The Chronicles of Obamacare Enrollment – Lessons Learned

A few random lessons learned from my six (I think) attempts to enroll for insurance eligibility on Healthcare.gov (see previous postings for colorful details):

• One can input essentially the same information into the healthcare.gov forms repeatedly, expect and receive different results (goes against the laws of nature I know).
• If one wishes to re-open for revisions an existing enrollment form, one should expect to re-answer some of the previously answered questions because some previous answers appear to be arbitrarily deleted.
• There is no identifiable logic to which answers are saved, and different ones may be saved between enrollment or revision sessions.
• If one is speaking with either a Representative or Specialist, just know, they are working off the same form in seemingly the same web application you have access to.  Therefore, they will experience the same problems you are.  For example, in filling out the form, they are as likely to get kicked off the site as you are. In otherwords, their tools to help you are NO BETTER than what you have.
• The only difference I could tell between a Representative and a Specialist, is that a Specialist has the ability to go back into your enrollment application after it has been submitted to revise information. BUT REMEMBER, even if one wants to change one field in the form, the act of going back in at all will arbitrarily wipe out info previously input.  Therefore, do not expect the Specialist to be able to work through the revisions faster than you can on your own.
• If you put in your estimated annual income,  but you have no income at this moment and  enter $0 monthly income into the form, expect to be kicked into the Medicaid bucket.
• If you are kicked over to state Medicaid, Healthcare.gov and its representatives will tell you must get proof from the state that you are not qualified. In my case they suggested a three way call or a letter from the state.
• In Georgia, to qualify for Medicaid one basically has to be disabled, have no income, or be a child of a parent with no income to qualify. Even though the information I provided Healthcare.gov and its representatives clearly suggests I could not qualify for Medicaid; if the enrollment notification says you may be qualified for Medicaid, the Representative and Specialists not lead you around this issue—basically they will shut you down.
• For one of my enrollment attempts I agreed to have my application “reviewed” (kicked up the ladder). However, the specialist could not and would not even guess, either how quickly my file would be reviewed or even how I would be advised. To this date and it has been close to a month at this posting, I have had no communication from healthcare.gov. (beware of black holes)
• Due to some sort of internet security threat I was asked to re-set my password with a new one. I reset it with the old one and it worked just fine.
• In all my conversations with the Healthcare.gov representatives and specialists, not one time have they ever suggested that they do not really have the tools, training or knowledge to effectively do their jobs, nor have they ever registered any frustration with their lack of tools.   They will however,  admit at times their customers do get frustrated from time to time and I was thanked multiple times for being nice. These folks seem obliviously bulletproof.
• Do not expect empathy, any sense of humor, or too much guidance from representatives.   Once I realized this, it made my interactions far more tolerable.
• There should be some quick pre-screening tools to determine eligibility and even subsidies, however, these are limited. When calling healthcare.gov, they will not pre-screen you. You will have to go through the entire enrollment process to see if you qualify to purchase off the exchange.
• Each time you call Healthcare.gov, plan to have an hour to spend with your new friends.
• Some (if not many) of the questions I answered in the enrollment process, online, were not asked when I enrolled by phone (for example, COBRA is a specific one not asked by phone).
• Do not expect a representative or specialist to advise you with regard to how you answer the questions; especially related to income. I made it very clear over multiple calls, that I was unemployed and my goal was to get as large a subsidy as legally possible. In order to do so, one must answer the questions in a certain way. However, the representatives and specialists either do not know, are unwilling or are not allowed to really help you obtain the correct subsidy.
• If you know approximately what your subsidy should be, there is a chance, if you are patient (and I mean REALLY patient) that you can keep re-working your enrollment application until you get results that align with your expectations. In my case, because I knew about what my subsidy should be based on my situation and qualifications, I just kept re-working the enrollment form until it got into the ballpark of reality (this was accomplished over many hours and weeks).
• Remember in the end, your subsidy is pegged to an estimate, so if you under or over estimate it, you will be obligated to true up come tax time, but as best as I can tell, there is no penalty for being unable to predict the future.
• When attempting to enroll for insurance through Healthcare.gov expect (a) TMD experience 🙂  (Google it).

