would end up with a monthly cost of $390 in 2018, which is $14 less than this year.
In 32 states, all residents who are below the federal poverty level qualify for insurance under Medicaid expansion. However, Florida is among 18 states that decided not to expand Medicaid benefits to very low-income adults of working age who are not disabled.
Centeno said it is important to go through the sign-up process even if a person knows their income is too low to qualify for a subsidy, citing an example in which a woman’s very-low-income uncle was living in her home. Even though he could not qualify under her family’s health insurance and could not afford to buy insurance, she could claim her uncle as a dependent and get a break on her taxes. Because he went through the enrollment process, he could get an exemption number, proving he did not have to pay a tax penalty.
“There are those who say, 'I would rather pay the tax penalty than purchase health insurance,' ” Centeno said. “The penalty is $695 per adult in the household and $347.50 per child under age 18, or up to 2.5 percent of household income – whichever is higher. However,” she said, “the maximum penalty is $2,085.”
In addition to halving the number of enrollment days, access is being further limited by healthcare.gov having scheduled maintenance of the website every Sunday from midnight until 5 a.m., she said.
Jodi Ray, program director of Covering Florida – the primary program in Florida coordinating enrollment — said returning clients started setting up appointments three months before the enrollment period opened Nov. 1, and numbers of returning enrollees have been strong.
"You don't know what your options are until you apply," Centeno said. "But don't wait until the end to apply."
Marilyn Meyer cam be reached at firstname.lastname@example.org or 863-802-7558. Follow her on Twitter at 863-802-7558.