The end of open enrollment for the Affordable Care Act, March 31, is only days away. Although the past five months have been full of their share of challenges, stories of triumph have emerged. The ACA was, in part, written into law to expand coverage to people who had not had access to health insurance before or who found it too expensive. The story below tells of a couple who experienced both of those barriers and is now happily covered by an affordable, comprehensive health plan.
In order to protect the privacy of these consumers, their names have been changed for this testimony.
In December, Anna and Mark, residents of Orange County, were able to purchase a family health insurance plan on Healthcare.gov with a total monthly premium payment of $215. They are paying $882 less than the actual cost of their plan thanks to the generous Advanced Premium Tax Credit, only available through the Federal and State Health Insurance Marketplaces.
Anna and Mark certainly have good reasons to be thankful for health insurance. They can testify to its importance in different ways. As college-educated, self-employed career professionals, Anna and Mark have been responsible for purchasing their own health insurance for many years. To cover Anna, they paid $900 per month in premiums, while Mark went without coverage for 18 years because adding him would have been too expensive.
Mark was fortunate to have no major illnesses during that time but says it was a terrifying experience not to know. He did not access routine care and would only go to the doctor for something urgent. Any medical costs had to be paid out-of-pocket. As he grew older, he developed a pre-existing condition, which made acquiring health insurance much more unlikely.
Anna had a very different experience. In 2008, she woke up unable to walk normally and made a trip to the emergency room. After one week in the hospital and a plethora of expensive tests and scans to figure out what was wrong, she was diagnosed with an uncommon neurological disorder. A lesion was found on her spinal cord, likely originating from a simple, barely noticeable virus similar to the way the Polio virus functioned. With her insurance, Anna and Mark paid $5,000 for all of her care that week, much less than the total bill. Without insurance, she says they would have ended up in a financial hole and would still be digging their way out today or simply not accessing adequate healthcare.
Unfortunately, the cost of premiums to cover Anna became so unmanageable that they had to drop her coverage, even though she also would be considered as having a pre-existing condition if they sought insurance in the future. They both waited eagerly for a year and a half for the implementation of the Health Insurance Marketplaces through the Affordable Care Act, when they could no longer be denied health insurance for pre-existing conditions and would have an opportunity to access a premium tax credit.
Anna and Mark said they had very similar difficulties as many others did early on in the open enrollment period. It took patience and persistent computer work, and they are grateful they were able to complete the application online, receive a subsidy eligibility notification, and choose a silver level plan in December 2013. They believe the early challenges were worth their focus to accomplish this, and now they are satisfied with their purchase. They’ve already begun to make use of their new insurance and would say to others who are considering a similar purchase to check it out and “please do it.”
Anna and Mark believe that “God intends each of us to live strong and courageous lives. Engaging health care for ourselves permits us to live such lives including service to others. It is an act of God to seek and provide health care for all.”
Advice from Mark and Anna for consumers who are shopping for health insurance plans on the Federal Marketplace:
- We thought that to be in compliance with the Affordable Care Act we had to have health insurance coverage and that the penalty for not doing that would be $95.00. Then, we found that it is $95.00 if one is below the poverty level and may increase in time. It also means that the penalty will be 1% of income for those with more taxable income — that can mean hundreds or thousands for every citizen with a higher rate of taxable income.
- The thing to know is that like most people we wanted insurance but needed to be able to afford it. That is the essence of the new Affordable Care Act — with its “subsidies” and “market place,” it helps health insurance to be affordable.
- We encourage healthcare consumers to make a list of your regular providers and check to see if those providers are in-network for the specific plan you are considering either by calling the insurer and the medical provider or by looking on the insurer’s website. We did this and found a satisfactory plan that included all of our regular providers in-network.
- Just know you are not unusual in having doubts and fears about this new process. It has new twists and turns including a new vocabulary. Once one understands the new system, it is a simple process for most people. Still, it is one that requires research and sometimes support from others to complete. Do ask for help in signing up.
*If you have a story about the Affordable Care Act that you would like to share, please complete this form and send it to Lauren Chesson at firstname.lastname@example.org.