Monday, January 13, 2014

"Obamacare": One Average American Family's Experience

Guess what? I'm going to write about Obamacare. Guess what again? I'm going to call it the Affordable Care Act (ACA) because that's actually what it's called.
(There' s chance this will be part one of a series. This is the just the report of how it went signing up for an insurance plan. I think it's important for people to understand what the ACA means to families like ours, but I'm not super into talking about politics publicly. So we'll see.)

Let's get started with some back-story:

We are an average American family. My husband works full time as a self-employed television editor. I work occasionally as a freelance writer and I am also a graduate student, but mostly I am a stay-at-home mom to our two children.
Because Sam is self-employed and I am not really employed at all, we have purchased our own private insurance up until this point. It's actually not as simple as it sounds. Because of pre-existing conditions and cost, Sam has actually not had any health insurance since he was in college. Our daughter and I also flew by the seats of our medical pants until two years ago when we were finally in a financial position to pay for private health insurance. Up until that point, even though Sam worked full time (often up to 80 hours a week), and I worked consistently as a freelance writer and editor, we could not afford health insurance for any of us. I can't tell you how happy I am those days are over. But those are stories for another blog post. So there's a basic idea of where we are coming from.

Two years ago, we finally bought health insurance for me and our daughter. It cost about $360/month with a $2400 deductible. Nothing was covered until we met the deductible, but, thanks to the ACA, our daughter's well-child visits and my preventative care visits were covered at 100%. This meant she could get her immunizations and a check-up for $0. One year ago our premiums increased so that coverage for the two of us cost $459/month for the same plan.

I was eager to find out what our options would be going through Virginia's marketplace. I logged onto pretty soon after it rolled out and was able to quickly start an application. I wasn't able to do much since I was pregnant. I was expecting our son at the end of November, so it made no sense to start our application just yet-- we needed coverage that started February 1st.
Shortly after the baby was born, I got back to my application. Only this time, I couldn't get past basic log-ins to start an application. Every time I tried, there was an error. I finally chatted with someone online, and they said I would need to call in order to complete my application. Annoying. Though I hadn't been aware I was able to complete everything over the phone, and the phone lines are open 24/7.
The first time I called, I waited to talk to someone for over an hour (though I recently called my current insurance company and waited on the phone for over 90 minutes, so...). I talked with the customer service representative for almost an hour as she verified all my personal information for the application, and gathered data according to my tax return to calculate our subsidy. She explained that we are able to use as much of the subsidy as we like. If we don't use the entire amount, it will become a tax credit, and we will receive a refund on next year's tax return.
Then, because I could not access anything online, she went over each of the insurance plans available to me. This was particularly frustrating because I had to write down the information for each plan. There were plans ranging from $120-$4000/month, so you can imagine it was a lot of information to go over-- though I obviously didn't bother going over the plans costing $4000. Sheesh.
I told her I would think about my options and get back to her, so she saved my application and gave me a reference number. Including wait time, I was on the phone for 2 hours.
I took the next week or two to research the plans we were interested in. I was able to find the plans on each insurance carrier's website. I compared deductibles, premiums, and coverage details. I was also able to search which providers were covered. Everything was very straightforward, simple, and easy to compare. We chose a plan with Innovation Health for two main reasons: the available plan already covers our pediatrician, my midwife, and psychologist. Also, visits to primary care and specialists are covered before meeting a deductible. So, if our daughter gets an ear infection, I pay $25 flat-- not $25 after meeting my deductible. Our deductible is quite a bit higher: $7000 for the year. If I were anticipating a big medical event (like having a baby) I would not choose a plan with such a high deductible. But under this plan, I only have to pay $50 to see my therapist, so the higher deductible is worth it to me.
I called back to update and finish our application. This time I waited less than ten minutes to speak to someone! (Note to self-- wait until January to make phone calls regarding insurance.) I told them how much of our subsidy we would use (not the entire amount), and informed them of our insurance plan choice. Then we went over dental plans, and I chose a plan that allows us to get check ups for $10 and covers everything else around 50%, with an out of pocket maximum at $1400. We finalized everything else, and he told me our new insurance companies (health and dental) would be in touch with me within 3-5 business days. Once I paid our first month's premiums, coverage would begin February 1st. We were on the phone a total of 30 minutes.
Health insurance to cover our family of four will cost $513/month and our dental insurance will cost $68-- including our subsidy.

So, was it frustrating that I couldn't get the website to work and that I had to wait on the phone for over an hour the first time? Sure. But I now have legitimate health insurance for my entire family for $100 less per person per month. High fives all around.