As the one-year anniversary of the Affordable Care Act's initial rocky rollout approaches, opinions on the law remain as heated as ever.
While the Obama administration boasts many successes this year – over 8 million people now have health insurance through the exchanges, and the percentage of uninsured adults fell from 17.1 percent to 13.4 percent, -- overall views on the law are still negative, according to the latest Kaiser Health Tracking Poll.
Forty-seven percent of Americans surveyed said they view the law unfavorably, with only 35 percent saying they have a favorable view. It’s no surprise that most of those surveyed have not signed up for Obamacare, since 84.6 percent of the population is covered by employee insurance.
Perhaps because of the ambiguous wording in the Kaiser poll, 56 percent said the law has not directly affected them or their families. Still, 16 percent complained the law has increased the cost of their health care or insurance. At the same time, users have praised the law for allowing someone in their family to get or keep health coverage (6 percent), or made it easier for them to get the health care they need (4 percent).
We wondered: Are the 8 million Americans who have signed up for Obamacare this year happy with what they have? What is the daily reality of having health insurance through the exchanges? We spoke to a variety of people about their experiences -- from signing up and figuring out which plan was best for them to actually using medical services covered by their insurance.
With the next open enrollment session on November 15, what's unknown is how many of these new Obamacare users will keep the same plan. Many people we spoke to expressed concern over rising premiums, and according to the Department of Health and Human Services, premiums for the cheapest silver plan, the most popular choice around the country this year, will increase by 8.4 percent on average next year.
Here's what five Obamacare users had to say about their experience so far:
1. Jason Wardrop, Redding, CA
Occupation: Athletic Trainer
Date signed up for Obamacare: Feb 2014
Name of plan: Blue Cross Blue Shield (BCBS) through Covered California - Silver
Qualify for the subsidy? Yes, qualified for an EPO (exclusive provider organization) cost-sharing reduction plan for those with income between 133 percent to 250 percent of the federal poverty level.
Monthly Premium: $117
Jason Wardrop had a part-time position at a college when Obamacare was implemented and was hoping to enter the university's health care program, but was laid off before he was eligible. Though he's young and healthy, he's had health issues in the past and didn't want to go without insurance any longer.
How He Chose His Plan: He tried signing up multiple times on the Covered California website, but it kept crashing. Finally, a month before the March deadline, he called a representative and gave all of his information over the phone; they recommended the Blue Cross Blue Shield plan. He had a BCBS plan in the past and was happy with his coverage, but since he’d recently moved to a new city he checked the BCBS website to make sure a significant number of providers in his area were covered. He wanted something affordable, and since he’s had major medical expenses, a low deductible was important to him. The silver plan seemed the best fit.
His Experience Using Medical Care So Far: He’s been to the doctor a number of times for lab work with no issues. He was surprised to learn many of his prescriptions were cheaper than in his previous plans. However, after a visit to a prompt care provider he thought would be in-network, he later found out the provider was out-of-network. It cost him $90 for a visit that would have cost a $10 co-pay. He also hasn’t received any “Explanation of Benefits” forms he was used to receiving.
His Takeaway on Obamacare: "I think it's a good thing overall. I know how important insurance is for peace of mind and in the event of a major health problem. Without the subsidy from the Affordable Care Act, I would not be able to carry my own insurance. I have been quite happy with my coverage, minus a few hiccups with registration and out-of-pocket costs. I would like to know how it's affecting businesses and I don't feel it is perfect but I have seen far more good from the law than negative.”
2. The Breier Family, Downers Grove, IL
Age: Dennis, 32, Kim, 31, and their four children (all under age 6)
Occupation: Dennis runs his own wealth management business; Kim is a stay-at-home mom.
Date signed up for Obamacare: 01/01/2014
Name of plan: BCBS PPO - Gold
Qualify for the subsidy? No
Monthly Premium: $1,171
The Breiers had great health coverage through Dennis's prior job at a bank, but he opened his own business in March last year while Kim was pregnant and needed an insurance plan to cover the pregnancy given her "pre-existing condition." With the pregnancy, a newborn on the way, and three young kids, the family visits the doctor frequently and therefore wanted a plan with a low deductible.
