Counting the days for insurance from marketplace

Posted: October 20, 2013

Gail Thomas can count on one hand the number of times she's been to the doctor in recent years. The 63-year-old Willingboro woman considers herself healthy.

But two years ago, she ended up in the hospital for 22 days. She was dehydrated and feeling poorly. The doctors ran test after test, but the cause is "still a mystery to this day," Thomas said. It was the first time she'd she'd been in the hospital since giving birth to her son, who is now 29.

"The hospital bill was over $200,000 and I didn't have any insurance," said Thomas, who was already retired by then. "That, right then and there, made me realize I needed it."

So, too young for Medicare, she bought a plan on New Jersey's costly individual market. This year, her monthly HMO premium rose from $434 to $487. Thomas recently dropped the plan because she couldn't afford it anymore. She knew she'd soon get coverage through the Affordable Care Act health insurance marketplace.

"Oct. 1 couldn't come fast enough for me," she said. "I have waited for this day to come."

When Thomas first heard President Obama talking about affordable health insurance, she said, it piqued her interest. Then, her accountant mentioned that she might be eligible for the tax credits and subsidies available to people with qualifying incomes.

Under the law, individuals and families with incomes between 100 percent and four times the federal poverty level qualify for discounts on premiums. Eligible incomes range from $11,490 to $45,960 for an individual and $23,550 to $94,200 for a family of four. Some will also pay less in deductibles and for their share of health costs.

"Based on what the accountant was telling me, they were talking around the $130 area," Thomas said of her potential premiums. "I can live with that."

But so far, Thomas doesn't know what a plan in New Jersey will cost her. She has been able to log onto the government enrollment website only sporadically (New Jersey opted to have the federal government run its marketplace), and hasn't been able to browse plans or learn her potential discount.

The website, - where Pennsylvanians also can enroll - has been plagued by glitches that have prevented many would-be shoppers from browsing.

But Thomas doesn't mind, just as she doesn't mind paying for health insurance she hasn't really needed to use. Yet.

"It's like a mortgage, you do what you have to do," she said. "Even if I don't have to use it, I have comfort in knowing I have it."

302-983-6787 @kellyperil

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.

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