Health News Florida
11:20 am
Thu September 26, 2013

Many Still Don't Know About Marketplace

Originally published on Fri September 27, 2013 10:17 am

Starting Oct. 1, millions of uninsured people around the country are going to have a new place to shop for health insurance, but many still don’t know about this provision of the Affordable Care Act. 

Take Maggie Banta, a St. Petersburg woman who works a part-time job that doesn’t offer insurance. She is likely to find affordable coverage on the Marketplace, but she said she didn’t even know that was an option.

Joe Gregor, the vice president of consumer and exchange markets for Florida Blue, an insurer that will be selling health plans on Florida's Marketplace, said that’s very common.

"Overwhelming, across the state and across income levels, people are under-informed about what's coming in 2014,” Gregor said. 

Banta knows how important health insurance is, and just how pricey things can get without it. She had to have emergency surgery in June after complications that resulted from Lap-Band weight loss surgery she had a few years ago. She is paying $10 a month to chip away at a $31,000 hospital bill. 

"I laughed when I opened the bill. I was like, seriously?” Banta said. “I just called them and said, 'I don't know what you want me to do with this, but there's no way.' That’s like three year's salary for me."

Banta and her husband used to have health insurance through their employers, but they both lost their jobs during the recession. 

"A few years ago, when we did have insurance I wound up having to have some emergency surgery, and the bill for that, thank god I had insurance, because that bill was $75,000,” Banta said.  “And when I broke my leg, I had insurance; that was $106,000."

They paid about $900 a month for COBRA to keep their employer coverage after she lost her job. She said they quit paying that because they didn’t use that much health care each month. She started paying the doctor cash when she needed to go. 

Banta works about 29 hours a week for Hilton Hotels and makes about $1,000 a month. They don't offer health insurance to part-timers. Recently, she found out she could get care through Community Health Pinellas. It's a not-for-profit that provides primary care services at prices Banta said she can afford.

"The day I went, normally, it would have been $40 and they were running a special. It was $10, and I got a $5 gift card to Target,” Banta said. “I'm like, 'I just got a Pap smear for $5 bucks!' Something that cost me $275 somewhere else, I got for $5."

Come Oct. 1, Banta will have options beyond special discounts because she can shop on the new online health insurance Marketplaces. They’re designed so people can shop for plans at different prices. Banta said she had never heard of his option, but plans to go to HealthCare.gov and research her options.

The plans that will be for sale on the Marketplace will offer coverage starting as soon as Jan. 1. Consumers can choose from different plans: bronze, silver, gold and platinum. Gregor said the big difference is in monthly premiums and out-of-pocket costs.

"Now, depending on what those claims are about, that could be a fairly sizeable amount of money compared to, for example, a platinum plan, which for the same covered benefits would pay 90 percent of the claims instead of 60 percent of the claims,” Gregor said. “You'd expect the premium to be higher on the platinum plan because the out-of-pocket risk to the member is lower on the platinum plan than it is on the bronze plan." 

Federal health officials estimate the average cost of a silver plan on Florida's Marketplace will be $328 a month. That estimate doesn't include tax credits that will be available to some individuals depending on their income.

Banta and her husband, who is self-employed as a cab driver, make about $30,000 a year. According to a premium subsidy calculator from the Kaiser Family Foundation, she should be eligible for tax credits that would bring the cost of health insurance down to about $150 a month.

"You know, I have to think about my bottom line,” Banta said. “I have to think about what's best for my wallet. And my health."

--Health News Florida is part of WUSF Public Media. Contact Lottie Watts at 813-974-8705 (desk) or e-mail at lottiewatts@wusf.org. For more health news, visit HealthNewsFlorida.org.