Step Through The Wardrobe Of Obamacare and IntoThe Magical Land of Narniaozlamabad.

After a three plus week recovery, regrouping and re-strategizing period, I decided to start over on my healthcare.gov enrollment; this time with a representative vs. an attempt to go it alone.

After an hour and forty five minutes on the phone with first a representative and then a specialist, it appears I can take advantage of a $557 per month subsidy to help pay for my insurance. My goal from the beginning was to find affordable insurance, which, with the subsidy, is a bit closer to reality.

I am going to spare a long rant this time, because, in my next posting, I will try to summarize my learning. Hopefully that might help you, should you find yourself in my shoes. Suffice it to say the process was a painful schlep through the muddy and foul stinking trenches of Obamacare.

CONGRATULATIONS. You qualify for a $3 Obamacare Tax Credit.

 

So this past Monday (that would be April 28, 2014 for future readers), I decided not to put my trust in the supposed case worker assigned to review my Obamacare enrollment application. As of this posting, it has been over a week since I was supposedly assigned to my case worker, but have received no acknowledgement and have no clue if I have a case worker or if Priscilla was blowing smoke.

Anyway, I girded by loins, went back into my application, under the premise of updating my income and re-enrolled. Once again, some of my information was saved and some not. I am guessing the data input took a half an hour or so. Anyway, after putting all the same information back into the system…. again…. for the fourth time…., I nearly fell out of my chair when it actually said I was qualified to enroll. Furthermore, my unemployed family is entitled to a $3 per month subsidy which would lower the monthly premium on the cheapest plan to $738 per month BUT…. it only has a $12,600 deductible/out of pocket max.

So annualized if you add my premiums to my maximum out of pocket, I will have to spend $21,456 before I get real relief. Is this affordable healthcare? In fairness, one does get the benefit of the insurance companies’ negotiated rates with healthcare providers, but one must become very sick and in my case very broke, before getting any relief.

I want to mention once again that at the end of 2012 I was on an individual insurance plan with Humana. The premium for my high deductible health plan was $300 per month and my max out of pocket was $10,400. My total annual exposure was $14,000 (total annual premium plus maximum out of pocket).

So what does all this mean? It means I am going to step back and assess my options off the exchange, take a break from this nonsense and then try again.

“If This Does Not Work, I Can’t Tell You What To Do”

These are not the words of comfort you want to hear from the enrollment specialist after trying for three hours to enroll in the Federal Health Insurance Marketplace.

After receiving the panic inducing quotes from my insurance broker, she recommended my wife and I come into her office. This way we could go onto the Exchange together, and we could explore our options on the fly. The fact that I had to enlist the expertise of a broker might suggest that attempting to sort out individual insurance in the era of Obamacare/ACA alone, may not be a good idea for the average bear.

Prior to my meeting, I went on the Exchange and created an account. I didn’t want to create an account because all I wanted to do at that moment was research, not enroll. Unfortunately, after the general enrollment deadline on March 31, I could not find the tools I had used prior to the deadline to research plans and estimate costs. If they are still there, I could not find them. Perhaps they figure individuals experiencing death, divorce, or loss of job don’t really need the tools. This smacks of the Nancy Pelosi comment years ago when she basically said we had to pass the ACA and then we would figure out what was actually in it. Enroll first, then we can tell you what you are enrolling in….

Anyway I did not complete my first enrollment because ½ way through the process they asked for my broker’s agent ID number, which, not surprisingly, I did not have at my disposal.

Yesterday, when I tried to log in….over and over and over again unsuccessfully, I finally threw in the towel. I started the entire process from the beginning and amazingly it allowed me to re-use the same user name and password as I had the first time, and then it let me go through the process.

