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When last I wrote on the topic of healthcare back in February, I envisioned writing many posts on the ACA this year.  I was HOT.  I wanted to showcase some stories (besides mine) of people who have been helped by the law, and I wanted to encourage activism to prevent its repeal.

But I find my capacity for outrage is finite, and the constant barrage of bad news on this topic and others has stretched it to the limit.  ObamaCare has survived almost an entire year without Obama, with little help from me other than the occasional Resistbot letter to my Congressmen (who voted in favor of every lame proposal thrown up by the GOP this year despite my pleas).

In just a couple of weeks I’ll be back on the ACA website, and I wanted to tell y’all a little about the way this year–on a new plan–has gone for us.  I want my readers to see at least one story that demonstrates that the ACA is NOT imploding (Yes, it needs revision.  I have always said that) and that it is still helping people.

In addition to regular checkups for John, Emily, Teddy, and me, we’ve had some expensive extras that would have either been out of reach when we were uninsured or would have thrown us deep into medical debt had we chosen to go forward with them.  Back in March, John developed bursitis.  He went to the doctor three times–including twice to a specialist–and the chiropractor once, had two sets of X rays and an MRI, and got a cortisone shot and several medications.  All this helped us to meet our deductible early in the year (we are still paying for the MRI), but we wouldn’t have gotten in the door to run up these bills if we didn’t have insurance.  I cannot stress this often enough:  insurance equals ACCESS!

In September, John’s doctor was concerned with some symptoms he was having and ordered an EKG, and then sent him to a cardiologist for further testing.  I haven’t seen the bills yet for the stress test and heart ultrasound performed at the hospital and two visits to the cardiologist (he’s fine, by the way), but I know that we will only be paying 20% of the negotiated rate.  Insurance equals LOWER PRICES!

I had my first mammogram this year, and am scheduled for my first colonoscopy in November.  If I didn’t have insurance, rest assured I would not be getting these screening tests performed.

Finally, last week I noticed some discomfort and a coating on my tongue.  I was pretty sure I had an oral fungal infection.  Did I wait to see if it got better on its own?  Did I look for home remedies? That’s what I would have done and did do, back in my uninsured days.  No, I called the doctor and made an appointment IMMEDIATELY, got some medication, and felt better after two doses.  Being able to go to the doctor right away is a privilege I do not take for granted.

Have we had issues with the ACA this year?  Certainly.  Due to quirks in the sign up process, we were not allowed to insure Jake.  So when he wanted to go to the doctor in September, he went as a self-paying patient.  However, the fact that he has been insured the past three years meant that he had a relationship with our doctor, and she was willing to see him and even give us a discount for paying the whole bill up front.

Also, I don’t much like having to get my prescriptions at Food City with its limited hours; but on the other hand its small size means a very personal touch that I didn’t always experience at Walgreens, and a relationship with the actual pharmacist.

Look for another update after I undergo the tribulations of Healthcare.gov.  Last I heard, Blue Cross will be making a reappearance in the Marketplace, but I have no idea whether our former plan will still be available or how much the rates may rise.

For more of my ObamaCare stories, see below and click away!

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

Obamacare in Practice:  An Update

An Open Letter to My Friends Who Want to Repeal ObamaCare

Obamacare Update: Good, Bad, and Ugly

 

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Writing about our ObamaCare experiences with the future of the program so much in doubt seems almost pointless, but I did promise to keep honestly updating you so here’s the latest.

Learning that Blue Cross was pulling out of the Marketplace in our area was really scary.  We were used to everything about the plan after three years and were happy with it.  I wasn’t looking forward to getting onto the (terrible, still) Healthcare.gov site and having to compare all the plans like I had to do when we first signed up.

Turns out I didn’t have to worry about that, because when I finally got through the approximately three hours over three days of attempts and two phone calls it took me to update my application (yes, really), I had one choice and one choice only.

We have Humana now and before I get into the nitty gritty of the pros and cons of that, can I just mention that Humana announced that they too will be pulling out of the Marketplace in 2018?  Which will leave us . . . where?  I don’t even exactly know.  If someone else were in charge of the country I’d be confident it would be fixed by then.  As it is . . . well, I am not going to worry about it yet because what’s the point.

