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Consumers asked to verify income, other information — or risk losing subsidies for health insurance

MIAMI – Luis Martinez of Hialeah survived two heart attacks during the more than 10 years that he went without health insurance.

So he was relieved to finally find coverage on the Affordable Care Act’s insurance exchange in March, two weeks before the enrollment deadline.

But four months after he and his wife signed up for a subsidized, bronze-level health plan with Coventry, Martinez, 51, said he feels as though he has fallen into a black hole of government bureaucracy while trying to prove his income and his wife’s citizenship in order to keep their coverage, part of a national effort to verify policyholders’ eligibility.

Martinez, who has stents implanted in his coronary arteries, said he has tried repeatedly for more than a month to comply with the government’s requests for additional documentation to resolve inconsistencies in his personal information – or risk losing his $457 monthly subsidy, and health insurance for him and his wife, Rocio Balbin, 46.

So far, officials with the U.S. Department of Health and Human Services are not satisfied with his response.

“I am against time,” said Martinez, a computer systems administrator who is studying at night to earn a bachelor’s degree in electrical engineering. “I have a dream, and I want to finish my career before I die. This is stressing me out.”

HHS officials declined to comment on Martinez’s case, but the agency is contacting hundreds of thousands of people with subsidized health plans bought under the ACA to verify their eligibility, particularly income and citizenship status, months after they first applied for and received financial aid to help them pay premiums and out-of-pocket costs for their coverage.

About 8 million people signed up for a health plan through the ACA exchanges. According to the Kaiser Family Foundation, 85 percent of them were eligible for financial aid, and the government is expected to deliver about $10 billion in subsidies during the first year.

Health care analysts say some consumers will end up paying higher monthly premiums as a result of the verification process, while others may have to repay some or all of their subsidies if they are found to be ineligible.

But for some, like Martinez, the verification process has become a maze of red tape.

Martinez has receipts showing that he mailed at least five identical packages — containing, he said, copies of his U.S. passport, his wife’s residency card, their 2013 income tax statement and his Florida driver license — by certified mail to the HHS-designated address in London, Kentucky.

More than a month after Martinez says he sent his first packet, he received a letter from the government stating that his information had been received, but that more documentation was necessary to establish Balbin’s immigration status. She was born in Colombia, and Martinez in Cuba.

“I just don’t know what else to do,” Martinez said.

Martinez said he bought his health plan with the help of a counselor at a kiosk in the Westland Mall in Hialeah. He and Balbin pay $5 a month for their coverage, after qualifying for a $457 monthly subsidy that reduces their premiums.

About two weeks after selecting the plan, Martinez received the first of several letters from HHS requesting his tax statement and other documents to verify his income, and Balbin’s proof of citizenship or immigration status.

The March 22 letter gave Martinez until June 20 to submit his documents, and until June 25 for Balbin to establish her immigration status. He tried to upload the documents on healthcare.gov, the federally run online exchange used by states including Florida, but he kept getting a system error. Finally, he resorted to sending copies by U.S. mail. Then he put the issue out of his mind.

His insurance, meanwhile, came in handy. He ended up in the emergency room at Kendall Regional Medical Center in June when he began to feel chest pain. He followed up with his primary care physician, who ran multiple tests and suspects a vein near his heart has expanded and “could explode,” Martinez said.

“They’re trying to find out where’s the vein,” he said, “where’s the problem in the heart that has developed.”

At about the same time, he received another letter from HHS requesting that he submit additional documentation.

Martinez said he sent another package, by priority mail, on June 16. He has a U.S. Postal Service receipt showing the package was delivered to London, Ky., and signed for on June 18. But as of early July, he said, HHS had yet to process his documents. Frustrated, he sent four more identical packages by priority mail on July 12 – all to the same address in Kentucky, according to his receipts.

“All I want is for my papers to get to the right place,” he said.