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My Experience So Far with the Affordable Care Act (aka Obamacare)

Before I get started today, just let me put this out there – THIS IS NOT YAHOO.  DO NOT TURN THIS INTO AN AWFUL, NAME-CALLING COMMENT SECTION.  This is Crystal-ville, where we can whine like adults and not get personal.  Got it?

Oh, and I will keep using the name “Affordable Care Act (Obamacare)” simply since so many people actually don’t know the real name.  It’s not a political statement.  I’m generally an unofficial Libertarian that votes on candidates, not parties.  And just to get this out of the way too, I am not religious.  I am not an atheist either.  I’m like an undecided agnostic.  My children will have to figure some stuff out for themselves is all I’m saying.

Okay, time to get the perspective of a self-employed, 30 year old and her husband (same stats) on this new health insurance stuff.  I just received my letter notifying me about upcoming changes.  It also said that I needed to make a choice between Option A and B for 2014 (see below).

Current Policy

Humana 80/5000

  • $5000 individual deductible / $15,000 annual family deductible
  • $7000 additional family annual coinsurance maximum ($17,000 a year maximum out of pocket)
  • 20% coinsurance
  • Six $35 doctor’s visits per year and the 20% coinsurance thereafter.
  • Special prescription rates for long-term meds.
  • No vision coverage.

Total cost has been $267 per month.

New Options for 2014

Option A – Humana 80/5000

  • Same everything as the basic plan.
  • A few tiny changes to comply with 2014 Affordable Care Act (Obamacare) minimums

Cost of $278 per month starting and running for all of 2014.

Option B – 2014 Affordable Care Act Compliant Policy

  • $3500 individual deductible / $7,000 annual family deductible
  • Unknown additional family annual coinsurance maximum (it didn’t list it in the summary and I didn’t bother asking)
  • 20% coinsurance
  • Six $35 doctor’s visits per year and the 20% coinsurance thereafter.
  • Special prescription rates for long-term meds.
  • No vision coverage.
  • “Essential Health Benefits” – seems to include maternity coverage and I stopped reading because of the info below…

Cost of $627 per month starting in 2014.

Our Choice

Option A.  Done.  Already called, confirmed, and moved onto dinner.

My Honest Reaction

Here were the thoughts that literally went through my mind in this order:

HAHAHAHAHAHA!!!  No way in hell.  Option A looks tasty.  Hmmm, if we do decide to have a baby for sure, we should start trying in late 2014 so that we can use that maternity care coverage that is going to cost a buttload in 2015 anyway.  Wow, that’s a weird thing to think about when looking at insurance policies.  Sort of a realist view/ cynic.  Oh no worries, you knew you were weird.  Oh, okay.  So, what was for dinner?

Yep, the takeaways from this are that I am weird.  And if we are going to have a baby anyway, it’ll be in 2015.  Oh, and more than doubling our monthly insurance premiums is the opposite of “affordable”.  Yeah, that should be mentioned here…

So, how are you handling the new healthcare policy changes?  Did something like this happen to you yet?

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16 comments to My Experience So Far with the Affordable Care Act (aka Obamacare)

  • I could never, ever, ever even get through on the healthcare.gov site. I tried for weeks and would get crazy error messages every time at various points in the process. I got so fed up that I just went with Blue Cross Blue Shield. I’m 43 and self-employed. My current plan is $343 per month. My new BCBS plan, a $3500 deductible “Silver” plan, is going to be $328/month. So for me it’s about a wash. The benefits are essentially the same. BCBS offered multiple plans to me that only had minor differences, so I just went with what sounded most similar to what I have now.

  • So are you saying Option A is not Obamacare compliant, meaning you will have to pay the fine on your taxes? As a non-fan of this “affordable” care act, seeing this just confirms my opinions. Your current plan looks to be very affordable and you are in a position to cover your deductible. That should be acceptable. Government needs to stop being so dictatorial.

  • On the plus side, being pregnant is no longer a “pre-existing condition”, so technically, you could switch as soon as you know you’re pregnant (I would assume – I’d check with someone else who has tried that….) :)

  • Since I currently only have catastrophic health care coverage that won’t be compliant my cost for health insurance will go up a lot, but I’ll have better coverage. Since I’ll most likely qualify for a subsidy my net cost will probably go down.

