Tuesday, February 11, 2014

An ACA fail: One family's saga

The following was written by my daughter, who has a master's degree and should be an ideal candidate for the new world of healthcare coverage.

The Affordable Care Act should benefit people like me. My husband is self-employed, and we have been paying for our own insurance for years now. I looked forward to the ACA marketplace opening up, and hoped that it would provide us with some options for lower-cost insurance. This was especially true after I found out that for our current plan, with a $10,000 family deductible, the premium was going up to $550 per month for 2014, with the addition of our new baby and the expected annual increase.

Searching the ACA website for my state, AccessHealthCT.com, I was happy to see that we qualified for a federal subsidy of $700 per month, and with that, there was an option for what seemed like a similar plan to what we have now. I selected the plan with Anthem BCBS that had a monthly premium of $298.61, with a family deductible of $12,600. This meant we could keep our HSA, and possibly save a lot of money for the year if we did not meet our deductible.

I spent 45 minutes filling out the application, and almost immediately received a letter from Access Health CT saying I had successfully enrolled in the plan I chose, although it did not list the premium on that letter. Ten days later, I had received nothing from Anthem so I called them. I waited an hour to talk to a human, who said yes I was enrolled and just had to pay the first month premium to complete the sign up. 

I would have done this, except that the amount I was told to pay was $2480.46, for the first month and for each month after that. But wait, I said, the premium was listed as $298.61 per month after the subsidy was accounted for. She said the $2480.46 was the amount due from me, having already accounted for the $700 assistance from the federal government. It’s interesting to note that the subsidy amount came through correctly even though my premium was now eight times higher. She said I would have to call Access Health CT to find out what went wrong with the premium.

After six phone calls, three to each Anthem and Access Health CT, with a lot of waiting, I got nowhere. Access Health CT said my application looked fine, but they couldn’t view premium information once an application had been submitted. Anthem said they can’t modify the premium when they receive an application from the marketplace. 

The last of the six phone calls went like this: I explained my story to an Access Health CT representative, who said he would get someone from Anthem on the line so we could all discuss and try to figure it out. When the Anthem rep picked up, the Access Health CT rep disappeared. I explained it all again to the Anthem rep, who listened politely and then said he would love to help me but he was only the person who took payments and had nothing to do with plan enrollment. Great. He said he would connect me to someone else who could help, I waited on hold for another 30 minutes, and then I got a recorded message: "This call has ended. Good-bye."

In the two weeks following this day of phone calls, I have received 14 letters from Anthem, each with a different date and application ID, but each with exactly the same message, telling me all I have to do is pay $2480.60 per month, for a plan where I will be responsible for the first $12,600 of my covered medical expenses.

Is this affordable care? What do I do now?

As disappointed as I am that no one can help me with this problem, at least I didn’t cancel my current insurance before finding out. What I am most concerned about is what happens next year when my current plan is no longer available because it is not ACA-compliant. I can only hope something changes before then.


Libby said...

wow. I'd pay Provincial premiums to sustain/subsidize our socialized health care over that system. The Prov. gov't cancelled them a few years ago. I don't think any provinces charge premiums. I can't imagine paying $500/mo. never mine a $10,000 deductible. The ACA fee is unconscionable.

RuggerMD said...

Well a colleague of mine who is an oncologist has been treating a patient with metastatic breast cancer with chemo. Her insurance got cancelled because of ACA and when she went to the gov site the deductable was 20k because of her pre-existing condition. She and her husband cannot afford the deductible or premiums. She will likely die without her chemo so her and her husband have decided to get divorced with her receiving nothing so that she can get medicaid.

Anonymous said...

I thought under ACA, the premiums are the same regardless of pre-existing conditions?

Prior to ACA, I was paying a $1250/month with a $2500 deductible, and couldn't find new insurance because I have a few middle-aged maladies (blood pressure, cholesterol, knee problems).

When my policy got cancelled because of ACA, I enrolled thru my state's website. There were no multiple-page questions about all my previous doctor visits, meds, etc., etc., that I remembered from my pre-ACA applications. In fact,the only medical questions were my age, sex, and (I believe) smoking history.

My new policy is $780/month with a $5000 deductible.

Skeptical Scalpel said...

I agree. I thought pre-existing conditions did not matter with the ACA.

I think my daughter needs to move to the state you live in.

Anonymous said...

I have BCBS. Though getting through to them was a nightmare, I have a platinum single policy for 572 a month, no deductible and a 2k personal payout cap. Pre existing illness don't matter anymore.

Skeptical Scalpel said...

Anon, that sounds like a pretty good deal for you. Thanks for commenting.

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