A Personal Journey Into The ACA

By Cyril Tuohy

InsuranceNewsNet

I can’t wait for 2015. I’m going on Obamacare. I’m participating in a grand social experiment, so I feel — perversely, perhaps — somewhat privileged. It’s an opportunity that may never return, as the Supreme Court reviews the challenge to the Affordable Care Act.

Working as an independent contractor, I’m responsible for coverage for myself, my wife and my 10-year-old daughter.

Since 1991 until nearly two years ago, I worked as an employee and we belonged to the group market where I simply renewed coverage as if on “autopilot.”

The copays and coinsurance started creeping in and up they went. Like everyone else, I was resigned to rising costs as the individual market didn’t offer an alternative, at least not after our daughter was born in 2004.

We entered the individual market in 2013 and again in 2014.

On Oct. 27, our carrier Aetna said it would raise our monthly premium to $763.18 for medical coverage only, from $402 a month we paid in 2014 for medical and dental. So we decided it was time to go shopping.

Through circumstances involving fluctuations in my wife’s income, we happen to qualify in 2015 for subsidized coverage as we can declare income below the $79,160 annual income threshold for a family of three.

I created an account on Healthcare.gov and followed the instructions. Within moments, I received a PDF document indicating we would be eligible for $283 a month, or $3,396 annually, in subsidies from the government.

Good news (I hoped). Healthcare.gov, here we come!

Last year, out of curiosity, I remember going to the website to see how it worked. Like millions of other consumers, the site was down and I was instructed to try again later. My foray into Healthcare.gov ended right then and there.

We didn’t qualify for subsidies anyway, so there was no reason to pursue coverage.

This year, though, our circumstances changed.

My wife’s small business had recently downsized and there were only two or three employees left. The business was in transition, and my wife started a new category for her small company. After working for more than 20 years in an office, she began working from home two years ago. Our garage is her office.

Her 401(k) plan was terminated last year, and her employer ceased offering health coverage before that.

We were legitimate candidates to apply for coverage under Obamacare. We did, and we were accepted.

Thanks to a complete revamp of Healthcare.gov following last year’s fiasco, the website is far more user-friendly and robust.

I’ve gone on the site multiple times in the past two months. I wanted to get acclimated to the site before selecting a plan, knowing how tedious Internet shopping can be if you need to edit or change selections after the final mouse click.

During the last 10 days of November, I perused the site at random, switching back and forth between one health care plan and another, sometimes in the wee hours of the morning, and then calling into the help line with specific questions.

Can I pay the premium out of my health savings account (HSA)? Does “dental child” mean that my daughter is covered for dental under the health plan? Is the tax credit automatically applied so that the monthly premium shown on the plan is what is withdrawn from my checking account?

I clicked around to my heart’s content, rifling back and forth through dozens of webpages open in multiple browser tabs.

The format took a bit of getting used to, but every time I went to the site, the pages loaded quickly and consistently and help was available 24 hours a day, as advertised.

After the torrent of criticism leveled at the U.S. Department of Health and Human Services last year, the government hired Google talent and a Healthcare.gov point man. The result is a spot-on retail Internet shopping experience.

The redesign presents information clearly and sticks to the information most relevant to a consumer-based decision: Premiums and deductibles, starting and ending dates, number of covered lives, and a comparison tool.

As anyone with experience in a Web design and retail purchasing knows, it isn't easy to present information and take consumers from browse to close. Healthcare.gov’s elegant, simple design delivers a case study in Internet-based insurance purchasing.

Details that outline copayments and coinsurance are available through a one-click function or through a PDF download.

In Pennsylvania, where I live, I had a choice of 40 health plans from four carriers: Aetna, Independence Blue Cross, Assurant Health and UnitedHealthcare. Premiums, without the tax credit, varied from $680 a month for plans with deductibles as high as $9,800 to $1,790 a month for plans with no out-of-pocket deductibles.

On the dental side, we had a choice of 26 plans from seven carriers. Premiums ranged from $56 to $105 a month.

We eventually settled on an HSA plan from UnitedHealthcare with a $3,200 deductible for $802.40 a month and a dental plan for $49.02 a month. The tax credit will be applied to the medical portion of our health care expenses, so we’ll be paying monthly premiums of $519.40 for medical coverage and $49.02 for dental coverage.

In the early morning hours of Dec. 14, a day before the deadline to choose a plan for the coverage period starting Jan. 1, I called the Healthcare.gov customer service line to make sure my selections had gone through. After remaining on hold for more than an hour, I hung up.

I called again a day later and after 30 minutes one of the health care “navigators” answered and helped me to make sure I was covered. As it turned out, I’d left out my daughter from the coverage. The health care navigator canceled my previous registration and reregistered us for family medical coverage beginning Jan. 1.

Three days later, I called again after I realized that my original dental selection was a health maintenance organization, not the preferred provider organization plan that our dentists accept. A navigator answered within five minutes and re-enrolled me into a new Delta Dental PPO plan.

Because I signed up for dental after the Dec. 15 deadline, my dental coverage won't begin until Feb. 1. No big deal, unless one of us has a serious dental issue, which we don’t expect. I intend to let my HMO dental coverage lapse by not paying the $38.98 monthly premium.

There was one unpleasant surprise. This week, I received a bill from the dental carrier for $131.30 for two months of coverage: February and March. At $131.30, the monthly premium amounts to $65.65, higher than the advertised premium on Healthcare.gov of $49.02.

At worst, this smacks of bait and switch.

I called Healthcare.gov. After a very short wait a navigator answered and apologized for the premium difference. She said the advertised premium on Healthcare.gov was, as indicated, an “estimated monthly premium.”

As I was on the phone with the navigator, the site still showed a dental premium for a family of three under that plan at $49.02.

Now we’re all set. All I have to do is pay the health care premium before UnitedHealthcare sends us our “welcome packet.”

My family medical and dental premiums have more than doubled: from $402 for medical and dental under Aetna to $868.05 for medical under UnitedHealthcare and for dental under Delta Dental.

With the subsidy, the total out-of-pocket health and dental expense comes to $585.05. The medical plan comes with a $3,200 deductible.

That’s still a premium increase of 45.5 percent from the $402 a month for medical and dental coverage in a plan with a $10,000 medical deductible.

At $585.05 a month, we’re out of pocket $183.05 more than we were last year, but with better coverage and less exposure.

In 2015, we’ll be paying more, but for more comprehensive coverage. The subsidy helps, no doubt.

The higher price just means cutting back elsewhere. As a result, part of our budget that would have gone to dining out or entertainment will go toward medical coverage.

What the market needs now isn’t more plans — 40 medical plans and 26 dental plans are more than enough. What the market needs are more carriers. As more carriers enter the market, the increased pressure there will be to keep a lid on price hikes.

As for how the Supreme Court decides, well that’s another story for another day.

Cyril Tuohy is senior writer for InsuranceNewsNet. He has covered the financial services industry for more than 15 years. Cyril may be reached at [email protected].

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Cyril Tuohy is a writer based in Pennsylvania. He has covered the financial services industry for more than 15 years. He can be reached at [email protected].