Puerto Ricans who fled to U.S. mainland struggle to find health coverage

The federal government has granted people affected by the devastating hurricanes that wracked coastal states and Puerto Rico 15 extra days to sign up for health coverage under the Affordable Care Act.

But Puerto Ricans who fled to the mainland face problems well beyond timing.

Many of those Americans have complicated questions about whether the Medicaid or Medicare coverage they had in Puerto Rico will shift with them to their new locations. And for those seeking private coverage, using the ACA's insurance marketplaces will likely be a new experience because the federal health law didn't establish those marketplaces in the U.S. territory.

Members of Congress from Florida sent a letter to Seema Verma, director of the Centers for Medicare & Medicaid Services (CMS), requesting that officials "provide much-needed clarity and alleviate confusion" among Puerto Ricans who have relocated.

Insurance enrollment on the health law's marketplaces ends for most people Dec. 15. In a bow to the hardships caused by the August and September storms, residents living in hard-hit areas of Texas, Florida and Georgia are allowed to sign up as late as Dec. 31. But waiting means the start of their coverage is delayed until Feb. 1.

Many Puerto Ricans driven from home are negotiating layers of red tape. In Puerto Rico, three-quarters of Medicare beneficiaries are in private plans. Many have questions about whether those plans will cover them stateside.

Also, the Medicaid program for low-income residents in Puerto Rico covers nearly half of the island's residents — a rate higher than any state — but it's not clear that people moving stateside will continue to qualify because they may not meet the tighter eligibility standards. That is especially true if their new home state did not expand Medicaid under the ACA to all adults earning up to 138 percent of the poverty level.

They can call the healthcare.gov help line for assistance. But a federal memo making that recommendation doesn't provide details about what documentation is needed. It also says that individuals affected by a hurricane could be eligible for a "special enrollment period" to access another health plan.

Anne Packham, director of the insurance marketplace project at Covering Central Florida, said the focus should be on encouraging consumers to register before Dec. 15.