In May of this year, my partner went for a gynecological exam after months of nausea and cramps. She hoped a change in her hormone medication would take care of the problem. However, after an exam, her doctor informed her that she had a large mass in her pelvis. After numerous tests and procedures, she had surgery in June. Fortunately, the tumor was benign. However, because we had catastrophic insurance, her medical bills totaled more than $10,000, not including the $2,407.80 we paid for her annual insurance premium. We paid the first medical bills with savings. The bills kept coming, so we liquidated investments and obtained zero percent credit cards to pay off the rest. At this point, in November of 2013, we are still carrying a balance on one of the credit cards and do not believe it will be paid off until fall of 2014.
In October, I developed a facial rash. After two weeks, when it became worse, I went to my physician and paid $40 for the office visit. I then went to the pharmacy to pick up three prescriptions. The pharmacy tech told me the cost was “Four-seventy-five.” Yes, three prescriptions were going to cost me $475. I have a high-deductible individual plan that does not cover prescriptions until I spend $1,000 (my annual insurance premium costs $2,353.80). The most expensive prescription was for an ointment I had used years ago for the same problem. Needless to say, I declined the prescription and used an expired tube I found in the bathroom cabinet. Within two days, my rash cleared up.
Welcome to American healthcare for the self-employed in 2013. One of the reasons I voted for Barack Obama was because I believe healthcare should be accessible to every America regardless of income. Since my partner (48) and I (56) are self-employed, we have been paying significant money for catastrophic healthcare plans that covered little.
Consequently, I was eager to find a plan through the healthcare.gov website. I had signed up with an ID and password almost as soon as I could, and then on October 1, I logged on to the Health Insurance Marketplace, expecting to easily enroll in an affordable healthcare plan. However, I found I could not get on the website. After repeated failed attempts throughout October, I decided to sign up again with a different ID and password. This time, in early November, it worked. I suspect the website changed the parameters for the ID and password after I signed up, and I assume that is why my original ID and password did not work.
This was frustrating and obviously not a good start. However, once I changed the ID and password, I was able to get on the site and go through the process. The biggest issue I had was when I got to the section that required I provide information about my income. Since I am a self-employed writer, I have no idea how much money I will make in 2014. My guesstimate came back with information explaining that since Georgia has not set up their own exchange (Republican Governor Nathan Deal and the Georgia legislature chose not to do this), I am not eligible for Medicaid, though the other states that did go along with the Affordable Care Act (ACA) are offering Medicaid for their citizens with my income.
I was, however, eligible for a tax credit. I could take the credit as part of my monthly insurance premium, or I could receive it as a refund when I filed my 2014 taxes. Since I was afraid I might owe additional tax because my 2014 income did not match my estimate, I decided to go with a hybrid. In other words, I asked for a partial credit that would take a certain amount off my insurance premium.
I suspect this is going to be an issue for other self-employed people. Most of us have difficulty accurately estimating our income. This is similar to estimating taxes for self-employed workers. Many of us pay estimated quarterly taxes. If we underestimate, we can get hit with a tax bill when we file. On the other hand, if we overestimate our tax liability, we have to wait to receive the refund. It was further explained on the website that you can contact healthcare.gov during the year you are receiving the tax credits and adjust your income.
After successfully signing up for ACA, I am now paying $157.23 a month for my monthly premium ( in 2013, it was $196.15). This includes the premium less the partial tax credit. I had a choice between HMO and POS plans. I did not want an HMO because my previous experience with Kaiser had not been good, and I wanted to keep my doctors.
After I signed up, enrolling my partner in healthcare.gov went much faster. In fact, it took less than fifteen minutes from the time she got her ID and password to choosing her health plan. She also opted for a partial tax credit. Consequently, her premium is $120.42 (in 2013, it was $200.65).
Unlike in 2013 and preceding years, we now have health insurance that will actually help pay for health expenses. The plan we both chose is the Silver Humana Employers Health Plan of Georgia. My deductible is $500, and my out-of-pocket maximum is $750 (in 2013, my deductible was $7,500, and I never fully understood what my out-of-pocket maximum was). My partner’s is the same (in 2013, her deductible was $5,750, and her out-of-pocket maximum was $10,750). Our doctor visits will cost $35 per visit, and our prescription deductible is $500.
Is the Affordable Care Act perfect? No. I’m disappointed that the website would not allow me to sign on the first day and did not alert me that my ID and password no longer worked. I also wish Obama and Congress had instituted a single-payer system. One thing I realized while going through the process is that the poorest Americans will have no tax credits to help them pay for their health insurance.
Still, the Affordable Care Act is much, much better than what Americans had before the ACA. For years, we, along with many other Americans, often chose not to go to a doctor because we feared not only the cost but also the very real possibility that we would be labeled with a pre-existing condition and thus be unable to afford or even obtain insurance. For example, many years ago, my partner had a treatable case of skin cancer while she was on a traditional health care plan. However, when she became self-employed and applied for an individual health policy, she was denied by several insurers until one agreed to insure her–but would not cover skin cancer.
For months now, we have continued to receive letters and other communication from our insurers trying to get us to opt out of the ACA and instead keep the same plans we have. They want us to “lock in” the 2013 rates before the ACA takes effect. It appears they are trying to mislead and milk what they can during the initial confusion over what the law covers.
There are clear differences between the healthcare system run by health insurance companies in 2013 and health insurance through the ACA in 2014. Rather than continue the fight against the ACA, I’d like to see Americans come together and fix what needs to be fixed with the ACA. It is no longer an option to defund or remove the ACA. In fact, the new law is wonderful in terms of providing accessible, affordable, actual healthcare to Americans, and it might turn out to be the best thing to happen to healthcare in this century.