Let me start off by saying this: I don't want to see ACA repealed in any part. I know it's helped millions, and it's the best health care reform we're likely to get any time soon.
As a bit of a disclaimer I should also mention I've been on some form of Medicaid or nothing most of my adult life, so I'm also pretty new to how “real” health insurance works. I'm going to share my experience with Obamacare, and this is also for those of you who still get health insurance through your employer and maybe aren't aware of how the Marketplace works. It's a long, convoluted story so follow below the orange squiggle.
My husband and I live in Utah, a state that has thus far refused to expand Medicaid or start a state exchange. We're both too old to be on our parents' insurance. We work together full time, and our company does not offer any benefits at this time. I started working there about a year and a half ago; I specifically asked about it at my interview and they said they would start offering health insurance last year, and I'm pretty sure when I applied that it mentioned benefits on the careers page as well. Actually that was one of the reasons I accepted the job in the first place. Well 2014 rolls around and I don't hear anything new. I no longer qualify for Medicaid, so I talk to our corporate manager and said I need to have health insurance, what can you do for me? He puts me in contact with their insurance broker, who quotes me something like $235/month just for me, with a $6000 deductible. F that. So we go on the Marketplace web site and apply so my husband and I can get something before I get kicked off medicaid.
Somehow the application gets corrupted, so I can't access it and change it at all and have to go through the call center to finish it and enroll in a plan. Our combined income would be around $30k/year. We pick a silver plan with no deductible and we pay $71 a month and get a $300-something subsidy for a SelectHealth silver plan. All well and good; the plan is actually rather decent. I could see the same doctor I had been seeing. We actually ended up getting married a couple months early so my husband could be on it as well when the coverage started on April 1. I also picked a dental plan through a different company while we were at it; my husband still had his dental insurance.
A few months later stuff changes at my work and my husband gets hired on there with me. This raises our income by roughly $10k/year. So we call the Marketplace again to report the change and now qualify for a lower subsidy, bringing our monthly premium up by about $100 and suddenly a $2500 deductible if we want to keep the same plan. So we pick a different plan with a higher monthly premium and a $500 deductible. This is an Arches gold plan, starting Sept. 1. I also asked if this would affect my dental plan, and the woman on the phone said no; this is relevant later on.
This is where things start to get interesting.
I go sign in to our account on the Arches web site, and they have our address wrong. So I call them and they say I have to call the Marketplace and have them fix it, I can't do it directly through Arches. So I did and they eventually fixed it, a couple months later.
Anyway, I've been type 1 diabetic since 2007. I've never had a problem getting the same kind of insulin other than Utah Medicaid making me use old-fashioned vials and syringes instead of the pens. I could deal with it, it was just dumb because I never used all of the vial before it went bad where the pens keep as long as they're refrigerated, so I always use all of them before they go bad and a box of 5 pens lasts 2-3 months. I use Lantus and Novolog. Some insulins are made from bacteria, and some are made from yeast. The ones I take are bacteria-derived.
So I get my insulins refilled once, and then suddenly the first week of December Arches decides I need a prior-authorization to keep getting them, or switch to the yeast-derived ones. It probably wouldn't have been that big of a deal, but you never know how changing to a different medication will affect you or if you'll have side effects or an allergic reaction. While rare, some people can be sensitive to yeast, for example. And our work doesn't offer paid time off and we can't afford to take time off if something did happen. My blood sugar test strips have been changed several times in the last few years, but that's mostly a minor annoyance because they're pretty much all the same and it isn't like something you ingest or inject. I always make sure the plans we look at cover the insulin I take, and the Arches one said they did on their formulary.
Anyway, so I bring the messages in to my clinic to give my doctor to get the prior-authorization, but he happens to be on vacation that week. Because of course he is. So they say they'll send it to the provider they have on duty. A couple days go by and I don't hear anything. So I call them again and they say they'll send it right away, which the provider sent the prescription to the pharmacy, and not to the insurance company. I call the pharmacy to check on it, and they didn't hear anything from the insurance yet. By now it's Friday afternoon so I start calling the clinic every 15 minutes and argue with them about how to do their job. Finally the woman on the phone says they'll send it to the insurance and I can pick up a sample at the clinic on Monday, as I'm down to my last 100 units or so of Novolog (which I take with meals). I call the pharmacy again Monday to check on it and they still hadn't heard anything. I go in to the clinic to pick up the sample and then the doctor is back so I tell them once again to make sure the insurance gets the prior-authorization. My doctor actually does his job but of course the insurance denies it. Of course. But at least I had enough insulin to get me through until January.
