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My Obamacare Experience

I usually use this space to write about my adorable (I’m slightly biased) children and my eternal search for DaddyBalance.  Today, I thought I’d write and give you a Obamacare Experience from someone on the front lines of the issue.

Let’s start with a little background.  I’m a small business owner.  I’m structured as a sole proprietorship, all of my income comes through on a 1099. I have two W-2 employees, both work part-time.  I don’t provide health insurance for my employees and am not obligated to do so through Obamacare.  My wife stays home and cares for our boys, so I purchase my health insurance on my own.  I currently pay about $400/month for a high deductible ($7,500) plan for my family of 5 (wife, and 3 boys, ages 7,4, &1).  This plans provides us with good care and we pay out-of-pocket for most items.  A doctor’s visit is somewhere between $80-$140/visit.  Prescriptions run between $20-$60/piece.  We utilize a HSA to pay for most of our costs, and generally, I’m OK with this plan.  It’s not great, but it isn’t a disaster.

Let me also share with you my politics, because for this discussion, in the current environment, it matters.  I consider myself an Independent.  I’ve voted for Democrats and Republicans.  I lean fiscally conservative, while I’m more progressive on social issues.  I find myself in the middle most of the time.  The more extreme a position or politician, the less likely I’ll follow or listen.  I believe we are American first, Republican/Democrat a distant second. 

I’ve been curious about Obamacare from the start.  As you can tell, I spend a lot of money on healthcare and health insurance.  Between the $4,800 annual premium and the $7,500 deductible (which I hit this year due to my son’s epilepsy, which you can read about here), my total out-of-pocket (which I calculate by adding my monthly premium and my deductible) is around $12,300, or about $1,000/month. 

I was curious to see if my premiums would go down.  Would I qualify for a policy with a lower deductible? How about those subsidies, would they apply to me? Would I want to hold onto my current policy or head onto the exchange?

So on October 1st, the day the exchanges opened, I was on it, ready to go.  Let me be the first, or possibly the 500th person to tell you, the website is awful.  I’m 35 years old, I’ve been shopping on websites for most of my adult life, and this was the worst experience I’d ever had.  I tried to access the site everyday for about two weeks.  Each time I was stalled on at different step in the process.  First I couldn’t log on, then I couldn’t enter my family’s information, then I couldn’t see my results.  On and on it went until I just gave up. 

Fast forward to the 28th of October.  After logging onto Helthcare.gov, I finally, for the first time, was able to see my results.  Now, it’s still the clunkiest consumer website I’ve ever come across…it’s terribly slow, glitchy and user UNfriendly, but I found the information I was looking for, and have begun to answer some of my questions.

First, I don’t qualify for any subsidies.  Fortunately, or unfortunately, I make too much money to qualify.  I had 22 policies to choose from, but from only 2 companies, Anthem Blue Cross/Blue Shield and Coventry.  (Coventry, by the way, did not appear to have either my primary doctor or my kids pediatric doctor available.) I compared two policies, a bronze and gold, both offered through Anthem.  I did not see many differences in coverage between the two policies, other than the gold offered child dental, whereas the bronze policy did not.  Most of the other comparison services (ie pain management, pregnancy, depression, etc) were the same.

The cost for the bronze plan is about $700/month with a $15,000 deductible.  That’s a 75% increase in my monthly premium and a 100% increase in my deductible.  My total out-of-pocket (using the same formula as before) goes from my current $12,300 to $22,000, or about an 80% increase.  I can still use my HSA, and there are some eye doctor services that I would be getting under this new policy that I don’t currently have.

The cost for the gold plan is about $1300/mo with a $1,500 deductible.  This policy offers some dental coverage, for my kids only.  Once again, there is not a lot of difference in the covered services between my current policy, the bronze policy or this gold policy.

I have two major take aways. 

First, I don’t see a big difference in coverage between bronze, silver and gold policies.  What I do see is a big difference in monthly premium.  The 3 level metal system seems a bit disingenuous.  My assumption was that gold policies offered substantially more coverage, hence they would be more expensive.  Along that same thought, I figured you could have large deductible (HSA eligible) gold policies, and vice versa, small deductible (HSA ineligible) policies available in the bronze arena, but that’s not the case.  From what I can tell, each of the policies offer most of the same services (90% or so), the major difference is whether I want to pay a smaller premium or higher deductible.

Second, I want to keep my current policy!  If I’m not getting substantial better coverage, why would I want to be forced onto the exchange?  My current policy is not a “catastrophic” policy, it’s good coverage and a much lower premium and deductible. 

I recently received a letter from my current insurance company.  They told me they were in the process of reviewing my policy and would let me know if they were going to cancel by the end of the year.  I’ll hold out hope, but I’m not encouraged.  I’ll keep you posted.

If you are interested in learning more about my Healthcare.gov experience, shoot me a note or make a comment, I’ll do my best to answer.

UPDATE: A letter arrived yesterday to inform me that my policy will cancelled Feb 23rd.

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