For this year’s ObamaCare update, I am sharing five ObamaCare facts.
The Affordable Care Act and ObamaCare refer to the same thing. I hope that’s obvious to you, but it isn’t to everyone–I have seen many a “man on the street” video with folks saying how awful ObamaCare is while in the same breath raving about the healthcare they receive under the Affordable Care Act.
One ObamaCare provision requires your insurer to pay you back a portion of your premiums if they fail to spend a certain amount of their profits on patient care. This is the second year I have gotten an unexpected check in the mail.
ObamaCare includes a yearly cap on out-of-pocket expenses. Once you reach that cap, all your care is free. The cap varies by insurance plan, and this year some of us will should be getting free care in December.
The Affordable Care Act benefits you even if you don’t buy your insurance from the Marketplace or a state exchange. The ACA made it illegal for insurance companies to refuse to insure you or charge you more due to pre-existing conditions. This is a big freaking deal, and it is just one example of protections put into place by the ACA that apply to everyone.
Enrollment is NOW OPEN at Healthcare.gov. If you are already covered by an ACA plan, it’s time to re-enroll. If you are currently uninsured or unhappy with the insurance you have, you can sign up until December 15, 2019.
For more of my writing on the Affordable Care Act aka ObamaCare, see below and click away!
Well, it’s that time of year: Open Enrollment is upon us. It’s a time I both dread and welcome. I dread the clunky website and the endless data entry and the long but usually helpful calls to customer service, but I welcome the opportunity to once again share with you my gratitude for the blessing that Obamacare has been to our family.
As I wrote in last year’s update, Blue Cross returned to the exchange, and Humana left. There were two good results for us: one of our doctors that we see regularly was back in network, and our premium was so low that Advance Premium Tax Credit covered the whole thing. Yes, you read that correctly: our monthly payment was reduced to zero. On the negative side, our deductible went up to (I think) 1350 per person, and John has still not met his. And even after the deductible is met, we are now on a 50-50 plan instead of the 80-20 we had become used to–and this was the only choice we had.
We haven’t had major medical expenses this year, so we have made out just fine with this plan. I haven’t run the numbers, but my sense is that not having to pay a premium made up for the higher deductible, especially since we still get the negotiated rate advantage on all our prescriptions. But we got a letter the other day saying that this plan is going away and we are going to have to pick a different Blue Cross plan for next year. These changes do get old, but my preview of Healthcare.gov last week left me hopeful–we have several plans to pick from and they look as good as what we have currently.
Another bright spot was a letter I received from Humana (last year’s insurer) a few weeks ago–a letter that included a check refunding us a portion of our premiums! Apparently a little-known aspect of the ACA requires that if insurers earn over a certain amount of profits, they must refund a percentage of the premiums paid. Yes, you read that right–under the terms of this imploding law that is so bad for insurance companies and consumers alike, Humana ended up doing so well that they had to give me money back!
So, yes, no matter what you may have been hearing in the news, Obamacare lives on, and is still helping people, with all its flaws. It needs changes but it doesn’t need to be repealed. And the constant uncertainty caused by the GOP threats to get rid of it isn’t helping anyone. I know it hasn’t been the unadulterated blessing it has been for us for some of my readers, and I am sorry for that. But I continue to believe it is important for me to share the positive experiences that the ACA has brought to this previously uninsured family.
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
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.
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.
Premiums paid: $3,796.75
Physician Charges: $41,191.17
Our portion after insurance: $5,454.47
Total health care costs: $9,251.22
Premiums paid: $7,558.68
Physician Charges: $10,083.20
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
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.
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.
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.
It’s been a couple of months since my last update, and things have been happening (and also some things have not been happening, as you will see!).
When I updated you last, I was complaining about the bureaucratic elements (mess) involved in Obamacare, AKA The Affordable Care Act, despite my overall satisfaction. We were waiting to get a letter notifying us of our official hearing on the appeal I filed to try to get Teddy, William, and Lorelei covered. Well, I am still waiting. I have never received a letter or a call or ANYTHING.
However, I also told you that I was going to have to submit another huge batch of financial information, and proof of citizenship, and I don’t know what all else. So I got that all together and went to upload it to the (still very user unfriendly and prone to crash) website, and could not for the life of me figure out where to upload the documents. Last time I think I just mailed them. So I called the help line.