So we go back on the Marketplace web site and apply anew for 2015 coverage. Arches had sent us a letter saying we would be automatically re-enrolled in our plan and the monthly premium would only go up by $9. But when I searched for it on the Marketplace web site so we could decide to keep it or not it wasn't on there and I called them again and they said it had changed. So we picked yet another plan, and now we're up to a $468/month plan with a $69/month subsidy, and $1000 deductible. But at least this plan actually covers my insulin pens. All good again, so far. I also had to call Arches and tell them we were canceling our plan and had picked a different one, because the Marketplace didn't do it like they're supposed to.
Meanwhile I had to get a bunch of dental work done. I also had never had dental insurance on my own before, so had no clue about how they work, the 6-12 month waiting periods, and low yearly maximum benefit (I think mine was $1000.) unless you get it through your employer. I hadn't been to a dentist in a couple years either, so in October I went in and had a cleaning and exam, and ended up getting a root canal, four fillings and two crowns, the last of which I had done on January 7. I went to my husband's dentist, even though they didn't take that specific plan but they gave me a discount just for having it so I figured it was worth it.
January comes around and I never got a premium statement for that month. I figured with the holidays they were behind so I called on January 7 and asked about it; the girl on the phone said they had just gone out in the mail. Another week goes by and I still didn't hear anything so I call and ask about it again and ask if I can do a payment over the phone. The woman on the phone said they don't do phone payments and that things changed with the Marketplace and I would have to re-enroll in the plan. So now I don't have dental insurance anymore because neither they nor the Marketplace notified me of any of this. And if I understand it correctly you have to pick a dental plan the same time as you enroll in a health plan, which of course by then it was too late. I decided to just not bother fighting it because I realized how much of a ripoff the dental insurance is. Add in starting over with another 6-12 month waiting period and it just isn't worth it. Luckily I had enough money in the bank to pay for it and everything I needed done is done for now.
So anyway now we're getting on to tax season. So far we've gotten one 1095-A form, which only has the few months we were on the SelectHealth plan on it, and it has our old address, which we weren't even living at when we first signed up (it's my mother-in-law's house) so why they started sending us mail there is beyond me, other than they can't seem to do anything right and every time I call they say something different. We're supposed to get one form for each plan we were on, and one from each of the insurance companies. I called the Marketplace and asked them about it and said our address was wrong, and they said they'd correct it and send a new one. Guess what? We got another one, but the exact same one we already got! They didn't fix anything. If we ever do end up getting the rest of the forms I think we'll probably just take it to a tax preparer this year; I don't even want to deal with it. I've been doing my own taxes for the last several years because why pay a tax preparer which would eat up a big chunk of my refund? But nobody is going to know how to do any of it yet and from what I've seen so far it's going to make everything more confusing.
Finally, not long ago our GM at work gave us an update on the health insurance: he said they should be starting it this summer, and they've already gotten in trouble for not offering it but that it would be crappy, bottom of the barrel insurance. We haven't heard any more about it beyond that though. The excuse they gave us was that they aren't a national multimillion-dollar company. Bah!! They have several locations throughout the western states, most of which are franchised.
I am exhausted from dealing with all this bullshittery; I just don't want to deal with it anymore. Our best option right now seems to be to find full-time jobs that offer health insurance so we don't have to deal with the Marketplace. I've been trying for the last year; I've already applied to Costco three times and haven't heard anything. Anything less than full-time with full benefits is a waste of time at this point. I don't want to ask for another raise at our work because that would mess everything up, and I don't want to move to a bigger apartment because we'd have to report the change of address to the Marketplace and they'd probably screw it up if we did.
We can do better than this. We HAVE to; we must demand better. Demand better benefits and better paying jobs. I've been saying for years that health insurance shouldn't be dependent on your job and vice versa. While the ACA is a baby step in the right direction (more like dipping a toe in the water), it seems to have made a mess of things more, at least in states that didn't expand Medicaid and open their own exchanges. Medicare for all is the next logical step; the money is there, we just need to boot the troglodytes out of congress and elect humans so we can make it happen. Deductibles are bullshit. Coinsurance fees are bullshit. There's no reason we should be paying anything beyond a monthly premium and copays for prescriptions. $10,000 deductibles are more than a lot of people can ever hope to pay in one year; nobody should be paying 25% of their income for health insurance.
I mean, going from a $325/month subsidy to $69/month, when our income didn't even really increase all that much. I have to wonder what the subsidy is for the cutoff at about $65k/year income, $1/month? That's ridiculous. It's also bullshit that dental and vision aren't included in most health insurance plans. As if your eyes and teeth aren't part of your body.
I'm sure we're going to hear a lot more stories like this soon. Please feel free to share your experiences in the comments.