Hello fellow Kossacks.
I am posting about the nuts and bolts of my recent experience with the ACA as a super small business owner in New York State. I am one of the 100-and-some thousand folks who has selected a plan and is now awaiting the arrival of my first premium bill.
First, it took a couple of frustrating weeks to get registered. The website appeared to be changing on a daily basis, and I finally was able to see the plans available to me. My spouse and I own a super small business with no employees, so we are required to go on the individual exchange.
Before ACA, our current plan: Our monthly premium with a major insurer in this state is currently $655 per month for two of us. Zero dental mind you. Our deductible is just shy of $12,000 annually. We have an HSA. In addition to our premium, we spend anywhere from $0 to $2000 per year toward our deductible. I believe that, due to the ACA, my flu shot was covered 100% for the first time last year--before that, I remember shelling out something like $30 for the shot at a local pharmacy every year.
After January 1, 2014, here is what we get:
Insurer: Health Republic (covers NY, NJ, and OR).
We went with the "gold, primary select" option. What this means is that we have to have a primary physician on record where we start when we have a problem other than an emergency. I am okay with that, since I currently view my primary physician through that lens, anyway. I did a quick physician locator check, and ours was fortunately in the ACA database, so no change there--I selected her.
Pro: There is never a co-pay when I visit our primary.
Con: I have to list a primary.
Premiums for the "primary select" plan were significantly less than the open plans (10% to 20 % less, as I recall).
Cost: We do not qualify for subsidies. That said, our monthly premium will go up by about $200 to around $850.
However, we will now have dental insurance for the first time in about ten years, and that is huge for us in NYS. The dental plan costs an additional $22 per month for both of us and is an optional add on. It is not the best dental insurance in the world, but considering our cleanings cost about $120, cash, for each of us every six months, it makes sense. Plus cavity fillings are included. Cleaning and filling visits require a $48 co-pay per visit and not per service. Financially, that makes sense for us. Bigger things, like root canals, may or may not be covered, according the official I spoke with--they are going to figure that out over time. Fine.
The big news, however, is our new annual deductible: $500 for the both of us. Repeat: $500 for the both of us. That represents a tremendous advantage should something really bad and really big happen--especially if things go wrong two years in a row. Plus, we cannot get dropped; there are no lifetime limits; all emergency services are fully covered; and all preventative care is fully covered.
As a business owner in NYS, I am very, very happy with this deal, especially with the cost controls in place.
I cannot tell you how frustrating it is to receive a 20% or 30% premium increase notice. Every. Single. Year. Like clockwork. Man, that sucks rocks! It gets me enraged every time--especially in those years where we have not filed a single insurance claim (most).
The way I see it, our premiums would have gone up to $850 per month anyway. We would never be able to afford reasonable (i.e. "real") dental insurance in this state. And our deductible amount would only go up the keep ever increasing premiums as low as possible. A $20,000 annual deductible was sounding about right to me at the rate our increases were coming, and that would just stink.
Even with the $200 per month increase in the premiums, the additional benefits I will receive makes it totally worth it--you just have to think a little about the future, do the math, and factor in the very likely chance that I, in my mid-40s now, will need to draw on my insurance further as I age more. Makes sense to me.
For comparison, I lived in Japan for about seven years as a teenager and then as an employee of the Ministry of Education (JET Program for those of you who know it). When I was working in Japan, post college, I had to pay monthly premiums for my Japanese social insurance, and the cost (in 1995, mind you) was about 45,000 yen in Kagawa Prefecture. That is roughly equal to $450, and I had a 30% co-pay requirement on top of that, as I recall.
When I moved to Japan as a teenager, my mother and I were pretty broke. At that time, according to my mother, our monthly premium was about $50 for the two of us. As she became more successful in Japan over the following decades, she paid more and more. She never complained, however, always pointing out that she was happy to help folks in Japan who were in need the way we were. As a kid, I found that logic to be rational and just. It is called "helping each other out." Most every family has its losers, I believe, but we do not leave them to die in the streets.
I just wanted to put those numbers out there.
Finally--please note that I broke down after getting registered and went with a "navigator." He was my insurance broker for years, so we had a working relationship. I just had not considered reaching out to him for help since I figured we would be dropping the plan purchased through him. I did not want to be rude. My mistake! After a 40-minute screen sharing session, everything was clear to me. He really, really helped me out on that. So thank you to the navigators. Plus, my understanding is that he will now receive a commission, and I am happy to send some business his way.
Health Republic appears to be very financially sound at the moment, despite it being a brand new entity. Hopefully, they will get cost controls in place rather than pure greed enhancers, and we can all work together to make this happen. The U.S. "ME ME ME" generation sucks, and we need to rebuild teamwork into our thinking--this "every man for himself" approach may have been great for 1850 expansion (fear of starvation is a good job-finding motivator), but blows for 2013 social stability.
We all know the deal; we all know we have to work. So let us make America a better place to work. That will require a certain amount of cooperative social engineering, but if you think that is not already happening, you are a fool.
I am all for success and reward, but when some folks are getting paid more than $2 billion per year while 1 in 7 is on food stamps, well, there is no balance to our society, and we the people must fix that. The ACA, from my perch, is a necessary first step forward.
Would I have preferred single payer? Absolutely. The infrastructure is there--everything is set in place for Medicaid buy-ins, but the political reality is nope.
Additional note: Our child is on NY State "Child Health Plus" which is an extension of Medicaid, I believe. We get no subsidy there, either, but that is capped at $250 month, regardless of income. It is single payer, from what I can tell. EVERYTHING, including dental, is covered and then covered again. We are extremely satisfied with NY's CHP, and it even covers our progressive, holistic pediatrician. No co-pays, no nothing. Full dental. $250 per month. One bill. Lovely.
So from 0 to 18--check. From 65 to death--check. Medicaid. From 19 to 64--fuck you. So here we are, trying to deal with that reality. At 44, 64 still seems like a pretty far ride.
Finally, please help end the war on cannabis! Pot heads should not be in cages.