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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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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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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.

Me, Happy to Be Insured and Getting Healthy

Me, Happy to Be Insured and Getting Healthy

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

ObamaCare:  My Latest Update

Read Full Post »

As promised, I will continue to update you on our family’s journey out of the ranks of the uninsured thanks to the Affordable Care Act.  Here’s where we are now:  John, Emily, Jake, and I are fully insured through BCBST.  Lorelei and William remain on TennCare which seems to be in a kind of limbo status–we haven’t heard anything from them in months.  Teddy remains uninsured but I have been contacted regarding my appeal, so we’ll see.  I really think it’s a glitch of some kind.

If you did not purchase a policy on the Marketplace because you were afraid the outlay for the monthly premium would outstrip the value of the health care received, let me tell you a few less obvious benefits of having insurance, some of which I did not know until I had it.

1.  When you visit any doctor, even the Walgreens clinic, YOU DON’T HAVE TO PAY UP FRONT.  That’s right, they send you a bill.  So you don’t have to forgo medical care if you are short on cash on a particular day.  Yay!

2.  You reap the benefits of something called the “negotiated rate.”  That means everything is cheaper for you, even before your deductible is met, than it would be for an uninsured person.  Medicines cost less.  Doctor visits cost less.  That above-mentioned trip to the Walgreens clinic costs an uninsured person $90.  It cost us $60.

3.  You have access to more doctors.  When we had TennCare, it was easy to pick a doctor because there just weren’t that many who accepted it.  And many of the ones who did accept it would not have been my first (or second, or third) choice.  And get this:  at our former practitioner’s office, TennCare patients HAD to see the nurse practitioner instead of the doctor.  We happened to like the NP, but it still felt like we were being told we weren’t worthy of the actual doctor.

John is having his first visit with the doctor today.  Jake and Emily have checkups scheduled for next month.  Jake has been to the Walgreens clinic and another specialist already. We have purchased MANY prescriptions.  And I have had FIVE visits with health care providers since March.  That’s more visits than I normally have in five years, and I’m not exaggerating.  John has met his deductible, and I believe the family one was met as of yesterday.

Now on a more personal level, how is this benefiting us?  Well, I went to the emergency room a couple of years ago because I was worried about the possibility of a blood clot in my chronically sore and swollen leg.  Why the emergency room?  Because that is where people with no insurance go for health care.  I tried to go to the doctor I occasionally saw only to be told that I was no longer considered their patient because I had not been there in two or three years.  Anyway, there was no blood clot; I was told to follow up with my (non-existent) regular doctor; and I’ve continued to suffer.

At my first check up with my new doctor, she prescribed a mild diuretic.  It was like a miracle.  The swelling is greatly reduced, my blood pressure went down, my energy doubled.  If I’d had health insurance, I would have gotten this little pill years ago.

I used to lie awake in bed at night worrying that when I went to the doctor (I was counting down the months and days until the ACA went into effect) that there was going to be something really wrong with me.  I had strange feelings (attributable to high blood pressure, and GONE thanks to that little pill) that caused me anxiety.  When you don’t have insurance you are afraid to see a doctor even if you can afford one because what if they find something wrong which becomes a pre-existing condition and makes you uninsurable down the road?  But I don’t have to worry about that any more.  NO ONE DOES.  Because there is no punishment for pre-existing conditions under the ACA.  And there’s no more uninsurable either.  I also don’t have to worry about it because I got it checked out.  I had an EKG and now I know I am okay.

As I mentioned in the last update, I had my first check up (check ups are free under my plan, by the way) in mid-March.  That’s when I got the little pill.  I also had blood drawn.  I came back two weeks later for the EKG, and to discuss the results of the blood work.  I was low on Vitamin D so I got another pill (a much bigger pill!).  My glucose, cholesterol, triglycerides, and blood pressure all need to come down.  Did my doctor throw more pills at me?  No, instead she set up an appointment with the wellness nurse (for exercise) and the nutrition nurse.  I’ve seen the wellness nurse twice (that’s $20 each time) and the nutritionist once (six visits per year are included in my plan).  I’ve learned about a new way to eat (I will write on that separately later) and I am walking regularly (as you might have surmised).  I won’t know if my levels have gone down (and I’ve been warned that sometimes they go up before they go down) until my next check up toward the end of June.  But I do know that I feel great and that I’ve lost 15 lbs.

