Healthcare.gov easier to use, but ACA decisions remain mind-boggling

     (<a href='http://www.shutterstock.com/pic-125898980/stock-photo-female-doctor-with-stethoscope-holding-piggy-bank-with-bandage-on-face.html'></a> image courtesy of Shutterstock.com)

    ( image courtesy of Shutterstock.com)

    My health insurance company thinks I deserve a metal. On January 1, they would have awarded me a bronze health plan and I didn’t have to do a thing — except pay more than twice as much as I do now.

    To explain: I did not purchase my 2014 health coverage through the health care marketplace. I tried — repeatedly — but just couldn’t hack into Healthcare.gov. So last year, having received a “Your plan is ending” letter, and with the deadline looming, I chose a new plan from the same insurance company, increasing the deductible to reduce the premium. I thought I was set.

    Bronze coverage, platinum stress test

    In August, I received another “Your plan is ending” letter. The details arrived in November.

    I learned that if I did nothing, my insurer on January 1 would place me into a plan that bumps my premium up from $255 per month to $543 per month and raises my deductible from $2,500 to $5,750. The letter helpfully pointed out that I could choose another plan, or could get insurance through Healthcare.gov.

    Under the Affordable Care Act (ACA), health plans are categorized like Olympic medals: bronze, silver, and gold. There is also a platinum, which doesn’t exist for athletes and is almost as impossible to achieve for consumers. I would suggest rebranding them rust, tin, brass, and titanium.

    Maybe you’re wondering what I did to earn such an expensive rate. Me too. In 2014, I had four doctor visits, including an annual checkup. I also had a blood test, and two recommended screening tests.

    No Brussels sprout discount

    I don’t smoke. I exercise often and eat the occasional vegetable. I am, however, at that awkward age, somewhere between Young Invincible and Medicare.

    Having been self-employed for most of my career, I am accustomed to choosing and paying for health insurance. It has never been fun. Without a group to insulate us against spiraling costs and negotiate for discounts, individual payers are defenseless against insurance companies.

    So long before the ACA, I had endured a few breathtaking increases. My premium once went up by 50 percent simply because I turned an age ending in zero. But that pales in comparison to this increase.

    What’s going on?

    Is this happening because the ACA is the work of the devil, as many seem to believe? No. It’s just a world-rocking change in a mammoth, complicated, costly system shaped by politics, corporate interests, lobbyists, and money, lots of money.

    The intention behind the ACA and earlier attempts to reform and extend health care is valid: Everyone deserves health care. Getting from that noble idea to national legislation, however, is … well, we’ve all witnessed it. Then, there is the ongoing refusal by Congress to accept that the ACA is law. Instead of correcting shortcomings in the legislation, they’ve spent most of the time since passage using it as a political weapon and calling for its repeal. This would be the same Congress whose members have long had much better health coverage than their constituents. Even now, as millions of us sweat out the details of obtaining new insurance, Congress is fiddling. In addition, there’s a significant possibility that a pending Supreme Court case could effectively gut the ACA. The situation is fluid, the territory uncharted, and we’re the pioneers, hoping to struggle over Insurance Mountain before winter.

    Without knowing what to expect, we have to choose a cover for our wagons and hope it keeps out the flaming arrows coming from every direction. We conserve our resources and eye the horizon for desperadoes, who have more influence with the law than we do. We hang on and hope to stay healthy.

    Difficult decisions

    On the bright side, Healthcare.gov is infinitely easier to use this year, but the decisions remain mind-boggling. I had 40 plans from which to choose, with monthly premiums from $117 to $768 and annual deductibles from $0 to $6,600. What must unaffordable care cost?

    There are also co-pays, out-of-pocket costs, and networks and tiers to be considered, as well as hospitalization and pharmaceutical coverage. How intimidating is this for people choosing insurance for the first time? Health care navigators, specialists trained to assist individuals selecting insurance, can help, but they’re in short supply, and those who need them most may not even know they exist.

    I spent more time than expected in two meetings with my incredibly patient navigator, Carol. Though I had narrowed down my choices, signing up was still complicated. It was a relief to have her help.

    Eventually I chose coverage close to what I would have been assigned, under the same insurer, with an important difference: It will cost me less than that plan ($209 per month) because I qualify for a tax credit. The deductible, however, is still $5,750. So unless something awful happens, I expect to pay for most of my care in 2015.

    Marketplace subscribers: Like money in the bank

    I still wonder how my premium more than doubled. Also, why did my insurer all but force me into the healthcare marketplace, where I could purchase from a competitor? (Though the chance is somewhat limited: 29 of the 40 plans for me in southeastern Pennsylvania are provided by Aetna or Independence Blue Cross.)

    This skeptical pioneer thinks there’s a bigger prize at stake than subscriber loyalty: federal dollars. Lots of them. For every marketplace subscriber who qualifies (those earning 100 percent to 400 percent of the poverty level) the government pays a portion of their premium directly to the insurance company. Isn’t it inevitable that whenever the federal government throws money into the pot, things get more expensive?

    Hollow coverage

    So at these prices, everybody should be getting really good care, right? Not exactly. “They sign up, have that card in their wallet, and go for initial care,” Carol explained, referring to the annual check-up and immunizations provided without charge under the ACA. “What we are finding is that if follow-up care is needed, they aren’t returning.”

    This is because many of those who receive the most financial assistance with premiums choose plans with low up-front costs and high co-pays and deductibles, which they can’t afford. They have enough insurance to find out that they have a health issue, but not enough to do anything about it. “It will have to be addressed over the next several years,” Carol said. As will many ACA gaps and glitches, assuming the act survives Congress and the Supreme Court.

    Choose or else

    So I am going for the bronze in 2015. I’ll pay a little less per month than I do now, but my insurer will receive much more in total. My deductible is high, so I hope I don’t fall out of the buckboard into a raging river. Buckle up, fellow pioneers. The mountain is high, and it’s going to be a bumpy ride.

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