Looking for real healthcare.gov experiences

James

DTVUSA Member
#1
Hi everyone,
I am seriously asking for personal experiences related to the healthcare exchanges vs buying outright. This is NOT trolling for political comments. I really want to know if you or someone you actually know get a good product from .gov.

I am in the midst of some changes and am looking at all options. I easily signed up and got "approved" the other day. The site suggested I go with a fam plan which was for all three of us. I was able to view bronze and above plans. I did not see any catastrophic plans and I did not consider a separate plan for my 20 y.o. son.

All plans start at about $900. A friend who owns a small business told me he got a plant for under $500. I have to call his wife to see exactly what they got and for how many people.

I had a heart valve replaced and my wife takes a very expensive pescription. I am not sure how this throws a wrench in the gears. A distant friend had a spouse with a heart condition and they had to do the COBRA thing until the exchanges opened. I hear they are happy with what they got. Must talk with them.

I currently have an Aetna plan through an employer. That is going away. It is one of the most comprehensive plans in the US so it will be expensive through COBRA...which I do not know much about yet.

I did notice that my fam Dr and local hospital appear to accept Blue Cross and not Aetna on the exchange.


I am going to talk with a broker this week and see if they can advise. Interestingly my insurance broker started out as self insurance for the Mennonite community. Later it became a full service company offering banking, financial planning, etc. They are a pleasure to speak to and really helpful..so it is not something I dread doing.


Soooo. Can anyone tell some stories..without pushing a political agenda? Any helpful comments?

Thanks!
 

MrPogi

Moderator, , Webmaster of Cache Free TV
Staff member
#2
I lost insurance when we (wife and I) got laid off. It was quite expensive for employer provided insurance. No way could we afford to continue on COBRA at 2x what we were paying! So... The kids got on CHiP, and the wife and I get a subsidy for insurance on the exchange, we pay very little out-of-pocket. So, yea, it works for me for now. Of course, if my income rises I will have to pay back the subsidy. I guess the solution is to not make too much money until we can get employer provided coverage. Can you say "Unintended consequences"?
 

James

DTVUSA Member
#3
Ok. I am updating info for the benefit of the our forum. After consulting with a few trustworthy people I made a choice on the .gov heath plans. I am ineligible for any subsidies. I will pay whatever "full price" is for the plans. My position was eliminated recently and my Aetna insurance will vanish at the end of April. It was an excellent plan, one of the best coverages out there. COBRA is available but will cost over $2000 per month. Keeping things confidential, if that is possible, I will make too much this year for any help with the premium. Let's leave it at that. I chose the BlueCross Silver Proactive plan in my state. HMO. No deductible.

Here is what I did to make my determination.
Made sure my hospital and Drs were accepted and especially what is called Tier 1 level" preferred in my plan. No extra $ to see them. I have a heart valve replacement and need to see a cardio every year plus take at-home blood tests to check how the blood thinner is doing. I don't know if the home test system will be covered. I like having the same hospital and cardiologist available in case of emergency. I do not know how long I will be on this plan. It depends on where I land in new employment. My health is good for a 53 yo. I do know these valves "can" cause some problems at some time but I am not looking for it to happen.

My plan will cover three people. M/F/20 year old "child". One of these is taking a drug that has a retail cost of $800 per 30 days. It works with few side effects so I wanted to keep that med if we can. The max cost per refill is $250 they tell me. This was also a big deal. This med is crazy expensive but it really helps the person taking it. I could not find a better program.

So I completed the from to enroll in this plan. the .gov site then told me I will be contacted by the provider about actually paying the first month. The .gov site I do not have coverage until I make a payment. The Pay Now button was there but it goes no where. I guess that is because instant payments are not available from this provider. My hope now is that I actually get contacted about the plan! I hope and pray I am not lost in the vortex. After reading and researching as much as I could I feel OK about the choice. As far as I can tell it was the best plan per dollar for me and my family. There is no way I could have found similar coverage on my own. I do not know what my heart valve would have done to prevent me from getting insurance. I don't know if it can still hurt me if I have the opportunity to get on a company plan, at a new job, in the future.