So here’s the good, the bad, and the ugly update:

I guess the ugly would be that even though Jake is under 26 and should be eligible to be covered by our insurance, and even though we’ve been allowed to include a non-dependent child of the proper age in the past, the system flat out refused to let me sign up with him included.  And the nice person on the phone said it was because he isn’t a dependent for tax purposes, but right there ON THE WEBSITE INSTRUCTIONS it said he was still eligible.  But none of us were going to get covered if I didn’t take him off.  So then I tried to apply for him on his own, but because our governor in his “wisdom” declined the Medicaid expansion (which is also why we are losing insurers), Jake’s one of the unlucky who fall into the hole between being eligible for Medicaid and qualifying for a subsidy, which makes no sense, but whatever.  So what that means is that he cannot afford to pay for the high deductible catastrophic plan he was offered, and is currently uninsured until he has another opportunity to sign up at work (which he didn’t do at the proper time BECAUSE WE WERE COVERING HIM).  Hopefully he will qualify for one of the many exceptions to the mandate and won’t have to pay a fine come next year’s tax time.

And now for the bad:  Our deductible had been ridiculously low–$300 per person, $600 per family.  We were able to knock it out in a month or two mostly with prescriptions.  This year it’s $900/$1800.  I know that’s still way lower than many people so I shouldn’t complain too much.  The other bad thing is that some of our doctors–specifically, our mental health professionals–are out of network.  And since we are not going to change psychologists, we will be paying out of pocket for that.  Happily, our provider is working with us and charging what insurance would pay him if we had it; but that’s still $45 more a week than we were paying before.  Finally, Walgreens doesn’t take Humana, if you can believe it.  The closest pharmacy that does is Food City.  So I had to transfer about a million (give or take) prescriptions, and will have to actually WALK INSIDE to get our medicines, and do so before 7 p.m.

But there is also some good, some of it actually very good.  Our premium dropped by $450.  We are paying $241 a month! (By the way, this is for four people, as William and Lorelei are still on TennCare even though we have tried to sign them up with the rest of us.)  And there is no deductible for prescriptions–they are covered immediately.  They might be slightly more expensive but I got thirteen medications for about $65 so I’m calling that a good deal.  Of course that means they won’t apply to the deductible so it’s going to take longer to meet it, but all and all I wouldn’t be surprised if our overall costs end up being lower this year.

So there you have it.  We shall enjoy it while we can and I will update you if anything interesting happens. 🙂

P.S.  When anyone calls ObamaCare a failure, direct them here.  It has problems, it needs fixing, but it has helped us and many others.  It needs to be REPAIRED, not REPEALED.

For more of my ObamaCare stories, see below and click away!

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

Obamacare in Practice:  An Update

An Open Letter to My Friends Who Want to Repeal ObamaCare

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Dear Facebook Friends:

Next time you are tempted to gleefully post about how happy you are to see ObamaCare repealed, I want you to think about the people whose lives are going to be affected dramatically when that happens.  I want you to think about people who are terrified of losing their coverage, who went years uninsured,  who saw doctors only when in dire need, who went bankrupt due to medical bills, who visited the emergency room for care because they didn’t have the money a clinic would have demanded up front, who spent hours researching online and filling out forms and chasing down doctors for signatures to get prescription medication payment assistance, who figured out which of their medications they could forgo in a given month, who held their breath in the pharmacy drive-through line while they waited to hear the terrible total.

You are entitled to your opinion and the ACA isn’t perfect, but it’s sure better than the nothing many people had before it was passed.  You can suggest changes and discuss drawbacks and talk policy without appearing to be enthusiastic about the fact that millions of Americans stand to lose their care and that some of them are going to die.

Consider, please, how it makes me (and others) feel when I see people who are supposed to be my friends celebrating the fact that my family may soon be without health insurance and thus effectively without care.  In my posts on this topic in the past I have always been careful to affirm my friends who told me that the implementation of the ACA had caused them difficulties like higher premiums and changes in doctors.  I was always sympathetic and willing to concede the imperfections in the ACA, as evidenced by my many honest posts  (which I will link at the end).  I agreed that improvement–although not repeal–was needed.

Remember that there are suffering people who see your Facebook posts, people who are frightened, for whom this isn’t about politics or partisanship or finances but about staying alive.  Remember that, and if you care about those people, watch the tone of your posts.

Your friend,

A Once and Possibly Future Uninsured American

My previous posts on ObamaCare:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

Obamacare in Practice:  An Update

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There’s just something about a new year, isn’t there?  It feels fresh and new and full of possibilities.  Hence the talk of resolutions and the increase in gym membership purchases!

I am reluctant to commit to something so definite and portentous as resolutions any more.  Not sticking to them seems like failure and who needs more reasons to feel bad?

