When going without health insurance is not an option

Family Health
Hector Salgado and his wife, Liliana Pinzon depend on an affordable ACA policy to stay healthy and happy.

For Liliana Pinzon and her husband Hector Salgado, the Affordable Care Act (ACA) has been a blessing. Her husband has diabetes and depends on health care coverage to get the regular check-ups and prescription medications he needs.

For this family, going without healthcare is just not an option.

“When my husband changed jobs and lost his health insurance, we were able to get a new healthcare policy through the ACA at a reasonable cost,” Pinzon said. “This has allowed us to have access to good doctors and hospitals when we need them.”

Pinzon and her husband pay $500 a month in premiums. Her five-year-old daughter Maya is on Kidcare.  Before the ACA, the family paid $2,000 a month in premiums, an unsustainable amount that became impossible after Hector switched to part-time work because of his health.

Pinzon is very grateful to have an affordable policy, too. A few years ago she had a complicated pregnancy that resulted in termination due to a fetal abnormality and knows how it important it is to have health care coverage, especially women’s well-care.  

Her Florida Blue HMO healthcare policy allows her to receive care at a Community Health Center where doctor visits cost $3 and labs are free or very low-cost. She has thyroid disease and requires annual blood exams and monthly medications.

 “The ACA offers families like mine the opportunity to choose among many different healthcare policies with different prices,” Pinzon said. “This allows you to pick a healthcare plan that meets your needs – financially and health-wise, depending on your personal circumstances and health concerns.”

According to the Commonwealth Fund, among adults ages 19 to 64 who purchased or looked for a health plan through the ACA marketplace, 70 percent had two or more plans available, an even higher percentage than options available through employer plans. In addition, thirty percent of consumers buying marketplace plans said they had five or more plans to choose from. The number of options increases in more urban areas like South Florida.

 

For her husband, Hector, age 63, the various options available in Broward County, Florida meant finding a healthcare policy that included his doctors and had a good diabetes treatment program. Salgado works part-time as a college instructor where he has no health insurance.

“Thank goodness the Affordable Care Act has been available to me,” Salgado said. “Without it I wouldn’t have been able to stay healthy and helping to support my family.”

 

Choosing a Health Care Plan can be complicated.  You can learn more about how to pick a plan here: https://www.healthcare.gov/choose-a-plan/

The Epilepsy Foundation of Florida has licensed healthcare navigators who can help you make a decision about what policy is best for you and your family. Call our statewide toll-free number to speak to a navigator and set up an appointment for a personal assistance: 1-877-553-7453. For more information on the EFOF navigation program: http://www.efof.org/acanavigation/

Read the Commonwealth Report: http://www.commonwealthfund.org/publications/blog/2017/jun/health-plan-choice-in-aca-marketplace

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ACA offers healthcare & financial security: David Mendoza’s story

David Mendoza knows how much health coverage matters. It was a hard-won lesson that nearly cost him his life. But it could have also cost his family’s financial security.

 

David Medina photo
David Mendoza with his son, Kai

 

 

Mendoza owns a small tree-trimming business in Miami, Florida.  In 2016, while removing tree limbs from the roof of a garage, the chainsaw he was holding slipped and landed on his left arm, severing tendons and major blood vessels. He was rushed to the emergency room where the wound was cleaned and closed.

The accident came just two weeks after he had signed up for a health insurance plan through the federal Health Marketplace. For many years he didn’t think he could afford health insurance. But with the Affordable Care Act, he was able to find a plan where he paid $50 a month in premiums, with financial assistance. 

Nearly 93 percent of the 1.3 million Floridians who signed up for an ACA plan in 2017 received financial aid to pay their monthly premiums. One million of these consumers, about 75 percent, also qualified for financial aid to reduce out-of-pocket costs, including deductibles and co-pays for doctor’s visits and medications.  

 “I had never had an accident like this in my life,” Mendoza said. “So I had never really thought about having health insurance.”  As a healthy 35-year-old, Mendoza had never previously experienced any serious illness, either.

 

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Mendoza’s accident nearly cost him his life but the medical bills without insurance would have threatened his family’s future financial security.

The emergency treatment was followed by a visit to hand specialist (to make sure he regained movement in his hand), surgery to repair torn tendons and relieve a pinched nerve and six weeks of physical therapy.

Without health insurance to cover the costs of treating his injury, Mendoza said he might owe $100,000 in medical bills, or have gone without the necessary surgery and rehab that let him go back to work to support his family.

 “If I don’t have insurance and I get injured again, the medical bills I would incur would destroy me financially for the rest of my life. If I can’t afford health insurance in the future, I would have to close my business.”

Health care costs are a major burden for low- and middle-income wage earners like Mendoza. Before the Affordable Care Act, going without healthcare was often the only option.  A 2014 survey from the Kaiser Family Foundation showed that affordable health care relieves these families of problems with medical bills while also allowing better access to the medical services they need:

 “A primary goal of expanding health insurance coverage is to help people access the medical services that they need. The survey findings reinforce other findings that insurance facilitates access to health care, indicating that adults who gained coverage in 2014 are more likely to be linked to regular care, less likely to postpone care when they need it, and more likely to use preventive services than those who remained uninsured.”

Nationally,  more than half (53 percent) of low-income families and more than one in four (42%) of middle-income families that gained coverage in 2014 received financial assistance to afford their healthcare policies. Without financial assistance to purchase health insurance, these families would not have health insurance and would struggle to pay medical bills:

Finances graphic without insurance

 

Source: http://www.kff.org/report-section/how-does-gaining-coverage-affect-peoples-lives-issue-brief/