About three weeks ago, I wrote a long post about my ‘disheartening visit to Healthcare.gov.’ Well I have a happy update. With my new Obamacare health plan my premiums are going down 23%, or a bit over $100 a month.
I couldn’t get insurance because of migraines and hay fever
In my earlier posts, I explained how, after nearly a decade of being without any health insurance — and denied coverage due to the pre-existing conditions of migraines and hay fever allergies — I’d been enrolled in the temporary ‘Obamacare’ PPACA high-risk pool for the last two years (basically, it was new insurance for people who previously couldn’t get insurance).
Administered by Blue Cross (one of the companies that rejected me when I was in California), it was okay insurance. Not great, but certainly better than none.
I can’t find the full benefits descriptions, just summaries, since the plan is being phased out, but basically it’s a PPO, and with a few tweaks, this would probably qualify as a Silver level plan. It was also kind of expensive.
At the end of September, I received a letter informing me that my PPACA high risk pool insurance was going away – which was expected, this was meant to be a temporary plan until the exchanges kicked in – and that I’d have to apply on the new exchanges. Wheeeee (link is to a video that is not quite safe-for-work…).
A letter arrives
I had filled out the application and picked a plan via the Obamacare exchange, but it wasn’t entirely clear if it had worked. The site didn’t give me any sort of confirmation, and I started worrying that I hadn’t really “bought” anything at all.
While I was trying to decide whether I should start over again, and re-apply via the Web site, or maybe say to hell with it all and go to a local insurance broker, a letter arrived from Lovelace Health Plan — my soon-to-be health insurance provider. For those not familiar, Lovelace is like New Mexico’s Kaiser Permanente. A hospital network HMO/PPO with a pretty good reputation in the state.
(Unfortunately, within days of enrolling, I learned that Blue Cross of New Mexico is in negotiations to buy Lovelace. Word is we’ll be allowed to keep our plans and doctors, with no visible change, but BCNM would administer the insurance. Oh well. Dammit.)
The letter welcomed me to my new coverage and provided the information for paying that first month’s premium. I mailed the payment over the weekend. Later on, I can set up auto-drafts or automatic credit card charging.
Obamacare coverage comparison
If you’re wondering how this new plan stacks up against my old PPACA high-risk pool coverage, here are the highlights:
- Plan level/type: Gold HMO (my old plan would’ve qualified as a high level Silver PPO)
- Deductible = $750 (previously $1000)
- Co-insurance = 15% after deductible (before was 20%)
- Out-of-pocket max = $4000/year (previously $3500, so not as good, but close)
- Regular doctor visit = $10, or $25 for referred specialist (20% before, and subject to meeting deductible before any benefit)
- Routine exams = 100% coverage, not subject to deductible (same, due to PPACA requirements)
- Prescriptions = $10 generic, $20 brand ($10 and 30% w/max $250 co-pay before)
- Prescription benefits also have a $2000/year out-of-pocket maximum, beyond which I don’t have to pay any more (no maximum before to what I was forced to pay out of pocket)
- Asthma, heart disease, diabetes, and pregnancy medical management programs available (none before)
Cost before tax credits or subsidies = $371/month. (Before: $479/mo)
That’s right: A better plan for more than a hundred bucks less each month. And I’m 50 years old, although a non-smoker (though in some places, like DC, whether you smoke or not doesn’t matter).
But of course, without Obamacare, I wouldn’t have even had my high-risk plan. So we’re really comparing no insurance to my Obamacare plan. And like I said, at 50 years of age, $371 a month isn’t much at all.
The application/approval/enrollment process is in dire need of streamlining. They need way more than the bare-bones plan summaries on the site. There should be links to the full plan information. And contact information for talking directly with the provider — who should, by law, be able to explain over the phone whether or not a given plan covers something. Such as particular medicines, or allergy shots (BCBS couldn’t tell John if his shots were covered or not under the new plan he was considering), or whatever.
It’s dreadfully complicated for people who are eligible for Medicaid under the expansion, with little or no useful information as to how to go about applying for it. This needs fixing, stat.
The entire premium subsidy qualification process is geared towards people with steady incomes and regular paychecks. The former temporary high risk pool just let me use the last year’s tax form and my actual calculated taxable income. Expecting the self-employed to predict their subsidy eligibility based on pure guesses is insane.
Finally, they really need to work on the “you’re done” info. For more than a week, I went back and forth with wondering if my enrollment actually had gone through. It turned out they just should have said, “Wait about five to seven business days and your new provider should be in touch.” But they should also be including contact information for the providers, which appears nowhere on Healthcare.gov.
Suggestions for streamlining
Now then, how would I streamline the application process?
- Have widgets on the site so that without any kind of log-in ID people can see if they are likely to be eligible for exchange insurance and/or receive premium subsidies (and how much). And of course, to browse plans.
- To apply for insurance, you get yourself a log-in ID (can include email-return-URL verification).
- Answer the questions to verify basic eligibility. If the answer is ‘Medicare’ branch directly to the application for that. If the answer is ‘Not eligible,’ branch to information on why and how to appeal if this is wrong. If “Yes,” branch immediately to the plan browsing and enrollment process. Don’t make me download a PDF — just pop up a message that says, “Good news! You’re eligible. Let’s get you enrolled in an insurance plan now.”
- Pick a plan and fill out the enrollment questions. Allow applicant to review and/or correct anything at the end.
- Tell the applicant what to expect next, that if everything’s cool, they should be contacted by their new provider in a week or two.
- Important: Automate the ID verification. If the name, address, phone number, and SSN on the application match what’s on the current credit report, that should be good enough. Hell, the IRS isn’t even that fussy. Only contact the applicant if there is a serious mismatch.
- Make premium subsidies a completely separate application process. Use the same forms and procedure they had for the PPACA high-risk pool. Make eligibility based on the most recent 1040 form’s gross adjusted taxable income amount, not on future income projections.
Anyway, one of the reasons I’m writing this post is because after the “disheartening visit to Healthcare.gov” one from late October, my wife made me promise to write again when (or if) I was successful.
This all said, I did not touch on one urgent problem for many, especially those living in high cost-of-living areas, such as major cities: Affordability. I’ve read plenty of anecdotal stories of folks who are facing genuine sticker-shock (as opposed to the BS stories coming from Faux News). The premiums are so high because (1) medical inflation is still out of control and (2) profit-motive is a lousy way to run a health care system.
Let’s not forget that Medicare for All would be a far less expensive system right out of the gate.