I know that this story is only a personal anecdote, but remember, so are the Obamacare horror stories that you see in your newsfeed.  That’s why I’m speaking out on this very personal topic.

John is at the doctor as I write.  If he will allow it, I will include some of his story next time I update.  I promise to keep you posted.

If you want to read this story from the beginning, see below:

Who Are the Uninsured?

Uninsured No More

Obamacare Update

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I promised several people to continue to share my family’s experiences with being insured at long last via the Affordable Care Act, AKA Obamacare.  We are coming up on two months of being insured and so far it is an unqualified success.

There was a little sticker shock for us regarding some of the medications we’ve had to purchase, as we have to pay full price until we reach the deductible, and while some of the negotiated prices were better than what we’d been getting with the various discount cards we’d been using, a couple have been quite a bit more.  However, thanks to that, John has now met his $300 deductible and I told him to start making appointments for every kind of doctor he’s ever wanted to see!

Emily, typically, has not used the plan yet, since she has literally not had to visit a doctor for illness since she was two years old.  But I’m encouraging her to get a check up at least.  Jake has visited two doctors and purchased prescriptions.  Here’s a perk:  even though his deductible has not been met, because we HAVE insurance, the doctors file it and then send a bill–they don’t expect us to pay up front.  Maybe that’s not news to the rest of you, but it was a happy surprise to us!  Another happy surprise was seeing our first Explanation of Benefits statement and discovering that because of negotiated rates we will pay less for doctor visits even before we meet our deductible!

As for me, I have now been to the doctor twice and haven’t had to shell out one dime as yet.  The first task was finding a practice, and I couldn’t be more thrilled with where I’ve ended up.  We have a Blue Cross plan, and of course it’s super easy to look for doctors online.  I’m used to looking for TennCare doctors and not finding any, so I was overwhelmed by the choices that were available!  I ended up with Trinity Medical Associates, which is a Christian practice, about five minutes from my house, that focuses on wellness.   I love my doctor, I love her nurse, in fact everybody there is super friendly and helpful.  John, Emily, and Jake are all going to start going there.

My plan covers one free check up and one free gynecological check up per year–no charge.  This practice can do both of those, so I will not pay anything for either of the two visits I’ve had so far.  I went two weeks ago, did the gyno thing, got my tetanus booster, and had blood drawn.  I went back today to go over the results of the bloodwork and to have an EKG.

I’m fat and I haven’t had a check up in six (I think) years.  I was really scared there might be something wrong with my heart, or that I might have to take medicines.  Besides the cost, I’ve avoided having these things checked out for fear of being saddled with a pre-existing condition that would have made me uninsurable too.  But I don’t have to worry about that anymore.  Nobody does.  Because that’s one of the things Obamacare has accomplished.

My doctor recommended a mild diuretic for the swelling in my leg (caused by an unfortunate encounter with my own car ten years ago).  She wants me to take a Vitamin D supplement and a Fish Oil capsule.  My sugar, triglycerides, and cholesterol need watching, but she prefers we try diet and exercise changes first.  To that end, I’ve got a nutritional counseling appointment (covered by insurance) and an exercise counseling appointment (not covered, but only $20).  I’m to go back to the doctor in three months to check my numbers again.

After so many years without insurance, I’m almost giddy about this, y’all.  I highly recommend that you take a look at healthcare.gov and see if Obamacare can help you too.  You’ve only got until the end of this month before open enrollment is.  It wouldn’t hurt you just to take a look, would it?

 

 

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