So that is what has happened so far. I looked at the medical sharing plans. They seem OK if you are healthy but I am afraid of them. It may just be me. I get what they are doing. I like more of a contractual agreement with my health. If I could not have afforded the present premium (just under $900/month) I would probably have gone with a sharing plan out of desperation. This monthly premium is going to sting compared to paying less, pre-tax, through my former employer's plan.
 

James

DTVUSA Member
#4
Still waiting to get confirmation from the regional BlueCross. I called but they could not find me in the system. I am hoping this was due to me signing up on Friday and asking on Monday. Instructed to call Wed because Thursday is when the next round of people are supposed to get their insurance. I do not like it but this is what I have to do at the moment.
 

MrPogi

Moderator, , Webmaster of Cache Free TV
Staff member
#5
Understand that your employer's plan actually cost about $2000 total including your employer's share - so all in all, not too bad. My plan would have cost me $600 a month without subsidy, and I was paying $600+ a month on my employer's plan (the claimed they pay 1/2). BUT, my work insurance covered my wife and I, as well as 2 minor children and my 20 year old daughter. Now, the 20 yo is on her own insurance and the other kids are covered by CHiP, so it's not exactly an apples-to-apples comparison. But I do get to keep our current doctors, and co-pay is just $5, $75 for a specialist.

I also had some strange behavior when I paid online, so I called the insurer but I was not in their records yet. I was a week later and they confirmed my payment.

I think maybe people need to stop trying to repeal this law and spend their efforts on making it work. If not for the ACA, chances are only my 20 yo daughter would have any health insurance at this point. Trust me, if that was the case and we incurred major medical expenses, we couldn't pay the bill. We would just not pay our bill, declare bankruptcy, lose the house, and guess who WOULD be paying the bill? That's right, YOU, and all the people that DO have insurance. (That's why you pay $10 for 2 Tylenol in the hospital.) The middle class, of which I am no longer a part, pay too much of their income for health insurance as things stand. And employers are going to end up screwing their employees to save a few bucks!


Note: My insurance starts the first of May. I had some severe leg pain last weekend due to a fall, and it sucked knowing that I have to just "wait it out" until then. It would cost us over $100 to visit our doctor just to get a script for stronger pain killers.
 
Last edited:

Fringe Reception

Super Moderator, Chief Content Editor
Staff member
#6
... Note: My insurance starts the first of May. I had some severe leg pain last weekend due to a fall, and it sucked knowing that I have to just "wait it out" until then. It would cost us over $100 to visit our doctor just to get a script for stronger pain killers.
Bill, just do what thousands of others are now forced to do: buy pain killers on the street. Sadly, that option has spiked thanks to 'unintended consequences of' Obama "care".

Woohoo Obamacare! I have to pay toward my own birth control pills and abortions in spite of being a man.

Jim
 

James

DTVUSA Member
#7
Today I was able to confirm that the insurer had me in their system and that an invoice was being prepared. That made me feel better knowing that I was covered in case something drastic happened. At least that is the theory. Haha. I met with my Fam Doc yesterday to have him check a red patch on my face. Yea..probably too much info...but if it helps somebody feel better or something... So anyway. I told him the whole insurance transition story. He went through all my records and made sure I got what he could give me before anything hit the fan. Good Doc. Now I have wait to pay the installment and get cards and all that. Then I have to set something up with a dermatologist and find out how much that will be. And what they will find. Blah! I dislike health issues when you've got things like jobs and family to take care of. Haha. Wonder if Botox is covered.
 

MrPogi

Moderator, , Webmaster of Cache Free TV
Staff member
#8
Bill, just do what thousands of others are now forced to do: buy pain killers on the street. Sadly, that option has spiked thanks to 'unintended consequences of' Obama "care".

Woohoo Obamacare! I have to pay toward my own birth control pills and abortions in spite of being a man.

