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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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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.

John and I smiling and feeling healthy!

John and I smiling and feeling healthy!

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

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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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