This is the first bright spot of Healthcare.gov, and I want to reiterate it: The people who staff the help line are efficient, courteous, and knowledgeable, and there are no ridiculous hold times such I have experienced with, for example, TennCare (40 minutes or more). This guy was quickly able to tell me how to upload the documents, and also said that he thought from looking at my account that it was a mistake anyway. I wasn’t taking any chances, of course, so I did upload them, and thought I would also take a moment to ask him is he knew anything about my appeal.
Naturally, another department handles that, but he told me if I wanted we could reapply right then for the rest of the family, and that if we were successful, they could be covered by the first of the next month, and that the deductible we’d already met would apply for them as well. He did it for me while I stayed on the line and supplied the information, and lo and behold, one hour later, everyone in our family was on the way to being insured!
He also put in a request to make it all retroactive to my original application date. They’ve since denied that and I am getting ready to file yet another appeal.
Our premium did go up as a result of the addition of three people. We are now paying $411/month, which I am quite sure is still pretty darn low.
What have we been doing with all this awesome health insurance?
Emily, William, Lorelei, and Teddy have all gotten checkups now and have been pronounced in good health. William and Lorelei both got some immunizations, and Lorelei had several icky warts frozen off (she was very brave!). John and I both saw the dermatologist. Y’all, I have been dreading that checkup for years. Skin cancer runs in my family and I was sure I would hear some awful news. Instead, the doctor told me I have relatively light sun damage and she doesn’t think I have anything to worry about! (I celebrated by coming home and laying out in the sun. Just kidding. Sort of.) Teddy and I visited the chiropractor yesterday. Now if you know anything about chiropractic you know it usually takes at least a couple of visits to straighten out whatever brings you there (sciatica, in my case). So in the past, as a self-paying patient, I would usually try to get by with one visit. But with a co-pay of $8, I think I’m going back Monday.
Now you know that as a result of all this care and support, John and I have both made some significant dietary changes. John has now lost 20 lbs., and I’ve lost approximately 40. He had his blood drawn last week and will find out on Monday whether his numbers have improved along with his weight. I won’t have another checkup till October some time, but I can tell you that I feel great, have lots of energy, and can walk four miles up and down hills on a summer day without dropping dead.
I wrote a post on my five favorite low carb things to eat a couple of weeks ago and y’all, the page views on that post went out the roof! So I expect people might be interested in hearing in a little more detail about some of the dietary changes I’ve made, and I’m planning a post on that next week probably. But for now let me just share one amazing change that I am incredibly proud of: I now drink my coffee with NO SUGAR AT ALL. Only cream. And anyone who ever saw me drink coffee before will know how huge that is!
If you would like to read all about our healthcare triumphs and travails, please 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
I know I just updated recently but I have some things I really wanted to post about and I don’t feel like waiting!
Let’s start with the not-so-good parts, because while want people to see the enormous good in our Obamacare experience I lose credibility if I insist this new health care system is perfect.
I already told you that four out of seven of us were approved for subsidies and enrolled in a plan, while the other three were inexplicably deemed ineligible. And when I say inexplicable, I mean not only can I not understand it, neither can any of the Healthcare.gov customer service people I’ve spoken to. Anyway, I appealed this decision, through a formal process that involved submitting all sorts of paperwork. I think I had 30 days to do that, which means I probably did it in February some time. A couple of months ago I got a phone call about my appeal, and then last week I got a letter saying to expect a call at a certain date and time, and to be prepared with the information they wanted. Well, the day came and I waited and waited and they never called me. I called the next day and spoke to a very nice and very confused woman who finally figured out that they called Teddy instead of me even though it said RIGHT IN THE LETTER that they would be calling my number. So she fixed the number and said the next thing that will happen is that I will get a letter setting a formal telephone hearing. So we’ll see.
In the meantime, the Marketplace wrote me and they want MORE financial information, which is the second time since I applied that they’ve asked for more information, and I they want check stubs for everyone in the house who works, which is kind of difficult since two of us are self-employed. So there is no denying that it’s the government, and a bureaucracy, and that I (or you) could run it better. (Not that private insurance companies are any better, and that’s a moot point anyway for the many Americans who are uninsurable or can’t afford insurance–so you take the bad with the good.)
