Tuesday, September 18, 2018
Health

Tampa Bay consumers share health insurance shopping stories

It has been nearly a month since Americans were supposed to be able to purchase subsidized insurance at healthcare.gov. But the troubled website, the centerpiece of the Affordable Care Act, has produced far more political heat and public confusion than new insurance customers.

Federal officials won't yet say how many people have managed to buy insurance. Some agents acknowledge they won't even try to sell on the federal marketplace until the problems get sorted out.

Still, persistent consumers — many of whom have been told their current plans are being replaced because they don't meet the health law's requirements — are working to obtain or keep insurance. Here are a few of their stories.

Kathryn Larkin, 53, St. Petersburg

Larkin belongs to an apparently rare breed: Americans who have enrolled in an insurance plan through healthcare.gov.

After weeks of trying, she got through early one recent Saturday morning, qualified for a $104-a-month subsidy and picked a Florida Blue plan. She has already sent in her first payment — and is telling family, friends and strangers, including the woman walking on the treadmill beside her at the gym.

"I told her, 'I've got health insurance!' " Larkin said. "And she was so happy for me."

Larkin lost her retail job when the WestShore mall's Saks Fifth Avenue closed in May. Through COBRA, she kept her low-deductible health plan that pays 90 percent of costs on average. But premiums are an unaffordable $585 a month. So she purchased a "silver" Florida Blue plan on the Obamacare website. With her subsidy, she'll pay $315 a month, which includes dental care.

But there are tradeoffs for Larkin, now a Realtor. The new plan's deductible is $5,700, higher than her old plan, and pays only 70 percent of costs. But her annual out-of-pocket maximum is limited to $6,350, an Affordable Care Act feature.

On balance, she said, the new plan gives her the peace of mind she needs. "It's protecting myself for the future," she said.

Heather Goodwin, 39, Palm Harbor

So far, Goodwin can't see the upside of the health care law for her family of four.

A hair salon owner, Goodwin learned recently that Florida Blue would end her family's plan in July. It carried a $10,000 deductible and paid next to nothing for her 13-year-old autistic son's therapy. But it cost only $400 a month, allowing her to save for therapies that cost up to $18,000 a year.

Goodwin and her husband, James, who runs a charter fishing business, make too much to qualify for subsidies. Her agent has offered quotes for new plans of $900 to $1,300 a month.

Such plans would have far more generous benefits. And the law caps the family's yearly out-of-pocket expenses at $12,700.

But one-on-one therapies for her son are not covered. The federal government left states to decide whether to cover certain autism therapies. Florida mandates coverage only for large-employer plans, according to advocacy group Autism Speaks.

"For this plan, there's nothing more for us," said Goodwin. "The people who get stuck are the ones they're trying to help, the middle class."

Mike Honeysett, 63, New Port Richey

Honeysett says he and wife, Shirley, have had health insurance that "is good enough for us."

The couple, Michigan retirees with a winter home in Pasco, pay $439 a month for a Michigan Blue Cross policy with a $2,000 deductible that pays 70 percent of covered costs. It includes neither routine office visits nor prescription drugs, but it kept them from going deep into debt when he needed knee surgery and she needed her gallbladder removed.

Earlier this month, the Honeysetts got a notice from Blue Cross saying that the plan did not comply with the law's 10 essential benefits and would have to close on Jan. 1. When the couple met with an agent, Mike said, "my heart sank."

Their closest alternative was an $863-a-month "bronze" plan with an $11,900 deductible that pays 60 percent of average costs. The Honeysetts do not qualify for subsidies and will have to dip deeper into savings.

"It's just going to put a dent into things," he said.

The new plan limits their yearly out-of-pocket spending and covers benefits they will use, like drugs and office visits, and ones they won't, like maternity.

Mike Honeysett generally supports the Affordable Care Act but is startled at what it's costing them. "I'm very disappointed," he said. "I never dreamed for a second we'd have this issue of losing our (old) coverage."

Michael Grimes, 62, Indian Shores

Grimes doesn't complain much about a month of getting locked out of healthcare.gov. He has been locked out of affordable insurance for years.

Due to a pre-existing condition, Grimes has been paying $2,500 a month to insure himself and his wife, Marilyn. They help run the family's antiques trade-show business, and he also manages a motel. Money is tight; they had to short-sell their home. "It's been nail-biting," he said.

Grimes used an online subsidy calculator from Kaiser Family Foundation to estimate subsidies. It appears they can get a "silver" plan for around $900 a month.

"I'd love to start saving money right away," said Grimes, who is using an independent agent to help him sort his options. Count Grimes, who voted for Obama, a supporter of the law. "I voted for change," he said.

Jodie Tillman can be reached at [email protected] or (813) 226-3374.

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