Still, I can’t deny that some of the good health habits I worked so hard to form a few years ago have become somewhat less habitual. And a new year is as good a time as any for taking stock and making some changes.  I’m still lighter and healthier and stronger than I was before my healthy journey began, but let’s just say that pie has a lot of carbs, and that we don’t hike every weekend any more.  And I’ve got a BIG birthday coming up this year (gulp!), and I’d like to feel healthier and stronger by then.

So I’m going back to the gym and walking and healthy eating, but I’m not calling it a resolution.  In case you are feeling like doing something similar, here’s what I am going to do.  For the rest of this month I am going to reshare posts I’ve written on health, low carb eating, recipes, and hiking, to help motivate myself and anyone else who could use some motivation!  If you want to see what I’m sharing, follow Life in Every Limb on Facebook and be sure to check “see first” so you don’t miss any posts.

Happy New Year and good luck to you on your resolutions or goals for the year or whatever you wish to call them!  Tell me about them in the comments, if you want.

 

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The first year we had health insurance via the ACA, I updated y’all frequently and promised to keep doing so.  I realize that’s a promise I didn’t keep.  Now that the law’s very existence is threatened, it seems like a good time to share how it’s been going for us in the almost two years since my last post.

I’m listing here for comparison some numbers I just crunched from the three years we have been covered thus far.

2014

  • Premiums paid:  $3,796.75
  • Physician Charges:  $41,191.17
  • Prescriptions:  $9,581.96
  • Our portion after insurance:  $5,454.47
  • Total health care costs: $9,251.22

2015

  • Premiums paid:  $7,558.68
  • Physician Charges:  $10,083.20
  • Prescriptions:  $7,603.03
  • Our portion after insurance:  $2,668.16
  • Total health care costs: $10,226.84

2016 (to date)

  • Premiums paid:  $7,239.24
  • Physician Charges:  $16,849.10
  • Prescriptions:  $6,492.23
  • Our portion after insurance:  $2,613.13
  • Total health care costs: $10,452.37

You will probably notice a couple of things:  Our premiums went UP, and our physician charges went DOWN.

Well, it’s no secret that premiums are going up across the land, which many people blame on ObamaCare.  Ours would be unaffordable by now if it weren’t for the generous government subsidy we receive thanks to the size of our family vs. the size of our income.

Our physician charges went down because for one thing we didn’t have a major medical issue as we did the first year when Jake required surgery for a severed tendon, and the first year we also all went to the doctor a lot to make up for years of not being able to do so.  One of the things that has been driving costs up has been exactly this–people who hadn’t been able to access care, some of them very sick as a result, finally getting the care they need.   Presumably some of that will improve as time goes on, as it has for us.

So our experience continues to be positive.  We love our doctors.  We love that we can still provide insurance for our two adult children who are not in school.  We love that whenever anyone is sick we don’t have to worry about paying for or accessing care.  We love having regular preventive care and psychological care too.  And we love the lack of sticker shock at the pharmacy.

None of that is to say that there aren’t problems that need to be fixed.  Because insurance companies now have to cover those who they used to be able to reject, they haven’t been able to make a profit for the past three years.  Premiums continue to rise.  And Blue Cross has pulled out of Knoxville so we have to find another plan for next year.  Any day now I will have to devote a couple of hours to the hell on earth otherwise known as Healthcare.gov–which has only improved marginally since the last time I was there.

Now that I’ve got you all caught up, count on seeing more–a LOT more–on this topic over the next few weeks.

 

And here’s the rest of our ObamaCare story:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

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We were a little late getting signed up for Obamacare when it launched, so this month marks our one year anniversary–one full year of being insured!

I know that “anecdotes don’t equal data.”  I also know that UNBIASED data I’ve read on the success of Obamacare has been largely positive.  But right or wrong, anecdotes are what people listen to and remember.  That’s why I’ve been sharing my family’s experiences–both negative and positive–with my readers.

Obamacare has been a success for my family.  Here are the 2014 stats:

Premiums paid:  $3,796.75

Physician Charges:  $41,191.17

Prescriptions:  $9,581.96

Our portion after insurance:  $5,454.47

Total health care costs: $9,251.22

That’s a lot of money, but it’s $41,521.91 less than we would have paid if we DIDN’T have insurance.  Actually, what would have happened is we would have gone without care.  We wouldn’t have had the tools to improve our health the way we have this year (more on this in my next update post).  Jake would have been left with a non-functioning finger after his accident.  We would have tried to do without medications that were less essential.

