TAMPA — Carl Warren is grateful he has Medicare.
The government health insurance for seniors and a related supplemental policy were key to his getting the necessary surgeries, hospital stay and rehab to treat kidney cancer, he said.
Without it, the 66-year-old retiree says he doesn’t know how he and his wife, Regina, would have managed. Had he been a few years younger and not Medicare-eligible, the options would have been far different, he said.
“I have no doubt in my mind that I’m fortunate,” Warren said. “Between my age and having Medicare and my secondary insurance, I have been able to receive the best quality of care out there.”
Warren is also thankful he won’t have to log on and look for coverage on Oct. 1, when the online Health Insurance Marketplace opens for business for millions of uninsured Americans 64 and younger.
Warren and 49 million other seniors on Medicare — along with the 157 million Americans covered through private employer-based health plans — are good to go.
That point isn’t as clearly understood as it probably should be by now.
The Affordable Care Act’s complexities, and the political bickering and rumors swirling around the reform, have confused many Americans who aren’t even affected by the online exchange.
Millions of dollars are being spent to explain who needs to apply in order to meet an individual insurance mandate, but uncertainty reigns.
“Nobody knows what it’s about,” said Stephen Parks, a Brandon primary care physician and volunteer leader at the Brandon Outreach Clinic.
Health care is a personal, emotional issue, he said, and it has become even more complicated by the confusing details of the Affordable Care Act. Patients with and without insurance aren’t clear on the new requirements.
That’s especially true for Medicare participants, some of whom are mixed up by the similar enrollment periods for Medicare (Oct. 15 to Dec.7) and the Health Insurance Marketplace (Oct. 1 to March 31).
Seventeen percent of Florida residents are on Medicare and have the option to change their hospital and medical coverage every year.
Workers with employer-based insurance are growing anxious too, especially as they learn about companies with Tampa-area ties cutting coverage or some workers’ hours.
United Parcel Service, the international shipping company, announced last month that it will stop offering coverage to employees’ spouses if other insurance is available.
And last week, the owners of Busch Gardens theme parks confirmed they were reducing hours for some of their 22,000 employees across the country. Part-time workers averaging about 32 hours a week will see their schedules reduced to 28 hours a week, the company said of the move, which is being made long before the Jan. 1, 2015, deadline for businesses to comply with the law.
Still, it appears a vast majority of employers are not making major changes. About 90 percent of companies surveyed this summer by the Midwest Business Group on Health said they had no plans to drop coverage and make employees move to the government exchange or similar plans.
Tampa Electric Company employees shouldn’t see drastic changes in their 2014 coverage, said Brad Register, TECO director of compensation and benefits. The health law will affect employee insurance costs, but not like those at UPS, he said.
“We’re not planning on deviating,” Register said of the insurance plans that cover 10,000 TECO employees, their spouses and children and retirees.
His department has been implementing parts of the Affordable Care Act since it passed in 2010, such as the requirement that employees can keep adult children on their policy up to the age of 26.
Rates have increased about 3.5 percent the past two years. Rates for 2014 are still being negotiated, and Register expects they will be shared with employees this month. But the increase will be even larger, he said.
One reason for potential sticker shock, he said, is a $63-per-person fee TECO must pay as part of the Affordable Care Act startup costs.
“People are not going to be relatively happy, but I can’t do anything,” he said of the tax, which will cost TECO roughly $630,000.
Also, TECO will meet a new restriction that says companies cannot charge employees more than 9.5 percent of their salaries for coverage. Otherwise, workers would be eligible to shop on the Health Insurance Marketplace and the employer would face financial penalties, he said.
Details for many employer-based plans won’t be nailed down until right before enrollment. But the plans in 2014 will be different, that’s for sure.
The Affordable Care Act isn’t the only reason prices are going up for employer-based insurance plans, according to research from the Kaiser Family Foundation and Health Research & Educational Trust.
Health care and insurance costs have been increasing long before the reform was passed, said Gary Claxton, lead author of the 15th annual Employer Benefits Survey, released last month.
Employees have been assuming a bigger share of overall costs in recent years, and contribution increases have been rising at a pace faster than worker pay, said Drew Altman, president and CEO of the Kaiser Family Foundation.
An average family contributed $2,412 a year toward their employer-based insurance plan in 2003. This year, an employee will contribute on average nearly double that, $4,565, the survey said.
“People still feel the pain of health care costs and worry about it a lot,” Altman said.
It’s been four years since Riverview resident Tim Huckabee has been on the policy offered by his wife’s employer, the Hillsborough County School Board. Chronic respiratory problems and other injuries keep him from his trade as a floor installer, and the couple couldn’t afford the additional premiums on just her salary.
“It got to the point that she was just working for insurance,” said Huckabee, 46.
He’s unsure whether the couple can afford to add him back onto the policy to meet the federal insurance mandate. Initial estimates show he may pay $156 to $222 a month for coverage on the Health Insurance Marketplace — an option for him, but not his wife.
The uncertainty the Huckabee family faces is repeated in homes and businesses across the country.
Politicians, economists and consumer advocates have been speculating about the success or failure of the Affordable Care Act for years. That’s not going to change come Jan. 1.
It could take years for the Health Insurance Marketplace and its effect on health insurance in general to shake out, said Linda Blumberg, a senior health policy fellow with the Urban Institute.
Insurance companies will adjust their strategies once they see who the new customers are on the exchange and see how employers adapt to new regulations. Consumers will need to get accustomed to change, at least for the time being.
Many insured Americans will see a difference in their policies in 2014, and experts say it is critical they ask a lot of questions and read the fine print. Costs may go up and services could change. Some costs might even decrease.
It all depends on decisions made by employers and insurance companies that handle Medicare supplemental plans.
Only one thing is certain, Blumberg said: “The first year is going to be rocky.”