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My Obamacare nightmare, concluded

I posted a while back about my experience with Obamacare. To recap:

  • I was informed that my existing insurance plan (for which I was paying $7100 per year) would no longer operate;
  • I was offered other plans that looked to be better value for money.

I ended that post with:

So yes, Obamacare is a freaking Rube Goldberg machine, and single-payer would be simpler, more just, and cheaper. But at least in New York, at least for people like me, *it has nearly halved premiums.*

That ain’t nothing.

But at that point I hadn’t actually enrolled in a plan. Now I have. Here’s what happened.

The plan I finally enrolled in, which was offered on the New York health exchange website, costs less than $3700 per year. That’s almost exactly half of the premium I was paying. For me, Obamacare hasn’t nearly halved premiums; it has halved them.

For that, I get a plan with a high deductible and, once that high deductible is met, a high copay. The plan just plain doesn’t pay as much as my last plan did. So if I have, say, $8,000 in expenses in a year, I might wind up paying $5,500 of that, instead of maybe $1,600 with my old plan.

That sounds pretty bad. But there are two things mitigating that.

First off, preventive care–which is all I generally need anyway–is free (or maybe three visits are free. I’m not 100% clear here).

Much more important: Like all plans offered in all states through these exchanges, there’s an out-of-pocket limit; this year it’s $6350 for an individual.

That’s right–I can’t pay more than $6350, plus premiums, in a year (for covered charges; if a charge isn’t covered at all, I’m on the hook for it, but all plans need to have broad coverage, by law).

So yes, if I have $8,000 in expenses, I’ll have to pay more with my current plan. But if I have $80,000 in expenses, I’ll pay $6350, rather than maybe $16,000. If I have $800,000 in expenses, I’ll pay $6350 instead of $160,000.

For me, that’s much better than my old plan. I wasn’t paying $7100 per year in order to keep my medical costs down in ordinary years–I was paying it in case something really really bad happened that would otherwise ruin me. This plan actually protects me better (oh, and like all Obamacare plans, there’s no annual or lifetime limit on benefits either).

And the extra I’ll have to pay in years when my medical expenses are substantial but not ruinous? That can come out of the $3500 per year I’m saving in premiums.

Now: There are some caveats here.

One is that I live in New York, and New York is a special case. Essentially, New York made it illegal for insurers to exclude sick people (or to charge them so much that they were just pre-paying their medical expenses). BUT, this meant that they had to raise premiums on everyone else in order to cover those sick people, which meant that some young healthy people decided to drop their expensive insurance, which worsened the risk pool, leading to higher premiums, so more healthy people dropped insurance, and so on. This is called the “adverse selection death spiral,” and New York was in the middle of one when Obamacare came along. By getting more people back into the risk pool, Obamacare seems to have broken that spiral, at least for now.

In other words, in New York Obamacare replaced poorly-thought-out regulation with better regulation. States that didn’t have poorly-thought-out regulation to begin with will have different experiences. Although those states had other problems that Obamacare solves, like plans that excluded sick people or arbitrarily dropped them.

The other caveat is that my new plan has a narrow network, and my doctor isn’t on it. But that’s fine–I was never all that fond of my doctor. Still, that’s exactly what Obama categorically said wouldn’t happen, so score one for the critics there.

Of course, that sort of thing happened before Obamacare as well; I really liked my *previous* doctor, but I had to drop him when I originally enrolled in the plan I just switched from, and that was in the 1990s.

So: For me at least, Obamacare has meant more of what I want from insurance, at half the price. No wonder conservatives are having trouble finding people who have actually been hurt by the law. 

1 comment to My Obamacare nightmare, concluded

  • L Mc

    I’d like to point out a few things about Obamacare that may not apply to your income level.
    First, the federal ‘subsidy’ paid directly to your insurance provider is like a loan from the IRS. The amount advanced is based on last year’s income, but figured from actual income at year-end. Tricky, that. I imagine that there could be an option to pre-pay the full premium amount and recoup the tax credit at year-end. Short of that, one has to accept indebtedness to the IRS. Tangential to that, the last I checked insurance rates (the full price) were not lower under Obamacare (I have not looked into it recently, maybe things have changed). That industry is far far from reformed in most meaningful ways (in my opinion). Also, I believe there to be a new tax on exceptionally good/expensive health insurance. I cannot fathom why that is being disincentived, but it isn’t exactly my problem either.

    The other thing I’d like to mention is that anyone falling under a particular income (138% of the poverty level) is not eligible for any private-insurance subsidy at all, and must enroll in Medicaid (to have health insurance and avoid the penalty). Medicaid providers (state-level is my understanding) are required to recover costs, by seizing the estate/assets of Medicare recipients upon their demise (unless those assets have been properly sheltered). This federal mandate is not new, but will apply to many folks newly coerced into Medicare by the ACA (by definition, they will all be low-income). It seems that individual states implement it to different extents, but ‘costs’ for all Medicaid-provided services from age 55 onward are to be ‘recovered.’ I am guessing that these are ‘costs’ as billed and not reflections of actual expenses.

    I’m sure you have plenty of sources for this info, so I think you will find these stipulations easily without any links from me. To check my understanding of the second point before commenting, I searched ‘Medicaid asset recovery’ and looked at the text of the document on government sites.

    Personally, I am not comfortable with either of those two things. I find them troubling and predatory.

    Like you (I think), I was rooting for a single-payer scheme. Maybe even more than that I was hoping for some reform of the healthcare and health-insurance industries. If I could have one reform today, it would be to stop charging the uninsured many many times over what they charge insurance companies (it varies, but is consistent in that it is standard practice). I realize that they like numbers games for write-offs, but obviously this is another predatory practice that simply needs to go. If this news to you, take a look at any medical bill sometime. The bill amount will include what I call ‘sticker price’ (a fantasy amount that the uninsured is charged), then an insurance-member discounted rate, then whatever is covered and not by your insurer. My experience of this is limited to seeing my own bills and occasionally those of friends. Maybe you can include this point if you write a health-insurance or Obamacare or whatever comic. I never see this addressed in the media. I suppose this may vary by state and point-of-care. I do not think there are any statistics about it because even simple pricing for services (ex:MRI) are very difficult to obtain. I cringe every time I hear a reference to what the uninsured ‘cost’ the healthcare industry. I know what those bills look like from the patient end and they are a fallacy. Subtract at least 60% (a conservative estimate based on my experience) and those bills still include some profit for the provider.

    I felt the need to pipe up in regards to the last line of this blog entry. I recently discovered the net-neutrality comic which I think is excellent. I’m glad the health-insurance thing worked out for you. In the end, I wish that the ACA was as wellness-promoting for the consumer as it is for health-insurance companies.

    Have a great day and be well (fingers crossed!).

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