In all his years working as a high-altitude tree trimmer, David Mendoza said he never had a serious accident, much less with a chain saw, like the one that nearly claimed his left hand on Jan. 18 as he tried to remove a fallen tree from atop the garage of a Coral Gables home.
“I was going to start cutting to bring it down, like many of the jobs I do,” he said, “when all of a sudden the chain saw slipped.”
The chain saw tore a four- to five-inch gash in Mendoza’s left forearm. He was rushed to the emergency room at Mercy Hospital, where doctors cleaned the wound and sewed it up.
Mendoza, 33, followed up with a hand specialist and a two-hour surgery the next day to repair five torn tendons and a pinched nerve. He will need six weeks of physical rehabilitation. Full recovery will probably take about six months.
Fortunately for Mendoza, who owns a small business, he has insurance — an Affordable Care Act plan he signed up for in December that costs him about $50 a month after financial aid. The plan covers almost all of his medical care. His out-of-pocket costs for the care he has received to date: $4 for prescription medications to ease the pain.
“Honestly,” said Mendoza’s wife, Islara Souto, “if this would have happened when we were not covered, we would have been bankrupt. This was a major surgery with a top doctor.”
If this would have happened when we were not covered, we would have been bankrupt.
Islara Souto, about having coverage for her husband’s hand surgery
Mendoza is one of more than 1.6 million Floridians who have signed up for an Affordable Care Act plan since open enrollment began on Nov. 1. The deadline for consumers to sign up for a 2016 plan is Sunday.
The penalty for eligible consumers who fail to buy health insurance coverage by the deadline is $695 per adult and $347.50 per child, up to $2,085 for a family, or 2.5 percent of family income, whichever is greater.
According to a January report from the U.S. Department of Health and Human Services, about 11.2 million consumers nationwide had signed up for a plan as of Dec. 26, with Florida leading all states in the number of residents who had selected a plan as of that date.
Florida is one of 38 states using the federally run insurance exchange at healthcare.gov, while the remaining 12 states and Washington, D.C., operate their own marketplaces. Among states with their own insurance exchanges, California led the pack with 1.4 million residents signed up as of Dec. 27.
South Florida in particular has been a hot spot for enrollment. According to HHS, nearly 600,000 people in the Miami-Fort Lauderdale area had selected or were automatically enrolled in a plan as of Jan. 16 — the highest in the state.
The second-highest market in Florida, the Orlando-Daytona-Melbourne area, signed up about half as many, or nearly 300,000 people, according to HHS.
$695 Penalty per eligible adult for being uninsured in 2016
Carlyne Lafontant, an enrollment counselor with the nonprofit Epilepsy Foundation of Florida, which received a federal grant to advise consumers on ACA plans, said many consumers switched plans this year in order to keep their costs low.
“They mostly look for low cost sharing and low deductible, also with a low premium,” Lafontant said, noting that the most popular plan among consumers she advised has been the lowest-priced standard plan sold by Ambetter from Sunshine Health.
Lafontant meets with consumers two to three times a week at the Sant La Haitian Neighborhood Center in Miami. Because most of the consumers she advises live nearby, she said, most want to make sure that the Jackson Health System is in their provider network.
But like other enrollment counselors, Lafontant said she has noticed that many consumers still struggle to understand how to best use their health insurance, and that some face additional challenges.
“They’re still trying to get the sense of how it works,” she said. “The ones that understand it are doing more. But this is the Haitian community. Many are still trying to learn the language, and they’re still trying to learn the system.”
Among Floridians who had signed up for a plan as of Dec. 26, 89 percent qualified for financial aid valued at an average of $307 per month. On average, those Floridians were paying $89 a month in premiums after financial aid, according to HHS.
On average, most Floridians who signed up for an ACA plan as of Dec. 26 were paying $89 per month in premiums after receiving financial aid.
Despite Florida’s high number of enrollments, federal officials still see potential for the state to sign up even more consumers. HHS Secretary Sylvia Mathews Burwell is scheduled to visit West Palm Beach on Thursday at the Okeechobee Branch Library for a final push to boost enrollment in the Sunshine State.
Burwell, who has visited Florida three times during the open enrollment period, will focus on populations with a high number of eligible consumers, particularly in African-American, Hispanic and younger communities, said an HHS spokesman.
Last week, Burwell noted that consumer interest was beginning to rise again as the deadline for 2016 coverage nears.
Last-minute rushes for enrollment have led to problems for consumers. According to The Associated Press, a spike in enrollments prior to the Dec. 15 deadline to sign up for coverage that began on Jan. 1 has led to delays in consumers receiving ID cards, as well as billing errors and other problems.
Mendoza and his wife, who is an enrollment counselor with the Epilepsy Foundation, said they are thankful to have bought an ACA plan in time for Mendoza’s accident.
“I was just hoping to have it for doctor visits,” Souto said of the plan. “But we had this emergency, and so far it’s turned out well.”
Consumers who want to find out about ACA coverage can find in-person counselors at localhelp.healthcare.gov or by calling 800-318-2596.
Surging in South Florida
South Florida is the top region in the country for Obamacare enrollment. According to federal data as of Jan. 9, 14 of the top 15 ZIP Codes in the country for sign-ups were in Miami-Dade and Broward counties.
ZIP Code City Enrollment
- 33012 Hialeah 14,760
- 33126 Doral 10,213
- 33015 Miami Gardens 10,178
- 33010 Hialeah 9,617
- 33165 Miami/Olympia Heights 9,617
- 33016 Hialeah Gardens 9,252
- 33125 Miami/Flagami 9,225
- 33024 Pembroke Pines 9,152
- 33178 Doral 9,067
- 33175 Miami/Olympia Heights 9,062
- 33313 Fort Lauderdale 8,975
- 33018 Miami Lakes/Hialeah 8,840
- 33023 Pembroke Pines/Hollywood 8,737
- 30044 Lawrenceville, Georgia 8,683
- 33186 Miami/Kendall 8,507
Source: Office of Assistant Secretary for Planning and Evaluation, Dept. of Health and Human Services