    I have been able to get on the healthcare.gov site to see what my subsidy and premium options would be, but haven’t been able to actually sign up for a plan due to the site not working correctly.

  • Kinda sucky the affordable care act is not really affordable.

  • christie

    I have never been a fan of Obama care because I felt like I never knew how ” we, the people” would pay for it. Taxes ??? But, our pre Obama care system is clearly imploding. This has been the last 20 years:

    Medical costs and insurance go up so fewer people can get insurance. These people will get sick or injured sometime and not be able to pay their bill. So the hospital or dr will write it off as a loss and raise their rates to cover the cost of uninsured patients. Which will raise the price of insurance and medical costs and fewer people will be able to buy insurance. Some of these people will get sick or injured …..

    Kudos to the State of Oregon web site. It has been up and running with out any issues. Plus they actually thought ahead and were proactive! They mailed folks on food stamps with a stream lined application because they had already had their income verified by a social worker to get food stamps. I love that they didn’t duplicate work that had already been done.

    I don’t know if OBama care will be affordable. I looked up a hypothetical person. Single mom with kids. Insurance for mom only. Income 25k annual. With the largest subsidy, the monthly premiums would be just $100 per month. However, there is still the 6k deductible. So this person would have to pay over 7k before the insurance really kicked in. Is that affordable on a 25k income ?
    ~ C

  • I thought all plans had to include maternity now, although it is subject to the deductible. Honestly, if you pay cash, it really isn’t that expensive to have a baby. For me, the hospital had a prepay plan if they didn’t bill insurance with all natural childbirth for $5K, then you have your prenatal care and ultrasound, which is probably another $1-$2K. I think if it went through insurance and applied to your deductible, it would be $10-$15K easily. I did have some complications and had to have a C-section, but then it went on my insurance. It is all confusing, and I expect many changes before it’s all said and done.

  • retired

    We are paying 3X as much for same high deductible plan, don’t see much chamges. Do not think compliance ,much of issue the first year.
    Corporate policies are excluded from most compliancy requirements, if you hire more than 100 people…or something like that, so none of those supposedly covered things have been included with our policies. In 2010 some were suppose to go into effect, but none of the doctors will honor any, and started requiring payment before service.
    Biggest problem is insurance is not health care. There is not enough doctors accepting new patients in our area. You wait weeks for an appointment, unless you allow the doc to bill the appointment as an emergency. Wait hours to see the doc? Do not see how the insurance is helping us get health care. Now, there is just more demand for a very conciously rationed supply of medical care.

  • retired

    The argument that people have to have insurance to keep costs down is ludicrous. We now pay a third party for services we will never receive, while medical providers will stiil write off losses, thus getting sustantial tax benefits that come out of our taxes paid. Arguing that doctors, hospitals, and pharmacies should be allowed to claim all their losses, sometimes legally counting them more than 1x and be guaranteed insurance payments from every u.s. citizen just does not make much sense. Why anyone would think that the LACK of insurance has been the major problem with our medical system is a mystery to me.

  • The problem with Option B, the ACA “compliant” policy is – it is not a policy bought on the ACA exchange. It is a “compliant” policy that is being sold by your private insurance company. You have no idea what the ACA Exchange policy premiums were because you did not check the exchange options. ALL insurance companies out there are telling people they have “compliant” policies, but unless your state exchange has a good state insurance commissioner that bargained and worked with the insurance companies that are members of the exchange, you will not see any benefits in rates or subsidies.

    For the person that can’t get through on the federal website: there are multiple in-person places you can walk into and speak to someone face to face about a policy, and there is an 800 number manned 24/7. Total time to sign up via the phone has been running about 30 minutes from start to finish.

  • Chrissy

    Did you check out the exchange website for your state? Here in CA, the cost of health insurance with the tax benefit offered for our plan (for 3 people – myself, my husband, and baby) was around $257. I had been paying over 700 for my husband and son to have a plan by themselves. I have found that a lot of people are not able to figure out the exchange systems in their states (or get access to the federal website).

