How "Obamacare" helped my family
by Steve Guertin
Like millions of other Americans, I was thrilled to hear a couple of years ago that something was being done to try and help low-income people and families afford healthcare insurance. When "Obamacare" – the nickname for the Affordable Care Act – finally went live on Oct. 1, I was eager to see if my family could save money while still getting quality healthcare.
But before I go into the details of my recent experience signing up for "Obamacare", you have to understand my family’s healthcare circumstance. My employer doesn’t offer a healthcare plan, so several years ago I bought my own private health insurance plan through Kaiser Permanente – which has the closest hospital to my home and was my health insurance provider when I was a kid. My upcoming 2014 monthly premium would be $430 per month – a big chunk of change on a journalist’s meager salary. And that’s not including deductibles, co-pays and other out-of-pocket healthcare costs.
Because my health insurance is so expensive, we couldn’t afford to get health insurance for my wife. Like me, my wife’s employer doesn’t offer a healthcare plan, and my wife hasn’t had health coverage of any kind for the past seven years. Because of our household income, we qualified for financial assistance through the Affordable Care Act (ACA). And you don’t have to be poor to qualify for assistance. A family of three can have a household income of $78,120 per year and still qualify for assistance. For a family of four, it’s $94,200.
But to get the assistance, you have to switch to an ACA-compliant policy. As it turns out, there were several Kaiser policies offered by CoveredCA. I called my Kaiser representative to determine which ACA policy was closest to the current insurance policy I already had. I wanted something similar to what I had, and sure enough, there was a new ACA policy that fit the bill.
Now that I was ready to choose a new Kaiser insurance policy, it was time to apply – which was the biggest hassle in the entire process. The CoveredCA website wasn’t working. Not only could I not compare plans, I couldn’t even sign up even though I already knew what plan I wanted. But there’s a CoveredCA phone number you can call (1-800-300-1506), so I tried giving them a call.
After about five minutes of waiting on hold, I was transferred to a CoveredCA agent who was more than willing to help me apply over the phone. I had already printed out a .pdf of the application and filled it out at home, so the process over the phone was relatively simple. The representative peppered me with several questions I had anticipated. How many people live in my household? What was is my estimated household income for this year? Who is signing up for healthcare? After about 15 minutes of providing very basic information, it was time to pick a plan. The plan my wife and I wanted – Kaiser 73 HMO – is what’s known as a "Silver" plan under the ACA. This plan was eerily similar to the plan I already had. In fact, it was better! Every benefit of the new plan either COST THE SAME as my current plan, or was LESS EXPENSIVE!
Here are some examples:
*My annual deductible before Obamacare was $2,000 per year. Under the new plan, it’s $1,500.
*My annual out-of-pocket maximum before Obamacare was $6,500. Under the new plan, it’s $5,200.
*A routine physical exam before Obamacare would have cost me $50. Now it's free.
*A mammogram before Obamacare was $65. Now it's free.
*A primary care office visit before Obamacare was $45. Now it's $40.
* X-Rays used to cost me $65. Now it's $50.
* Brand name prescription drugs are 40 percent cheaper than before.
But here’s the real kicker. Before Obamacare, I was paying a $430 monthly premium for my own private plan and my wife had no healthcare coverage at all. After signing up through CoveredCA, my wife and I now BOTH have insurance through Kaiser Permanente, with the same plan and the same benefits. The total monthly premium for both of us? A grand total of $265. That’s right. Under the new plan – with the same, or better, benefits as my old plan – I’m covering an extra person (my wife) and SAVING $165 per month. When I heard the news, my wife and I celebrated by going out for a nice dinner.
There has been a lot of opposition to Obamacare, with some very real concerns. Let me address some of them as it related to my experience.
You have to change insurance policies
This is true if you want to get financial assistance for healthcare, but it’s optional. I could have kept my old Kaiser insurance plan. But why would I do that? My new Kaiser plan has better benefits AND is two-thirds less expensive. If I had added my wife to my old plan, our monthly premium would have been $756. Now it’s $265 per month. Change was a good thing.
You have given the government your tax information
This is true, but again, it’s completely optional. Your eligibility for financial assistance is determined by your household income. Had I chosen not to share my tax information, I would have had to re-apply for ACA insurance every year. But because I opted to let the government look at my tax forms each year, I don’t have to re-file again for another five years. Sharing my tax information was a small price to pay for affordable healthcare with no worries for five years.
Employers are dropping insurance coverage
This is true, but again, it needs to be put into context. Employers are saving money through ACA as well. If an employer was paying $400 a month for an employee’s healthcare, and it’s been determined that the employee could get the same coverage through the insurance exchange for a much cheaper rate, the employer usually makes the following sound business decision – get your own subsidized healthcare policy and we’ll pay you back to cover the costs. This "change" can save employers thousands of dollars per year per employee – which makes business sense – and the employee is still getting the same – if not better – coverage.
The goal of "Obamacare" was to provide affordable health insurance for low-income families. My family is now (healthy) living proof of how it can be successful. Yes, signing up for affordable coverage can be a hassle, but for my family, it was well worth it.