How He Chose His Plan: In addition to wealth management, Dennis is certified to sell health insurance, so he felt knowledgeable about the system and researched the plans online himself. He wanted a high-quality plan that would cover the many doctors his family visits, so he chose a PPO plan that kept their doctors in-network. Dennis makes just over the amount to qualify for the subsidy, so the plan was expensive. There was an HMO plan with a lower deductible, but he heard from friends that the HMO didn't cover as many doctors. “Because we have to be at the doctor a lot, we wanted one of the best plans, and this was essentially the best coverage we could get for the cost,” he says. He went directly to the BCBS website to sign up.
His Experience Using Medical Care So Far: His family has made about 15 to 20 visits to the doctor since signing up, and Dennis says they've had to dispute the bill almost every time over charges for things that should be covered. Then after two months of having the insurance and paying premiums, they received a notice that their insurance has been discontinued because the insurance company hadn't received any premium payments – their premium payments had been going to a different person's account.
Dennis and Kim had to make multiple phone calls and spent over 10 hours resolving the issue. In addition, when their son was born in March, they tried to add him to their policy and it took nearly four months for the paperwork to be processed. In July, they hired a health care agent to help them deal with their insurance company and things have been smoother since.
His Takeaway on Obamacare: “The insurance we had before Obamacare was far better than our new policy. The frustrating thing is it’s really expensive. You'd expect pretty good service for $1,100 a month, but the administrative work has been a nightmare. So much is slipping through the cracks. I’ve been with BCBS forever, but I will switch to a health savings account this year because of the tax deductions and the fact that our current premium is too high to continue.”
3. Kim Fuller, Tulsa, OK
Occupation: Public relations consulting
Date signed up for Obamacare: She tried the first day Heathcare.gov went live but it took until Dec. 31 to receive confirmation.
Name and type of plan: Blue Cross Blue Shield - Bronze
Qualify for the subsidy? No
Monthly Premium: $338
Kim Fuller has rheumatoid arthritis ̶ she receives monthly treatments that cost thousands of dollars, so she needs a plan that covers them. As a freelancer in the past, she typically bought private insurance, but in 2005, she was denied because of her pre-existing condition. She started working 20 hours a week at a company to get insurance, but was laid off in the spring of 2013. She was paying $540 a month for COBRA before her Obamacare insurance kicked in.
How She Chose Her Plan: First, she searched Healthcare.gov to research each plan. Like many who tried to sign up in the first few months of Obamacare's implementation, she experienced frequent crashes. She found only four insurance companies for her state listed on the exchanges at the time, so she printed out the names of each plan and went to each company's site to research more. She wanted to make sure that all of her doctors were covered (seven total: primary care, rheumatologist, pulmonologist, ophthalmologist, optometrist, dermatologist, and dentist), and she wanted to use the coverage in various states.
BCBS had the widest coverage and she wouldn't have to change any of her doctors, but she was worried about the high $6,000 deductible. In years past, she'd been part of the Genentech Rheumatology Co-Pay Card program, where the drug company helped pay for her expensive arthritis drugs and treatments. She found out the co-pay program would cover her $6,000 deductible after a few visits.
Her Experience Using Medical Care So Far: Her first few appointments went smoothly, but after she met her deductible, she ran into trouble. At her next appointment, she was charged in full for the treatment, and her doctor said she hadn't met her deductible. The same thing happened when she tried to fill her prescriptions. She called BCBS and they told her it was a glitch in their software.
After calling a representative at the insurance company multiple times and dealing with the mix-up almost every time she went to the doctor, three months later she finally received a letter from BCBS confirming she had met her deductible that she could bring with her to every appointment. “There is still confusion,” she says. “The problem is that most people don't stay on top of it.”
Her Takeaway on Obamacare: "For my health, it was the only option I had, but it's a freakin' headache. The system is not set up well yet. My coverage is exactly the same as what I had before. It’s just that my deductible wasn’t that high. If I had to pay the $6,000 deductible, I wouldn’t have been able to afford it. I think it’s cost prohibitive for a lot of people. I’m scared for next year – I think it’s going to be a nightmare. More doctors are asking for payment upfront now, and most companies aren’t offering insurance.”
4. Kathy Van,* Long Island, NY
Occupation: Realtor and Marketing Consultant
Date signed up for Obamacare: 12/1/13
Name and type of plan: BCBS, HMO - Silver
Qualify for the subsidy? Yes
Monthly Premium: $250
Deductible: $600 (certain instances where insurance won’t pay for things and had to pay out of pocket.)
