Open enrollment began on Nov. 1, an opportunity for everyone in the country to enroll in healthcare through the health insurance marketplace.
While this is good for most people, there are many who are left out, or are at a disadvantage. Low-income people, and low-income people with HIV receiving Ryan White services, face additional challenges in attaining and maintaining adequate healthcare coverage. Those same people are ripe targets for predatory insurance agents.
Health insurance was made significantly more accessible for almost all people though the Affordable Care Act (ACA). Through healthcare.gov, US citizens can get low or no cost insurance coverage. These plans are considered marketplace plans and are touted as being affordable and accessible. This is done through various subsidies, including the Premium Tax Credit.
In general, people who made less than 400% of the Federal Poverty Level (FPL) in 2022 are eligible for a tax credit intended to help cover premium costs. The tax credit is designed to limit the amount of money a person or household spends on premiums, up to a maximum of 8.5% of their yearly income. This means that someone who made $58,320 in 2023 (400% of the federal poverty level) will pay no more than $4,957.20, or 8.5% of their income, on insurance. Someone who made $29,160 (200% FPL) will pay no more than $583.20 for insurance. Those who made $21,870 or less (150% FPL) pay nothing toward insurance. This credit is not available if a person buys a plan that is not available on the marketplace.
While the ACA has made insurance easier to access than ever before, there are still challenges with access for many people. Just having the option isn’t enough, particularly for people who have never had health insurance before, or are on health programs like the Ryan White HIV Care Program and the AIDS Drug Assistance Program (ADAP).
Ryan White Programs provide further subsidies to their clients. Anyone with HIV who makes 400% or less of the federal poverty level can get their insurance, including copays and deductibles, paid for by Palm Beach or Miami-Dade County Ryan White Programs. Broward County provides copays and deductibles only. Clients must reside in those counties to access these services.
While all of these programs are beneficial, there is an ugly side to insurance enrollment: private insurance agents. Many insurance agents throughout open enrollment and the year offer incentives for people to change their insurance plans. This can be in the form of something as small as a Publix gift card, or something as grandiose as a cash handout. Insurance agents are able to go into a client’s marketplace enrollment and change it on the backend, without needing to do much else in the process.
This is particularly troublesome for those low-income people who are receiving benefits through a program like Ryan White. The insurance plans Ryan White covers are chosen specifically because they cover the services and medications people with HIV need, and the HIV specialists in the system take the insurance. They are also selected for deductible and copay costs. The plans that a client gets switched to are almost always the cheapest, worst plans available, which harms people’s ability to attain and maintain adequate healthcare. This is particularly problematic for people with chronic conditions and mental health disorders.
Anyone in Florida can become a licensed insurance agent. There is very little required to do so, and the ethical and training requirements are minimal to nonexistent. This puts vulnerable people at risk of getting swindled out of their healthcare - and their premium tax credit. Insurance agents do this in order to get the person’s tax credit.
The challenge of predatory insurance agents is not solved easily. Further regulation would be needed to truly end the issue. Until that happens, education is the best tool we have. Anyone utilizing healthcare.gov to enroll in health insurance is encouraged to speak to a professional at a reputable nonprofit organization, like the Broward Regional Health Council, Epilepsy Alliance Florida, any Ryan White provider, and medicaid and medicare representatives.
Disclosure: Sean Conklin is an employee of the Palm Beach County Ryan White Program & Ending the HIV Epidemic
