Commentary

Middle-aged, stuck in the coverage gap and still years away from Medicare

Seventeen percent of adults stuck in the Medicaid coverage gap are between the ages of 55 and 64 years and many have worked most or all of their adult lives. What’s more, 56 percent of adults in the gap are currently working. Unfortunately, when there are economic downturns, some hard working individuals lose their jobs.

Sonya’s story reflects the stories of many older adults that have worked and paid their taxes most of their lives. Unfortunately, Sonya lost her employer-sponsored health coverage when she lost her job. Now that Sonya no longer has employer-sponsored health coverage and no longer qualifies for Medicaid because her youngest child has aged out, she has limited to access the health care she needs.

While the Affordable Care Act has helped many people gain Marketplace coverage, Sonya was unable to enroll given her financial situation. She tried to gain coverage through Social Security disability insurance as she has chronic back issues that impact the type of work she can do. Unfortunately, she was denied disability coverage. This leaves Sonya in the coverage gap. Like 500,000 other North Carolinians, Sonya does not meet the eligibility for Medicaid and cannot afford to purchase coverage on the Marketplace. She is, at once, too well-off and too poor.

Thanks to the Medicaid Blockade led by Speaker Moore and Senate President Berger, Sonya is in the coverage gap. She has over five years until she can obtain Medicare coverage. Thus, Sonya is delaying the preventive and urgent care she needs to help improve her chronic back conditions and behavioral health concerns. Like many fellow Tar Heels, Sonya is working hard to pave her own path to coverage. She saves money to see a health provider for her ongoing health concerns. She is even going back to school to become a counselor. Sonya is hoping that with higher education she will be able to get a job that will offer insurance. For now, however, likes hundreds of thousands of her fellow North Carolinians, financial ruin is just one accident or one unforeseen illness away.

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