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Posts Tagged ‘Health Insurance Marketplace’

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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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

Read Full Post »

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

Read Full Post »

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