New Health Care Reform – Affordable Care Act

I have had my own private health insurance for years and even have declined employer health insurances in the past, due to high premiums for the mediocre coverage.  This past year, however, I was on a employer’s plan for over a year.  But to my dismay, after getting off their health insurance a few weeks ago, I realized how “private” health insurance have changed significantly, and we, as U.S. Americans, are faced with completely new breed of health care reform laws, under the Affordable Care Act.  I would say it seems to have its advantages and disadvantages. 

I actually was going to risk it for the first time in my life, to go without health insurance, but the health reformed mentioned a penalty or fine if we do.  Though there are catastrophic “coverage,” to pay for the increasingly high premiums, waiting until a catastrophe happens to meet the extremely high deductibles ($6200+), sounds.. well catastrophic already. Well, I thought to take a moment to give some more information or survival tips in this post.

So not too long ago,  I had my own private health insurance, and had the full experience of choosing, before the Affordable Care Act. It must’ve been at least 6 times in less than 7 years, that I switched back and forth between employer health insurance or different coverages under the same insurance company.  Each time I switched, it became a more painful process of filling out health history and being “audited” aka interrogated for over an hour.  It’s a painful process, sometimes degrading, especially when auditors are unfamiliar with the medication.  At one point the auditor kept asking me if my medication (for having my wisdom teeth removed) was for STDs. Even though, I explained exactly what it was, the auditor insisted I give her a valid explanation, and insisted she was right about her assumptions.  Then at the end, I get slapped a high premium.

Because premiums increase at a fast rate, I resorted to increasing the deductible to $5000, which means that I would have to spend $5000 out of pocket in a year before “benefiting” 50%-80% coverage or less.. (and co-pays do not count towards it).   That’s IF they decide to help you out.  Say, you get into a crises and need physical therapy or chiropractic treatment… look closely.. there is a cap, a max, that insurances are willing to “cover,” under copay.  Say it’s 24, and you max it. You never reach the $5000 deductible anyways, but even if you did, since you maxed the cap, insurance will not “cover.”  You’re then paying out of pocket anyways.

The health insurance auditors will also find a way to give excuse to give you a higher premium..  like having “minor” things just *once* like bronchitis, would place you at that “high risk” category.  It puts blame and punishment on the patient.  I was charged over $300+, even though I paid almost everything out of pocket for temporary cold issues, and my new coverage was still a high $5000+ deductible, which does NOT make $300+, a justifiable premium.  At one point, I had to appeal the premium 3-4 times using such reasonings, the actual costs of health care vs coverage (stating I paid, more out of pocket than what the insurance actually covers, and that insurance does not actually cover since I don’t reach the deductible for those treatments).. and they finally gave into chopping the premium to half.

Fast forward to the present..  signing up for health insurance under the Affordable Healthcare act.. actually was an “easy” process, in terms of not being “discriminated” on health history or pre-existing conditions. In fact, it didn’t even ask my health history. I immediately paid and got accepted.

However, the premiums and coverages were naturally even more horrendous.. and instead of having the flexibility of enrolling whenever you wish, and switching to another insurance or premium, you having to wait for the next enrollment or have a qualifying event.  Then you’re locked in to that insurance, for the year whether you like it or not.

Then the inability to choose the effective date, is also horrendous.  What happened was I signed up at the end of the month, but the effective date backdated to the first, therefore charging me for a whole month and the next month, even though I didn’t benefit or use.  As a coder who’s familiar with databases, I know it’s possible to change the date in the system, so any reason of “impossibility” is not valid (if anyone tries to use that!)  But unfortunately, the process of getting that approved and done is not quick.

It’s been weeks since I have requested an appeal, which I’m still waiting for an update with Access Health CT, and hoping for an approval. Definitely the amount of time and money saved from having to go through appeal process may be worth the refund to premium holders, especially, if money is concerned.

Should you risk going without health insurance??  That is up to you and your circumstance.  Say you pay $250 a month for health insurance for a high deductible, that is $3000 a year. For many people, that’s 1-2 months income (after tax) invested to insurance that only covers you for an annual physical, mammogram and gynecologist (or less than $1k in coverage). The remaining, is just, the price of having insurance.  In 5 years, that’s $15k.. (enough to buy a car).  If it’s all hefty pocket change, if you’re healthy, and you make low income, you can risk going without (which I am not recommending necessarily), but you do have to pay the penalty (a chunk of your income), which may be less than your premiums depending, and it is owed when you file taxes.  That pretty much forces those with a livable income, to want to pay the premiums.

But if you make less than $40k, you may qualify for the premium tax credit for insurances chosen in the AccessHealthCT Market place, which lowers your premiums. If you choose to take it immediately, you owe it back at the end of the year if you receive more than allowed (e.g. income increases). If you take it at the end of the year, it may be a chunk of change, and you don’t risk owing anything back, or losing the max premiums.

For more information and definitions:

http://www.accesshealthct.com
http://healthcare.gov

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