OnwardandUpward

It's better than it was WEBlue. Before ACA I couldn't buy health insurance because of pre-existing condition! But loads of people here don't believe in healthcare as a right. It's very common in Texas to find someone fundraising to pay their healthcare bills for themselves or their children.

I can't schedule my surgery though I had taken 2 months off to do so- the diabetes is too bad.
I'm taking medication for 2 months to see if it can be controlled that way.

I had no symptoms whatsoever except mild confusion and headache, so it's a good thing I got health insurance when I did and had routine blood tests. They cost about $250 to pay cash, and the diabetes and cholesterol drugs are pretty cheap even if you have to pay full price. I had 'flu and just thought the symptoms were that...

If anyone is wondering how much the subsidised healthcare costs, I put down my predicted pre-tax earnings for 2015 at $25000 for the year and the premium is $244 a month and $1500 out of pocket.

If I earn more than that I have to pay back the subsidy I'm not sure how but when I file 2015 taxes.

I don't really have any expenses any more so I can afford it but I think it must be hard for families. I bought the platinum as doctors here won't take the bronze level- but the platinum was actually better value if you plan to use it at all.

When people ask me do you regret emigrating to the US, that's the one topic I always raise- are you in good health, will your job provide healthcare. Especially coming from somewhere in Europe or Canada where you don't have to worry about that.

I think it's by far the biggest cultural difference between the UK and US.

WEBlue

I absolutely agree!!

Very true. We have a relative who became gravely ill a few years ago. He lost his job after a while, and the family went deep in debt. Friends & family scheduled fundraisers to not only to pay their hospital bills but to pay their mortgage & ordinary bills. Friends were bringing groceries & gift voucher cards to MacDonald's. Unfortunately they've still got those old medical debts, but last year & this year the ACA is covering the family. SO much better!

Yorkieabroad

We went through all the rigmarole of HC.gov, but ended up renewing with our current insurer 'privately'. The policy is not ACA compliant, and we had to sign a letter acknowledging that fact. The letter spelled out the ways it did not comply, which were all around their ability to not renew due to illness (although they cannot cancel within the term of the policy), and their ability to apply price-discrimination based on age and health history. As the coverage was better than we could get through the portal, we went with it. It works out about the same price as a Bronze plan (830/month vs 800-900ish), with a much higher deductible than some (11900), but then after deductible is met, we are covered 100% rather than copays and 60% coinsurance etc.

I did briefly wonder whether starting an application on HC.gov then not actually taking a policy out would raise an audit flag....?

My other "wonder" was why the HC.gov is still sooooo difficult to use. Each answer had to be submitted separately rather than filling in a "table" and submitting it all at once as on every single private company site. Applying for a family we also had all sorts of "relationship" questions from HC.gov - it wasn't enough to say that the kids to be covered were mine - I basically had a decision tree to complete for each family member stating their relationship to myself and every other family member - not sure why they needed that when none of the private companies do?

Oh well, at least that "joy" is over for another year.....

Steerpike

How is this legal? I thought all policies now had to be ACA compliant? Is this a temporary accommodation made to address all those complaints that arose soon after implementation, or is this going to remain as a long term situation?

My COBRA expires end of this month so now I really have to get going and find a plan. The first two plans I found did not include my current PCP, but I did find him on a third plan, but that plan only offers Silver and above. So if I go Silver, I should be OK as far as keeping my PCP. It's about $800 for me (old fart), just a bit more than I'm paying for my current Cobra policy.

To those complaining about doctors not taking ACA plans, I just had a bad experience with my current 'free market' ( ) Cobra plan. My Cobra plan is, of course, an extension of my former employee's offerings. At the end of 2014, I had to choose all new options as the company re-negotiated everything. I chose the options closest to previous options in every way, and rate went up from about $620/mo to $690/mo. I then went to my dentist in Jan for some fillings, and just got a call yesterday from them telling me their claim was denied. Looking into it further, the dental plan offered no longer allowed for 'out of network' dentists. Basically, they changed the plan from a PPO to HMO, and kept the rate about the same. So now, I have to pay several hundred $ for the work. My point being, all this BS about doctors not getting reimbursed, patients not finding their PCPs 'in network', etc is happening even in the 'private' sector - this is not just a factor of the ACA.

I will say, the 'covered California' site seems quite decent. Obviously, CA is totally on-board with the ACA so they are doing what they can to make it work. Further, I'm not looking for a subsidy so I don't have to go through all that extra stuff. But we shall see how it goes over the next two weeks when I actually try to sign up!

Yorkieabroad

I honestly don't know- I had the same declaration/acknowledgement to sign last year as well. Maybe there is a "grandfathering" of existing policies?