After two hours later, the system was telling me my daughter could be eligible for catastrophic insurance, my wife and I could be eligible for Medicaid, and my son could be dumped onto the state CHIP (Medicaid for kids) plan. Well this recommendation was patently absurd because I had included my income for year to date plus expected unemployment insurance and neither my wife nor I are disabled.

After failing online, my wife, our broker and I called the healthcare.gov customer service number and spoke to a nice man named Nathan. Nathan informed us that he could flush our application from the system and then we could wait 24 hours for it to re-set and try again online, or he could re-enroll us by phone, which he estimated would take another 20 minutes.

At the end of an hour with Nathan, he informed us my daughter could be eligible for catastrophic insurance, my wife and I could be eligible for Medicaid, and my son could be dumped onto the state CHIP (Medicaid for kids) plan. Sound familiar?

Our hypothesis relates to a single question on the enrollment form, which asks if you had any income “this month.” Being unemployed and not yet receiving unemployment, the answer was $0. Apparently, the system is having trouble reconciling the estimated income for the year with a single month of no income. Nathan could change the monthly income figure from zero to one twelfth of the estimated annual income, but the system could not handle it…….neither could Nathan….neither could I….nor my wife…nor our broker.

Because my broker had already wasted 3 hours and I had now spent 3 hours not looking for employment, we all decided to go to neutral corners. And yes, during the course of the conversation Nathan said, “If this doesn’t work, I can’t tell you what to do.”

He offered to trash the second enrollment application and start over, but we really had to get on with our day.

We decided to let healthcare.gov rest for 24 hours before we would try it again.

Stay tuned for more personal adventures of the “Affordable Care Act.”

What has Obamacare Done To/For You Lately?

I have to come up with $635 this year to fund the 21% premium increase Humana is subjecting me to for the privilege of a $10,400 deductible and no drug plan.  I do receive well care and the benefit of Humana negotiated rates for my family’s doctor visits and lab work.  I still save a ton of $ over a traditional health insurance plan and still receive the tax and savings benefit of my Health Savings Account but no thanks to Humana for that.

If anything, the overall health of my family has improved over the past 3 years since I switched to a high deductible health plan so the premium increase is neither the result of higher utilization of the benefits nor a general decline in health.  And it certainly is not the result of a stratospheric increase in the cost of the care we have received.

Our insurance costs are increasing primarily due to uncertainty created by the chaos of Obama Care.  Insurance companies are in business to make $ for their shareholders and as the government creates a burden for them, they simply pass it right on to their customers.  In this case, that would be me.

Pretend for a moment you were in business for yourself making widgets.  You are a pretty good business person and for every widget you manufacture, you make 20% profit.  You compete in the market with other widget makers and through competition, your prices are held at a reasonable level.  One day the government decides that because your widgets serve the greater good of society, everyone should be able to buy them.  As a business person, this sounds pretty good right?  Because the size of your market just increased exponentially.  But here’s the rub, not everyone can afford your widgets and in some cases they don’t even want them.  Normally, if you had control over your business, you would simply refuse to sell widgets to those who could not pay, but the government has said you must sell widgets to everyone, regardless of their ability to pay.  Well, you are not in business to lose money so, maybe you do some things to enable you to produce your widgets for less money which is a good thing, but you were pretty efficient to begin with.  If you still want to make 20% profit, what do you do now??  You increase the price of widgets to those who can afford them to maintain your profit and offset the losses from sales to widgets to those who can not pay for them to begin with.

In a nutshell, you are Humana, and I just got a 21% premium increase.  Now I have to come up with $635 to cover basically the same benefits I already have.  Suffice it to say, my privates are frosted over this latest insult, but it could be worse.  What if I had a traditional insurance plan and was paying, say $1,000 per month for my insurance and was hit with a 21% increase?  Annualized, I would have to come up with an additional $2,500 just to cover the premium increase.   That’s a pretty big nut in my book.

So looking at your own situation, how big is your nut and what has Obama Care done for you lately?  Is it the panacea we were led to believe it would be?  In the land of purple frogs and leprechauns, perhaps it is.

