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Whew! I'm done. I hope I am any way. My situation is such that I haven't had any large medical bills in years. Literally $0 from 2008 through 2011, $59 in 2012 and $80 this year. So I selected a Bronze plan for $446.45/month with a $6,350 deductible and $6,350 maximum out of pocket. I studied the other plans but there is no sense purchasing the higher priced plans with lower deductibles if I haven't needed that much coverage to date.

We spend more on veterinary bills for our cats and dog than we do on ourselves. Well, that is until this year. My husband turned 65 in 2012 so he's covered by Medicare and for the first time in years he's actually had major medical bills thanks to a 16-day stay in the hospital in October. And now he has to take several prescription drugs daily, so the last couple of months have been an eye-opener for us.

I had gone through the application process last month but was stopped in my tracks when I entered my husband's social security number incorrectly. I patiently waited for it to be fixed for several weeks before I finally gave up and created a second account with a different email address. Then I was able to get through the entire process, at the end of which I was presented with a choice of 96 plans. With my husband being released from the hospital, our days were filled with follow-up visits to doctors, and so I decided to wait to select a plan until things settled down around here and I had time to think. And so I went back to healthcare.gov on Tuesday where I discovered the waiting room and the fact that the 96 plans had diminished to 12 plans. I called the toll-free number and was told there was a glitch in the system, and to wait a few hours and log back in.

I waited until yesterday when I signed in to discover that the number of plans available to me went down to 9. I vented my frustration in a diary asking for help from this community. It turned out to be a good thing because I learned some additional information that I might not have found out if I hadn't written that rant.


You must enter an Intro for your Diary Entry between 300 and 1150 characters long (that's approximately 50-175 words without any html or formatting markup).

Ignorance may be bliss but it is not a defense when it comes to following the law. For example, as I mentioned above, my husband turned 65 last year. He received his Medicare card in the mail, but we didn't sign him up for anything extra like a supplemental plan or a Part D prescription drug plan. For almost a year nothing happened until I had to call an ambulance to take him to the hospital in October because he couldn't breathe. He's doing very well now, and has some really great doctors.

This was a wake up call that we needed to take the time to actually understand how Medicare works and what our options are. We were already being bombarded with mail from every insurance company that offers Medicare Advantage plans, prescription drug plans and supplemental plans. Not that just having Original Medicare isn't a good option. It's worked out fine for us. Out of the approximately $31,000 in hospital stay, doctors visits and prescription drugs, that have come in for the ordeal, our out of pocket has been slightly over $2,000, and that includes the $1,184 deductible we had to pay for the 16-day hospital stay. On Saturday my husband had to go back into the hospital for four days, but because it was within 60 days of his last stay, the $1,184 deductible covers that second stay too. This also serves as a cautionary tale because if this had happened to uninsured me we would be looking at some major debt. I'm very relieved to know that there is a limit to how large the expense will be if I get sick in the future.

But I digress. We did sign up for a Medicare Advantage plan that takes effect in January. Since my husband was just in the hospital, he's not eligible to apply for a supplemental plan. We were mainly concerned about signing up for the Part D Prescriptions because that has become a very expensive part of his healthcare needs right now. What I did learn and wanted to share is that since we did not sign him up for a Part D plan when he first became eligible, we now have to pay a monthly penalty for the rest of his life. It works out to about $4.30/month, which isn't going to break us but had we known that by failing to sign up for Part D when eligible, we were going to have to pay this penalty we would have signed up. I just wanted to share this so those of you who haven't reached Medicare age yet will be aware of this when you qualify.

Along the same lines, I learned a similar important point in the comments from my rant last night. If you think you may qualify for the subsidy, you need to get your healthcare through one of the exchanges. I'm in a situation where I don't exactly know what my income will be in 2014 since most of my income comes from commissions and it fluctuates. Remember, yesterday all the plans available to me were not showing up. I mentioned that I didn't want to actually use the subsidy but would prefer to get it as a credit on my income taxes at the end of the year. Somebody mentioned that if I wasn't going to use the subsidy, I could just buy a policy online from any insurance company offering policies because they all had to be ACA compliant.

Turns out that further discussion proved that not to be true. I may or may not qualify for a subsidy in 2014. It really all depends on what my Adjusted Gross Income ends up being at the end of the year. From what I estimated, the healthcare.gov site said I qualified for $107/month (or $1,284 for the year). I had three choices. I could apply all of the $107 and reduce my monthly premium, I could apply part of it, or I could apply none of it and get a $1,284 credit against the taxes I owe for 2014 ... if nothing changes.

According to the comments in yesterday's diary, if I went online and purchased a policy, I would not be able to take the $1,284 credit on my income taxes if I did not apply for the policy through a state or the federal exchange, even if I qualified for it. I thought how strange that sounded. If you qualify for a credit you should be able to take it even if you didn't get your insurance through an exchange, Right? WRONG! WRONG! WRONG! According to the IRS:


In general, you may be eligible for the credit if you meet all of the following:

    buy health insurance through the Marketplace;
    are ineligible for coverage through an employer or government plan;
    are within certain income limits;
    file a joint return, if married; and
    cannot be claimed as a dependent by another person.

If you are eligible for the credit, you can choose to:

    Get It Now: have some or all of the estimated credit paid in advance directly to your insurance company to lower what you pay out-of-pocket for your monthly premiums during 2014; or
    Get It Later: wait to get all of the credit when you file your 2014 tax return in 2015.

The Premium Tax Credit

The IRS is very literal so when they say that one of the conditions is that you buy health insurance through the Marketplace (Exchange), you better buy it there.

I think that some time around April 2015 there are going to be a lot of angry Republicans throwing fits because they could have qualified for a tax credit, but since they stubbornly refused to go to the exchanges to find out what their options were, will not be able to take the tax credit. I met one of those people on Facebook (a friend of a friend) who was complaining that her insurance premium went up $250 per month. I asked her if she did comparison shopping on the exchange, and she was adamant that she wouldn't be visiting that website. I wonder how many Republicans are paying more for policies than they have to because of their partisan refusal to comparison shop at an exchange?

UPDATE: Just saw this on The Last Word with Lawrence O'Donnell guest hosted by Alex Wagner tonight. There's a great site to help remind friends to get covered. It's appropriately called Tell A Friend Get Covered, and this video is from the site.

Extended (Optional)

Originally posted to hungrycoyote on Thu Dec 12, 2013 at 04:52 PM PST.

Also republished by Community Spotlight.

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