Jim
Jim, I've never heard of abortions being paid for by any US health plan, unless perhaps the mother's life is endangered. And employer provided health insurance pays for birth control, too, and therefore you paid for birth control even before "Obamacare". Some insurers even pay for ED drugs. Why should women pay for some old dude's boner pills? But it's all about sharing the costs as well as the risks. That's how insurance works. Unfortunatly, estimates are that insurance companies waste a large portion of the premium (as much as 30%!) trying to have only customers that will never use their benefits, and the paperwork they cause to be generated is massively wasteful.

On the topic of birth control, at one time health insurance would not pay for birth control pills. Now, from a purely capitalist standpoint that doesn't make sense from the insurer's perspective. I mean, the cost of giving birth and health care for a child over 18 years has got to be more expensive than providing a $20 monthly prescription for the same time period. Add in the hidden cost of government services to a poor family and the cost of NOT providing $20 worth of birth control becomes outrageous.

I also don't understand why companies wouldn't prefer to have the burden of providing healthcare transferred out of their hands. I mean, from their point of view, under the current system, they have to devote time and money for their HR people to seek out and administer their plan as well as pay a percentage of the total cost. If you were the owner, wouldn't it be easier and less costly to just set up a simple payroll employee deduction to another entity, pay your percentage, and be done with it?

Like you, I am also not very fond of the crappy system that was cobbled together by lobbyists and a government on the take. It's still to expensive for the middle class. But instead of a wholesale repeal of this mess, I would like to see it reformed - without the lobbyist's input and dirty money - and made to better serve the middle class.

Because someday, I would like to re-join the middle class, if God and Corporate America will allow the middle class to survive. What I was paying to my employer provided health plan was a big burden.
 
Last edited:

James

DTVUSA Member
#9
Update! I called the insurer. I was able to make the payment and instantly had access to my account. I printed out the temporary cards. My Family Doc accepted them the next day. I had already made sure he was in their approved system. I did have to switch to a different pharmacy chain. No problem. The co-pays were cheaper on the meds we needed. So far so good in these respects.
 

MrPogi

Moderator, , Webmaster of Cache Free TV
Staff member
#10
NOOooooo! Heresy!!
That's not possible! Everyone know that Obamacare will end civilization as we know it. Its a bad thing.
 

James

DTVUSA Member
#11
How to do spell that Ut Oh thing? Anyway. Not wanting to get into politics but I heard nothing but negative about the healthcare thing. Pundits gave bad news predictions every day. Sure, the roll out was terrible for such a project. But I started having discussions with people of all political leanings who checked it out and got good insurance from the program. Many got discounts. I guess they were below the threshold. Mine seems to be working. Not all horror. I like the fact that the insurance company can't boot me for pre-existing conditions. I also like that my son is on my policy while he interns (learns a career). Thoise two things are good things IMO.

I don't understand the so-called implications, hanging sword over the economy and all that. I simply cannot decipher what is true and what is lies and what is simply writting things because you are paid to create news stories and fuel fear, unrest, debate, push an agenda, etc.
 

MrPogi

Moderator, , Webmaster of Cache Free TV
Staff member
#12
It's not perfect - but something has to be done about health insurance. And no other solutions have been offered up, certainly nothing that stands a chance of getting through our obstructionist congress.

As I said before, I think it would be best to see what isn't working and fix it, see what is working and improve it. THEN, if it still doesn't work, that's the time to repeal it.
 

James

DTVUSA Member
#13
It's not perfect - but something has to be done about health insurance. And no other solutions have been offered up, certainly nothing that stands a chance of getting through our obstructionist congress.

As I said before, I think it would be best to see what isn't working and fix it, see what is working and improve it. THEN, if it still doesn't work, that's the time to repeal it.
Yes. I think you are right on this. Is that not the "American Way" of making things better? Try something, tweak, improve? With govt policy it sure seems like the myriad of interests obscure the main goal on a lot of things. I much prefer having both parties work together rather than having a president push through plans just to get something going.

I may be simple minded but why can't those people in Washington simply work together for the people?
 

MrPogi

Moderator, , Webmaster of Cache Free TV
Staff member
#14
I may be simple minded but why can't those people in Washington simply work together for the people?
The left pushes their agenda without compromise; The right pushes their agenda without compromise.

You and I, we get crushed in the middle along with the majority of Americans.
 
Top