But on the bright side . . . Last week I went into the doctor’s office for a fasting blood draw, in preparation for yesterday’s checkup, which my doctor set for three months out from the last one. When I walked in she told me that basically I had reversed every single problem I arrived with. 🙂 She was so impressed that she gave me a hug! My blood pressure has gone down to borderline, my cholesterol is just two points shy of normal, my blood sugar dropped nine points, and my triglycerides dropped over 100 points. And . . . I’ve lost 27 pounds, without being on any official regimented diet, and WITHOUT BEING HUNGRY.
Now, some people might say that Obamacare doesn’t deserve the credit for this, but let me tell you a story. Six years ago I had my last checkup and got blood work done. At that time all of the above factors were close to what they are now, so above where they should be but not yet dangerously so. But because I did not have insurance, that one appointment was all I got. No one offered me any suggestions. They said, “We’ll keep an eye on it,” but how could they when I couldn’t afford regular checkups and blood work? This time, I’ve seen my doctor three times, the wellness nurse three times, and the nutritionist once. The nutritionist will continue to monitor me and do bloodwork every three months to track my progress. Moreover, they gave me the suggestions and the support I needed to succeed. This is what preventive medicine is all about. Without it, people bumble along and get fatter and sicker and end up in emergency rooms having heart attacks, or going on disability, costing ALL of us money (not to mention the cost in human misery, which is far more important to me). This kind of care makes sense and I am so grateful to be benefiting from it.
I went to Walgreens yesterday to pick up some prescription refills that I had called in. I drove up to the window and gave my name and the guy said, “It looks like there are ten of them.” He rang them all up and I held my breath and he said, “That will be $36.20.”
Y’all, when I got home I looked at where the info sheet for each prescription says, “Your insurance saved you . . . ” and I got out my calculator and do you know how much those ten prescriptions would have cost me last year? $590.30.
That’s a WIN for Obamacare, folks. Those were maintenance prescriptions (and there are six more that didn’t need filling) for two members of our family who were uninsured this time last year. One of them had in fact been declared uninsurable. We got medicine through mail order programs; we filled out numerous Patient Assistance Forms and took them to doctor’s offices to get help from the drug manufacturers; sometimes we just went without the medicines that I (as the family health expert) decided were non-essential.
I’m used to getting soul-crushing news from the Walgreens clerk, but now our most expensive prescription is about $70. (That’s the one we used to go without.) More usually, I now pay five or ten dollars.
John has now had his first doctor’s appointment and a visit with the nutritionist. If you’ll recall, he was diagnosed with diabetes a couple of years back. As a self-paying patient, he didn’t get much attention from his doctor when this happened. He was told of this enormously life-changing diagnosis over the phone, and they called in a prescription for him. He wasn’t offered any education or told to change his diet. And although I was pretty sure he needed to do something different, I didn’t know enough about it to help him. (Nor did any recommendations I attempted to make carry the same authority as a doctor’s orders would have.) So he continued to eat the same way as before–which was pretty much a “Hey, let’s get diabetes!” kind of diet. And after some improvement due to the medication, he started getting worse again.
But our new doctor’s office is all about prevention and treating underlying causes, not just slapping medicine on an illness like a band-aid. “Food will be your medicine,” the nutritionist told him. And so John finally committed to going on the low-carb regime I’ve been following for the last couple of months. It’s been very hard for him for a variety of reasons, but he’s been doing it for almost two weeks and last time he weighed he was already down 12 pounds! (And he feels better, too.) That’s giving him the motivation to keep going.
I convinced Jake that even though he is not sick he should get a check up (it’s free, after all!) and become established as a patient in advance of future need. So he had his first visit with our new doctor yesterday. When his TennCare was about to expire, just a little over a year ago, I took him for a last minute check up. What he really wanted was a prescription for an asthma inhaler, something he needs infrequently, but does need when he needs it! The TennCare doctor could not prescribe this without giving him some kind of test which was not available at her office and had to be scheduled at the hospital. By the time it was approved and then scheduled, his TennCare had expired. I am happy to say that his new doctor called in an inhaler prescription for him that was ready by yesterday afternoon.
There shouldn’t be a set of assumptions about people who are on TennCare which influences the care they receive. There shouldn’t be different levels of care for people who have insurance and those who don’t. But that was our reality, and Obamacare has changed that for our family. For more on our journey from being uninsured to becoming healthy, and on my views on Obamacare in general, see the links below. The $64,000 Question, Answered Who Are the Uninsured? Uninsured No More ObamaCare Update ObamaCare Update 2