    For me, the Affordable Care Act will be saving our family hundreds and hundreds of dollars – mostly due to the extra that insurance companies were charging us for a mild pre-existing condition. This post is helpful, but it didn’t outline if you looked at the exchange website (and all of the different options) and if you just chose to stay with the same plan.

    I have several family members that have a rare genetic condition, they can’t change insurance due to the pre-existing condition clause of most current plans. Obamacare will give them options (and options are always good in my book).

    Either way, interesting conversation to be had. :D

  • Chrissy

    BTW – don’t trust the “preganancy doesn’t cost that much” claim above. You never know what can happen. I had major complications I could never have anticipated. From bed rest, to a rare medical condition called hyperemesis that led to several ER visitis, multiple visits to Labor and Delivery for pre-term labor, and eventually having pre-eclampsia which led to me having a C-section. The price tag without insurance for the delivery alone was ~54,000. Just make sure you have coverage for pregnancy. Also, unplanned pregnancies seem to happen to people who start thinking about having a baby – so you better watch out ;D

  • Chrissy

    Oh, and the last thing I will say is that we were on the wrong side of having no insurance in our mid-20s. My husband had no insurance and ended up having an appendectomy and a double-hernia – through a program provided through the state. That was $25,000 that tax payers footed the bill on. I would rather everyone pay a little into the system and be forced to get health insurance (much more important than car insurance we are forced to have here in CA). I have so many people with horror stories regarding health insurance. Elderly care here in CA is just horrible, my grandmother had 3 forms of insurance and they still managed to bill her for tens of thousands of dollars and eat up the bulk of her estate.

    For the nation’s sake, I hope the Affordable Care Act solves some of the grossest and more terrible problems in our system. <3

  • @Ronda, I’m going to try the government site soon since the glitches are getting worked out really slowly. We’ll see.

    @Denise, I called to make sure after seeing your comment, but both plans were compliant enough that I won’t get a tax hit.

    @Mom, there is that option probably but I’ll look into it further only if we want to move our conception date up. :-)

    @Andy, supposedly the site should work well by the end of this month…we’ll see…

    @Savvy, it seems to be on a case by case basis on whether it’s affordable or not.

    @Christie, you have done more research than me. :-)

    @Kim, I think the forced maternity care coverage starts in 2015…or at least grandfathered-in plans get until then. Humana thinks they are compliant at least, lol. And yeah, I looked into the cash price of having a baby before. But some coverage in case of big emergencies would be nice.

    @retired, yeah, the largest cities seem to have doctor options, but the smaller places are like doctor monopolies. Very odd but I guess it’s like doctor-office capitalism at work. Weird.

    @Wendy, true. The website didn’t work for me a month or so ago and I haven’t tried again yet. I’ll check it out later this month.

    @Chrissy, I’ll be checking out the exchange later this month. Oh, and the Nuva Ring sort of makes accidental pregnancies HIGHLY unlikely. Has worked great for years. :-)

  • Dee

    What a good post! I have been checking out my insurance vs. The Affordable Care Act alternative. It is hella cheaper for me to stick with my work insurance but.. I only go to the doctor when I’m dead on my feet.

  • Lots of good comments here already about things to check out. It sounds to me like your insurance company is using a little marketing language there. Up until yesterday, they were required to ONLY offer you ACA compliant plans for 2014. So whether they called it “compliant” or not, it was compliant. They just tried to trick you into buying a more expensive plan is all.

    Now the insurance companies are being told they have a waiver for next year and can continue offering plans that don’t meet the standard to their customers if the customers want them. This has really made the insurance companies mad because a) they’ve already set rates for next year; b) they can no longer blame the federal government for making them cancel their (often very crappy) plans. So now people who want to continue to be paying every month for an insurance plan that could leave them in the lurch when they need it can still do so.

    My partner has been unemployed since March. While he was offered COBRA it was outrageously expensive so he has been uninsured since then. While he had problems with the healthcare.gov website, it was great to see that he could get a plan for around $300 a month. He didn’t get far enough to check out the subsidies, which I’m sure he would have qualified for. Instead, I found out that I could insure him through my work for an extra $75 a month since he’s my domestic partner, so we went with that option.

    For people who have no insurance now the ACA is life changing. If we want a system that works better than it, we need to switch to single payer. (My opinion).