For want of anyone else to ask, I checked with my CPA last year whether it was likely to cause problems with the penalty, but fairly predictably, he didn't know, but "thought I'd be OK". I'm assuming that if I do get audited I can show enough to say that I have coverage in place. Hopefully I will never find out whether that is a valid assumption or not!

sir_eccles

The grandfathering of old plans goes to 2017 I think.

There is also a difference between being "ACA compliant" and "minimum essential coverage". The later will avoid a tax penalty but may not be ACA compliant. It is possible some old employer group policies are still non-compliant.

Giantaxe

It applies only to plans that were in place before the date of the passage of the ACA at the start of 2010. Apparently, because insurers "churn" their plans so frequently, few will be left by the time the grandfathering ends.

Michael

You can go on the open market and purchase a policy which will be ACA compliant. Not all plans are offered through Covered California. If you are in good health, a bronze plan which has your current PCP purchased directly from the health insurer may possibly be better.

Yorkieabroad

That makes sense...we've had ours 7 or 8 years, and while they have gradually whittled away the benefits and at the same time raised the premiums, it is still the same name/group number we originally started with.

Steerpike

That's where I started, looking at various plans, but all the bronzes I looked at didn't include my PCP; however - I was not necessarily going about this in the right way. Is there a 'directory' of all plans available in the state or region? I think I was using the list of carriers shown on the Covered CA site as a guide.

Also, is there a way to find out which plans my PCP may be available on? I sent a message to his office asking that question but got no reply. I probably need to call them

OnwardandUpward

I somehow got lucky. United Healthcare gave me 5 PCP doctors none of whom were taking obamacare or taking new patients. Finally I said put me through to your complaints department, and the woman said we don't have one! But then she offered me a doctor I'd used before and actually called her while I was on the line to confirm she would accept me.

I was pretty annoyed that the only way I could get help was having a meltdown, and I'm still having difficulty finding specialist doctors. This is despite Houston having one of the world's largest medical centres.

OnwardandUpward

And here we go again- received new insurance card in mail listing a doctor I've never met and he was one who wasn't taking patients either when he was assigned to me before... another day on the telephone Monday I suppose. Presumably someone must be doing this- I haven't requested or made a change. Thought I'd got it sorted too : (

Steerpike

I finally spent a couple of hours on the phone and the internet today, trying to get health insurance that was accepted by my PCP. I found a place on my doctor's 'medical group' website that told me which insurance plans my doctor (and/or his medical group) was accepting, but could not match those up with what I could find on the insurance company websites. EG - the medical group site said they accepted Anthem Blue Cross, and specifically listed "Anthem Prudent Buyer PPO". But on Anthem's site, they listed "Anthem 'blah' PPO" (can't recall 'blah' now), which was not the same and - when I checked for my PCP - did not include him.

I then called the medical group's customer service line and they gave me a list of insurance plans that were accepted by my doctor. I asked for it electronically but she said fax or (paper) mail only ... but I don't have a fax machine at home, so I painstakingly wrote down the details. I then went to the websites of each one and called their 'speak to a broker' number.

I finally got a guy at Cigna who confirmed they had a health plan - bronze - that was $530/mo, and included my PCP. I asked if this plan was listed on Covered CA, and he said no - in order to be listed on Covered CA, you have to offer a 'range' of plans (bronze, silver, gold, etc) and they only offered a bronze ... so they weren't included in Covered CA's listings. but nonetheless, this was an ACA compliant plan.

So bottom line seems to be - if you don't need the subsidy, you have a much bigger 'pool' of plans to choose from and you are better served by calling the individual plans.

I also ended up getting dental for $45/mo that was better than the dental I had under my Cobra, interestingly.

OnwardandUpward

@Steerpike, you are so right.
I totally regret buying ( assuming I have ) the marketplace plan, it has been more stress than the subsidy could possibly be worth.

At every turn there has been a problem, website not working, no answers for self-employed people, long phone delays to get advice, paperwork lost by health and human services, then when the insurance is finally issued going through the same nonsense with United Healthcare- website not working, inaccurate details, long phone delays, can't find a doctor etc etc.

Finally thought I had it all cracked- letter from government saying 'congratulations you are covered', accurate insurance card, PCP I like. Sigh of relief.

Until I tried to pay March premium this Monday. Website wouldn't work so I call to find out what to do and the operative says 'my information shows this plan was cancelled on 1/1/2015'....

So now 'someone' is looking into that ( takes three business days and we'll call you back. Sure you will...) and meanwhile- am I covered?

I wish heartily I had just gone to a private agent and bought insurance via them.

Glad you are sorted Steerpike!

Giantaxe

I wouldn't assume that all your issues are related to the ACA side of this. From your descriptions, some of the issues seem to fall into the lap of your insurance provider. I certainly agree, though, that the subsidy issues - especially for a self employed person - make the whole thing more complicated.