Too Young for Medicare, Couple Gets Coverage Under Obamacare

Too Young for Medicare, Couple Gets Coverage Under Obamacare

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OAKLAND, Calif. – As a child growing up in Guadalajara Mexico, Salvador Gomez started working at age ten to support his family, which included two younger brothers and three younger sisters. Both his father and grandfather had fallen sick and eventually had their legs amputated, which meant they could no longer work. So Gomez took on two jobs to pay the bills. At the age of twenty, a friend helped Gomez move to California in hopes of finding a better paying job.

“I just worked one job and it was, man, a lot of help,” Gomez said. “In one year, I buy the house for my mom.”

For forty years, Salvador, now 62, worked hard in the U.S. and supported his family back home in Mexico, as well as the three boys he was raising in the United States. Over the last decade of his career he worked as a maintenance man at a local hotel, painting, repairing things and doing a little plumbing and electrical work as well.

During that time, he and his wife received health care from Kaiser Permanente, which was paid for by his employer. Having good coverage was a necessity -- Maria had a painful stomach condition, Diverticulitis, which caused episodes of pain so severe she often required hospitalization.

“It was a pain, like, from one to ten, I think it was a ten,” Maria said.

But when the hotel’s lease expired two years ago, they shuttered their doors and let Salvador go – which meant that he, in turn, had to let his insurance go. He and his Maria worried about what would happen the next time her stomach problems flared up.

“I was scared, because where am I gonna go?” she said.

Maria’s stomach condition wasn’t the couple’s only health concern. Both also require medication to keep their cholesterol levels down. When Salvador went to pick up their prescriptions after his insurance ran out, the pharmacist said Kaiser would no longer cover the bill, and asked if Gomez had the money to cover the cost out of pocket -- the total was nearly $160 a month.

“He said, ‘I can’t afford it but I need it,’” Maria recalled.

There was, they discovered, another option: The pharmacist told Salvador he could go to LifeLong Medical Care, a network of community clinics, to see whether or not they were eligible to enroll in a special program that would cover the cost of their medications. So the couple made their way to the LifeLong Over 60 Health Center in Berkeley, California, to explore their options.

“I went there and, for me, it was hard to believe,” Salvador said. “I’m so happy -- I discovered a lot of things that I never knew.”

What Maria, 60, and Salvador, 62, discovered was that they are too young for Medicare – eligibility begins at age 65 -- but they do qualify for the HealthPac program, which is run by the County of Alameda. HealthPac is a combines of the previously-existing County Medical Service Program with an influx of new federal dollars from the state Low Income Health Program (LIHP), also known as the “bridge to healthcare reform.”

In order to enroll for benefits through LIHP, patients must qualify for either the Medi-Cal (California's Medicaid program) expansion or the Health Benefits Exchange, both of which are set to roll out on January 1, 2014 as part of the Affordable Care Act. The goal of the bridge program is to get as many people as possible enrolled now so it will be easier to transfer them into the new program in 2014, at which time all U.S. citizens will be required to have health insurance.

There are already approximately 90,000 people enrolled in HealthPac in Alameda County. A majority of those, 42 percent, are Hispanic. Another 14 percent are Black, 15 percent are Asian and nine percent are white.

HealthPac covers comprehensive health-care services at a select network of providers in Alameda County.

Through HealthPac, Salvador and Maria Gomez were once again able to afford their medication payments.

“I had to pay in the beginning, I think, $5 (co-pay) for each time,” said Salvadro. “That’s nothing.”

Furthermore, one year before he lost his employer-paid insurance, Salvador’s doctors at Kaiser diagnosed him as pre-diabetic.

Having been a relatively healthy man for most of his life, Salvador had a difficult time understanding how he could have a chronic health condition.

“When they told me I feel so bad, so down,” Gomez said.

“It’s because of the way we eat,” Maria said. “We grew up eating pork -- a lot of things you’re not supposed to eat.”

At first the couple found it difficult to change their lifestyle, but eventually they switched to a primary diet of fish and chicken. They stopped frying everything, and now either boil or steam their food.

Salvador still regularly goes to the Lifelong clinic for eye exams and other tests. Twice a year he consults with nutritionists there -- they’ve told him he must continue to eat healthy and exercise, to avoid full-scale diabetes.

“I try to do whatever they told me because I want to live, I don’t want to die,” Gomez said. “And if I don’t do something (they tell me), I feel it.”

Maria helps her husband maintain a healthy lifestyle, and she appreciates what the changes have done for her own health -- she’s lost weight and the new diet helps with her stomach problems.

Nevertheless, since their switch to HealthPac, she’s had to go to the emergency room at Highland Hospital in Oakland twice for her stomach problems. She had heard horror stories of people waiting long hours there to be seen in the emergency room.

“The first time that I went it was kind of scary,” Maria said, “Are they going to take me or not?

She was pleasantly surprised when they saw her after only a half-hour. She was thrilled when they asked her if she preferred a doctor who spoke Spanish.

“I speak English but when I’m in pain, I forget everything,” Maria said.

Maria spoke with the doctors at Highland about how to avoid hospitalization in the future.

“Because I don’t want to abuse the system, I want to go only if I need it,” Maria said. “I know there’s a lot of people that need it (emergency services) maybe more than me.”

The doctor advised her to switch to a liquid diet when she’s experiencing pain, and he also prescribed her painkillers.

“I’m blessed with this program,” Maria said. “It’s really scary not to have it (insurance) with this sickness.”

Now that Salvador is retired and Maria only works three days a week cleaning houses, they struggle to make ends meet.

“We don’t live a fancy life,” Maria said.

They only eat out on special occasions, and their children pay their cell phone bills and often buy their groceries. Just as Salvador once supported his family, so his children help him now.

“When you support your parents the blessings (are) going to come back to you,” he said.

This article was written as part of a New America Media reporting fellowship, made possible by The California Endowment.