Van had a sole proprietor plan PPO with EmblemHealth in New York, but the company discontinued all its sole proprietor insurance plans in preparation for Obamacare. Her plan was set to end the end of December, so she needed a new plan. She has endometriosis and sees her doctors regularly, especially her internist and gynecologist, so it was important to her to keep them.
How She Chose Her Plan: When she started researching the health exchanges, BCBS’s Silver HMO plan seemed like a good fit and was affordable for her; she called all her doctors (her internist, gynecologist, a neurologist and an ear, nose and throat doctor) to see if they’d be covered. When she asked if they took BCBS HMO plans, all said yes except the ENT. She signed up.
Her Experience Using Medical Care So Far: Her first hiccup was when she didn’t receive her insurance card or patient I.D. number. She called and spent an hour on the phone. She was able to get the I.D. number but didn’t receive the card until the end of January.
That same month, she was having severe pelvic pain. She tried to schedule an appointment with her internist, but she was told the office was no longer accepting BCBS through the health exchanges. She called her gynecologist and discovered the office was unable to accept Van’s insurance until March, when the ACA paperwork went through. She found a different gynecologist specialist who was covered under the plan, but was two hours away and for reasons unrelated to Obamacare, had trouble ordering her test.
Finally, Van found a new internist nearby and after a month had passed since first trying to see a doctor, she had the test. It revealed two large cysts on her ovaries. If she had waited much longer, the cysts could’ve burst and seriously endangered her health. She was put her on medication to shrink them, but the experience rattled her. She filed a complaint against the insurance company with the NY Attorney General’s office for dropping her doctors and they told her they’ve received many similar complaints.
Her Takeaway on Obamacare: "Before, I had greater flexibility with choosing doctors. Now, the insurance companies have decided what to offer and not to offer. I believe it will even out over the next few years but for those of us caught in between, it stinks. My flexibility and choices are gone. I have looked into getting on a group plan to get broader coverage but right now there isn’t one I can join.”
*Van’s last name was changed at her request
5. Jen Hancock, Manatee County, FL
Occupation: Self-employed owner of Humanist Learning Systems
Date signed up for Obamacare: 10/2013
Name of plan: Aetna Classic 5000 - Silver
Qualify for the subsidy? Yes
Monthly Premium: $291, plus another $41 for dental coverage
Deductible: $10,000 for family
Jen Hancock and her husband have always been relatively healthy, but her husband lost his job last June and they were without insurance before Obamacare went into effect. They have one son who has epilepsy and qualifies for Medicaid.
How She Chose Her Plan: Hancock researched various plan options using the Healthcare.gov website and called a representative to ask questions, as her family’s financial situation is ever changing. “I wanted to understand what my tax liabilities might be if our financial situation changed.” She tried researching plans by going to the insurance companies’ websites, but it wasn’t helpful; that didn’t tell her what their subsidy would be. Once she found a plan that she felt met her family’s needs, both in terms of risk and out-of-pocket costs, and included all of their doctors, she went with it.
Her Experience Using Medical Care So Far: She’s had no issues so far with her regular check-ups and blood work ̶ everything has been covered and her co-pays were what she expected. In March, Hancock’s gallbladder failed and she went to the emergency room, had a CT scan, and stayed in the hospital for a week. The total bill was $88,000, but her out-of-pocket cost was just under $5,000. “Obamacare saved my life,” says Hancock. “I am very sure that had I not had insurance, I would have waited another day ̶ and that delay would have probably killed me.”
Her husband has also ran into unexpected medical issues this year ̶ he had pneumonia, ended up with an infection and had to be hospitalized. During the year, Hancock had one dispute over a payment to her anesthesiologist, but the insurance company settled it. Her family has spent about $20,000 in medical bills and premiums this year, but Hancock believes their out-of-pocket expenses this year would have been well over $100,000 without insurance. “It’s basically the difference between hanging in there economically and bankruptcy.”
Her Takeaway on Obamacare: “The benefits were exactly as I understood them to be. It’s one of the better policies we have had and one of the better companies. The insurance company has been a joy to work with – and assuming the premiums and our subsidy are the same next year, we will definitely be staying with them. It’s been an incredibly positive experience considering what we’ve been through medically this year. The old system was totally broken. We feel so much more secure.”
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