If you’ve always had insurance you may not realize another huge plus:  ACCESS.  If you don’t have insurance, you are expected to pay for services up front, except in the emergency room (which is why the uninsured–and I’ve been there–head for the emergency room for primary care).  With my magic BCBST card, I can go to the doctor and pay later.  We still owe money for Jake’s surgery.  But he GOT THE SURGERY.  The only thing we had to pay in advance was about $150 to the surgery center.  Furthermore, you will pay MORE for those services because without insurance you lose the special negotiated rate, which basically halves the out-of-pocket costs.

I’ve been honest in my reporting so you already know that our experience has not been completely positive.  To recap, part of the family was not originally covered.  Although that was rectified in August, I still have not gotten a satisfactory response on the appeal I filed, which was your basic bureaucratic comedy of errors.  At this point I am probably letting it go, as the benefits really don’t outweigh the PITA factor.  The website itself is just terrible and while it may not crash as often as it did in the beginning, there are still plenty of problems with it.  On the bright side, the customer service is excellent.  They will do whatever you need right on the phone, and they are kind, pleasant, knowledgeable, understanding, and efficient.  As someone who has spent literally hours at a time on the phone with TennCare representatives, I appreciate that.

Finally, as seems to be true for many people, our premium went up at the beginning of the year.  WAY up.  It’s $200 more this year, and while it is way less than what we would pay (and couldn’t!) without the subsidy, it is still a stretch.  Many blame the rise in premiums on the ACA; I blame it on the greed of the insurance companies and think the solution is a single-payer plan, which I hope we finally get some day.

You have until February 15, 2015 to apply for your own plan!  It can’t hurt to take a look.  Maybe you will get lucky–and healthy–like we did.

And here’s the rest of our ObamaCare story:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

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I have been uninsured most of my adult life.  Even when our kids qualified for TennCare, even when for a brief happy time we were able to insure John via TennCare Standard thanks to his existing medical conditions, unless I qualified via pregnancy, we could not afford to buy private insurance for me.  For the most part, in retrospect, that worked out well for us.  We gambled on my continued good health, and we won.  It would have been nice to be able to go to the doctor for checkups like insured folk, but I was never hit with a medical catastrophe while uninsured.

It’s a gamble taken by many young healthy people, and one some of them don’t win.

Let’s take Jake, my twenty-year-old son, for example.  Jake was covered by TennCare until he aged out.  He was briefly uninsured until we obtained our policy through the Health Insurance Marketplace earlier this year.  If it were not for Obamacare, he would have joined the ranks of the adult uninsured.

Just about a month ago, Jake was cutting some sheet rock with a box cutter when his hand slipped.  He ended up in the emergency room with a deep laceration to his right pinky.  And a little over a week later he was at the orthopedist’s office being diagnosed with a severed tendon.  Then came surgery, and now rehab.  So far, we have been to various medical providers seven times.  We are just getting started.  We will be billed by the hospital, the emergency room doctor, the orthopedist, the surgery center, the anesthesiologist, the supplier of medical equipment, and the physical therapist.

According to the Blue Cross website, about $9,000 in bills have been processed so far.  What have we paid?  About $150.  I realize we will be paying much, much more.  We have already met our deductible and have to pay 20%; but we won’t be paying $1,800 of that, because as insured folk we are offered the negotiated rate which is much, much less.  Also, as insured folk we are offered the courtesy of being billed.  Only the surgery center insisted on being paid up front.

Without Obamacare, this would have been a financial catastrophe.  What would we have done?  Well, what we would have done probably is gotten help from family members to pay the necessary up front charges, then paid off the rest in installments.  But what would happen to a young working man with no family to help him?  He could end up without the use of a finger on his dominant hand, permanently affecting his grip and his ability to write, not to mention causing disfigurement.  That should not be an option in the United States of America.

Jake has to endure two months or so of not being able to work or drive or write or do much of anything, and that sucks for him.  But at the end of it his hand will be almost as good as new, and we won’t be bankrupted by the bills.  BIG WIN for Obamacare.

Jake with Red Hair

 

 

Less dramatic wins . . . John has lost 30 lbs. since his first check up.  His cholesterol and triglycerides are now within normal limits, and his diabetes is under control.  He will see the doctor for more blood work to monitor his progress in November, and there’s a good possibility he may be able to ditch some medicines then.  My third appointment was today.  I’ve lost 46 lbs., but much more impressive and important is that my cholesterol and triglycerides are now within normal limits, and every one of my numbers improved since my last appointment.  I still have a few points to go on my blood sugar, and then I will be able to sign my name on the “normal numbers” poster on the doctor’s office wall!

Want to read the beginning of the story?  See below:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

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