So, it's official: I cannot keep my medical team together with a marketplace policy through ACA in Indiana. I am a cancer survivor, 18 years post treatment and N.E.D. For the uninitiated, N.E.D = No Evidence of Disease. For breast cancer survivors, this is as good as it gets, even 18 years later. Follow me over the orange squiggly-do for a reality check.
So here's the deal. This afternoon I finally attempted to navigate www.healthcare.gov around 4pm ET. Although I already had an account it still took me a full 90 minutes to fill out the application that confirmed that I qualify for a marketplace policy and subsidy. Yea!!
Finally got to see what was available in Indiana. The good news? There are 12 plans. The not-so-good news: they are from 3 insurance providers. I live north of Indianapolis in Hamilton County which is the southern edge of one provider: PHP or Physicians Health Plan of Northern Indiana. i ruled them out immediately because my oncologists are out-of-network in Indianapolis, one county south of Hamilton. Next!
Anthem. They have served me relatively well for the decade that I've been in Indiana's high risk pool (ICHIA). Expensive, but comprehensive.
MD Wise. A relative newcomer that looks like they've got it together. They are currently serving Hoosier Healthwise, the Healthy Indiana Plan, Indiana Care Select and now the MDwise Marketplace.
So I'm thinking ... so far so good.
Check provider networks.Anthem will be providing services through the Community Health Network,, a progressive organization where my primary care physician (I've been with her for a decade) and my physical therapist (I've been with her for 18 years) practice.
It's been widely reported that one of the ways that insurers have been able to keep premiums more affordable on the exchanges is by limiting provider networks. If it's important to you that certain doctors or hospitals be in your network, check those details before signing up.
Smaller isn't necessarily less desirable, say experts. "If all your providers participate in a narrow network, it's not a problem," says Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation.
If I stick with the new Anthem network (my primary care doc and physical therapist) the IU Medical Center where my world-class oncologists are located will be out-of-network. No coverage. Zip. Nada. These guys saved my life. Literally. I'm here today because of the care I got from them in 1995.
So what to do? Do I stick with my primary care physician and physical therapist that I see on a regular basis? Or do I take a catastrophic policy that will give me the coverage I need if cancer returns? For the record, I'm from a cancer family. I've had more than 12 family members die of cancer in my life time (including my mom and dad) and we currently have 6 survivors. Obviously, it's in the DNA.
I qualify for a hefty subsidy, so I really need to do this. However, this is a real dilemma for me.
Don't let anyone tell you that it's a myth that you can't keep your doctor. It's not. It's a trade off that I'm willing to make, but it's not going to be an easy choice.
Love to hear your opinion on this.
Several people suggested that I update the diary with a bit of history about how I got into this situation. In the comments I clarified that although I currently have health insurance, it's through a high-risk pool that will be dissolved on 12/31/2013.
Indiana Comprehensive Insurance Association, (8+ / 0-).
its a 30-year old non-profit that Indiana created to insure the uninsured. Anthem has been managing it and it's expensive. We've been paying a 50% premium over individual insurance rates to obtain coverage.
ICHIA will be dissolved on December 31, 2013 because the ACA mandated that pre-existing conditions no longer automatically disqualified us from individual insurance policies.
It's a long story, but ICHIA has been my only option and now I have to move to the ACA
The long story is that I was diagnosed with breast cancer in 1995 at a time when I had an excellent individual health insurance policy through my business. In 1999 that insurance company sold it's individual policies to another insurance company. Same rates, lesser policy, but I had no choice since I now had a serious pre-existing condition. In 2003 the second company made a "business decision" to no longer insure individuals. Arrivederci! Good luck! Sayonara! No one would insure me except ICHIA, a progressive, visionary non-profit that Indiana created 30 years ago before Indiana went nuts.
Now the ACA has taken away the need for ICHIA. I actually wrote a diary about this here.
I am a fan of the ACA. I love Obamacare. It's not my intent with this diary to bash it. Simply to open eyes to one more thing that needs tweeking.
AND to ask for you thoughts about how to navigate this, so thanks for stopping by!
I want to give a h/t to guyeda in the comments for pointing out that
MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 by the Health and Hospital Corporation of Marion County and Indiana University Health to help vulnerable populations needing health coverage in Indiana. Our mission is to provide high quality health care. We only take care of families in Indiana.Thanks to everyone who has helped me think through my dilemma. How can I not support the local, nonprofit health care company? Decision made. Thank you.