After successfully logging on to healthcare.gov several times last month, completing my application, and being approved for a tax credit (subsidy) towards premiums, I got stuck. I tried to log back in several times over the past few weeks and couldn't. I called the 800 number several times and they couldn't get into my account either. It appears that my account was locked up.
Today, I finally had success. I enrolled in a health plan! So, the good news is, the site and call-in support appear to be working. The bad news is that it's more complicated than it should be. Details to follow...
Last night, I called in to the 800 number and the woman I spoke to was unable to get into my account. She told me that it's okay to submit another application (it's not) and to try again. Her reasoning was that I had created my login before the exchange opened and created my account early, before they had made major changes to the website over the past couple of weeks, and I needed to start over.
This morning, I created a new account with another email address I have and achieved success! I entered all our information and was approved with a slightly different subsidy (due to the fact that I'm self employed and any estimate of earnings for 2014 is a stab in the dark). I could have enrolled online, but I had a question about my application and decided to call in again.
I again was helped by a very friendly, patient person. I must say that the telephone support people are wonderful, although some know more than others about the process. We completed the enrollment for me and my husband on the phone. I had already researched the plans, so she just gave me some pricing and I picked one. I still have the option of changing the plan up until it goes into effect and I'll be dealing with Blue Cross at that point, so it should be smoother.
We chose a high-deductible ($4000) Bronze plan rather than Silver for a few reasons:
1. We will be able to open an HSA and put the difference in premiums (more than $200 per month) into an account to pay for our medical care. If we don't use it all in a given year, it accumulates and we come out ahead.
2. Even though the Bronze plans have higher-deductibles and coinsurance, ALL plans are bound by the ACA's $6,250/$12,500 out-of-pocket maximums. This is a lot of money, but on the off chance we need that much care, we can find the money to pay it. The fact that Bronze and Silver plans both have the same maximums makes the differences between the plans relatively minor -- within one to two thousand dollars if you max out versus a similar difference in what you pay out over a year's worth of premiums.
3. We usually don't use more than $2000-$3000 worth of health care in any given year (and now the preventative part of that will be covered 100%). If we end up needing more care and can put it off until 2015, we'll be able to switch to lower-deductible coverage for 2015 during next year's open enrollment. It's a bit of a gamble, but we're betting on staying relatively healthy.
4. We would have had to choose a Silver plan to qualify for assistance paying the out-of-pocket costs. However, I'm hoping that our income is higher than my estimate, which is close to the limit for this help, and we are healthy and don't anticipate needing to spend that much on our care this year (knock on wood!).
As self-employed people, we've always had to weigh our insurance options in this way, so this is nothing new to us. We've also always had to question every procedure and prescription with our doctors, letting them know that we pay out of pocket for them. This helps keep our out-of-pocket payments low and our doctors often change their recommendations to lower-cost options when they know this. (This highlights the problem with the current fee-for-service system.)
To those of you who haven't signed up yet, I have a few recommendations:
1. Go online without logging in to research the plans before you apply. You will not see the actual premium costs (especially if you are older), but you can look at the deductibles, out of pocket maximums, and networks before you need to decide. It's especially important to look at the networks since the Healthcare.gov people don't have access to this information. I found the insurance company websites to be most helpful for this. For example, BCBST in Middle Tennessee has three networks available: E (skinny), which is like an HMO and only includes doctors and facilities in the St. Thomas group, S (narrow), which had all our regular doctors and hospitals in it, and P (wide), which includes most doctors and even some multi-state options. Also, if you're interested in a higher deductible plan with an HSA (healthcare savings account), you need to check with the insurance company to make sure the plan has this option. Again, they don't know this at Healthcare.gov.
2. Once you've chosen which plan or plans you're interested in, go ahead and create your account and apply. If you've already created an account and can't log in, clear out your cache and cookies and try again. If you still can't log in, call the 800 number and have them go through the enrollment process with you. They are very patient and helpful (although they can't really help you with the different health plans...they can only tell you your premiums for each plan). They can stay with you on the phone all the way through enrollment now. Yay!
Our bottom line of approximately $260 per month is great, but it's complicated:
1. My last private insurance premium (which ended three years ago), adjusted for annual increases, would be about $650 per month (just a guess...it may have gone up more if the company wanted it to). This would have given us lower deductibles and better copayments than my new plan, but we were not fully covered and our provider was not technically an insurance company and could have dropped us at any time. We were happy with this coverage, but I dropped out of the grandfathered plan three years ago when I became eligible for workplace coverage. (I recently quit that job, so we're back on the open market.)
2. Our premium is based on a relatively low estimated income for 2014. The caveat is, if our income goes up, our premiums will go up to a maximum of $689 per month, about the same as my old grandfathered plan but with higher out-of-pocket limits. We would have been one of those families that was dinged by Obamacare if we were not eligible for subsidies.
Ultimately, I'm happy with our new plan and even happier to have this process behind me. The bugs are still being worked out, and buying insurance from private companies will always be complicated. But it is what it is and it's finally working.