Those in the “coverage gap” are people with poverty-level incomes who earn too much to qualify for Medicaid but not enough for subsidies to buy health insurance through the new online exchange.
“They really will be without affordable options,” Sebelius said during her September visit to Miami.
The coverage gap was an unintended consequence of the 2012 Supreme Court decision that upheld the Affordable Care Act.
The law was supposed to provide health insurance for most Americans next year by expanding Medicaid in every state to include people earning up to 138 percent of the federal poverty level — which is about $15,900 for an individual in 2013, or nearly $32,500 for a family of four.
Tax credits would then go to other low- and middle-income people to help them buy coverage on the insurance marketplaces. But the Supreme Court ruled in summer 2012 that states could opt out of the expansion. Florida was among the states that took the option.
In Florida, Medicaid does not cover single, childless, working-age adults, a restriction that affects mostly men.
Also in Florida, a family of four with an annual household income between $4,721 and $23,300 — or 20 to 90 percent of the Federal Poverty Level for 2013 — would be on their own to find health coverage, according to HHS officials, with no option for Medicaid or a premium subsidy on the insurance exchange.
HOW do I sign up?
There are a variety of ways for consumers to learn more about the law’s requirements, the health plans advertised on the exchanges — also called marketplaces — and eligibility requirements for tax subsidies.
The Healthcare.gov website created by the federal government for enrollment is where you go to create an account to shop for an insurance plan. You’ll be asked to provide information such as household size, location and citizenship status.
The exchange will refer you to Medicaid if you’re eligible. If not, you may be eligible for a subsidy to defray the cost of buying a health plan on the exchange. Subsidies will be paid directly by the government to the insurer.
Once the question of subsidy has been answered, the exchange will show you a list of health plans offered in your area, with premiums and out-of-pocket costs including deductibles and co-payments.
If you decide to buy one of the plans offered on the exchange in your county, you’ll be directed to the insurer’s website to pay for the plan. You can also complete a paper application or get help over the phone by dialing 800-318-2596, the consumer help line for the insurance exchange.
Among the resources available to help consumers:
In August, HHS awarded $67 million in grants to more than 100 organizations nationwide to act as “navigators” who help the uninsured understand the new health law and enroll in coverage through the online exchanges.
In Florida, eight groups were awarded $7.8 million in navigator grants. The groups will not canvas neighborhoods knocking on doors. They’re also prohibited from selling plans or steering consumers to particular insurers. Instead, they will be based in offices or temporary quarters where consumers can meet with them for in-person guidance only.
Navigators in South Florida include the Epilepsy Foundation of Florida and the National Hispanic Council on Aging.