$22 a month: ‘I am totally flabbergasted’

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Name: Irene Martin* 

Age: 62

Location: Richmond

Insurance in 2014: Private pay

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Last year, Irene Martin knew she needed health insurance.

She had spent years taking care of her ailing parents in New York. Now that she was back home in Richmond, she was starting to piece her life back together — and that meant health care.

Then 61, she was too young for Medicare. As a book illustrator, she wasn’t able to get insurance through work. And an ACA expert told her her annual income was too low to qualify for a government subsidy to buy health insurance through the ACA marketplace.  In some states she would probably qualify for Medicaid, but Maine decided not to expand Medicaid — or MaineCare — coverage for people under the poverty line.

If she wanted health insurance, she’d have to pay for it herself. 

Most people under the poverty level aren’t able to afford that. But Martin had inherited some money from her parents.

“People said you really should be insured or it’s possible all the money you inherited is just going to go (in a medical emergency),” she said.

So Martin paid more than $500 a month for a plan with a several-thousand-dollar deductible. 

“It was OK. It seemed kind of expensive,” she said. “I was paying more for insurance than I had in income before that. But I was lucky. I had inherited money, so I was able to afford it.”

During 2014 she worked to re-build her life as an illustrator, and publishers started to take notice. When she sought insurance help this year, she went armed with two potential book contracts. Between them, they would push her over the poverty level and into the threshold for an insurance subsidy, relieving the hit on her inheritance.

A couple of weeks ago she signed up for the cheapest middle-of-the-road plan she could find. With a subsidy — a substantial subsidy — it will cost her less than $22 a month.

“I am totally flabbergasted. I didn’t expect it to be that low,” she said. “Before this whole (health care reform) turnaround happened, with Dirigo I was paying just under $160 a month. I expected it to be something like that. That was a very nice subsidy, I thought.”

Martin still has concerns. If one of her book contracts falls through, she’ll likely dip below the poverty level again. And dipping below the poverty level means no more subsidy.

“If I don’t get two book contracts, I’m going to be repaying a lot of (subsidy) money,” Martin said.

Experts say people can be asked to pay back some of the subsidy in certain cases, but that payback is limited. Still, Martin doesn’t want to risk it. Or risk her insurance. 

“Now I just need those two book contracts,” she said.

* Irene Martin is not her real name. She asked to use a made-up name because she was concerned about making her finances public.

ACA 201 Online: A one-year checkup on how the ACA is doing in Maine and a subsidy calculator can be found at SunJournal.com/ACA201

Profiles of Mainers who bought health insurance through the ACA marketplace:

You’ve seen how the Affordable Care Act affected other Mainers in 2014. How about you? Good, bad or neutral — share your ACA stories

Resources:

Affordable Care Act 101: We break down the ACA, what it does and what it requires you to do.

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