Health Insurance and Life’s Inconveniences

Some real cool cat whacked my car a couple of weeks ago when it was sitting on the street.  In addition to putting about a 12” x 12” tattoo on the side of my door broke my side view mirror off.  Thanks for not leaving a note Jack.

I took the car to the dealership and they kindly glued the mirror unit back together at no cost, but sadly the glue did not hold and I had to go shopping for a new mirror.  The part at the dealership was $160. I found a replacement part online, new (but not original manufacturer I don’t think) for $67 delivered to my house.  I’ll do the install myself.

“Consumer Driven Health Care” for my car as it were.  My car was sick through no fault of its own.  I decided what “doctor” I wanted to have look at it.  With the diagnosis and pricing in hand for the cure, I elected to cure of my choice at a price that was competitive in the market.  If I had been in a wreck and significant damage were done to my car, my insurance would have been there to take care of what would have been a really big problem.

High Deductible Health Plans with Health Savings Accounts are the same concept.  You, as the consumer pay for the smaller stuff (although many HDHPs provide basic well care) and if something major happens, your insurance is there to cover you.  You have some ability to shop based on price (transparency is getting better over time) and can decide from whom you want to purchase services.

Folks have lost sight of the fact that health insurance is there for the big stuff.  Not really a novel concept, but really the basis for sustainable value based health care.

My HDHP Premium Is $212 Per Month

When I stepped out from under the wing of the Mother Bird in 2006 I had pretty good insurance but I could not begin to tell you what I spent on health care each year or what the value of the policy was worth.  I bitched because I was having to pay more each year than the preceding year but that is about all I remember.

I am self-insured now.  I pay $212 per month for my HDHP which covers my family of four potentially from financial disaster.  My deductible is $10,400 per year.  Each member of my family of four gets one well-visit per year.  I have had no hesitation in buying my family’s expensive meds from Canada, and the basic low low cost drugs at WalMart, Publix and Kroger.  I am much more in tune with my body than ever I was in the corporate world.

If anyone in my family gets sick, they go to the doctor.  Yes I pay for it at 100% but I get the Insurance company’s discounted rate and because of the huge inefficiencies in claims processing, I generally get a couple month interest- free loan on my money.  Over the past, almost 3 years, I have managed to get my HSA almost fully funded to the point of covering my deductible in the event of a medical nightmare.

Is my insurance perfect?  Hardly, but today is not the day to rant.

The point here is the health care I once took for granted is now a priority in my life.  As a struggling entrepreneur, it is really important for me to watch ever nickel going out the door, while at the same time doing the best I can to take care of my family.  In my former life I was a health care automaton.  And sadly, I believe we are a nation of health care automatons.  Just put it on our plate, and we will eat it.

But now, with the health care debate raging, there is an opportunity for us to shake ourselves out of this zombie-like mindset toward our health and our wellness.  An opportunity to engage and get involved.   It can be done.

The Health Savings Account (HSA) Mindset Is A New Way Of Thinking

 

Most peoples’ eyes glaze over like an old Krispy Kreme donut when they are presented with high deductible health plans (HDHP) because an HDHP means they are going to cover 100% of their health costs up to their insurance deductible.  It does not matter if in their current plan they are paying a zillion dollars a year in premium and forking out for co-pays left and right.

 This defense mechanism of eye glazing does not make them bad people nor does it make them unintelligent people.  They have just come to accept an old model of paying for their health care.  One, which if you have been living in a cave, is not working very well.

 Periodically, I wonder about the math of traditional insurance vs. consumer driven health plans and inevitably I’m brought back around to the same conclusion.  In most instances the math works.  It simply requires a different mindset.  Indeed, a different approach to one’s view of their health and healthcare.

 Along my path of HSA education, I met a guy named Scott Borden.  Scott “got it,” meaning he understood the value of consumer driven health early on; in fact way before HSAs were even available.  Scott is a benefits consultant out of Kansas City, and like us, he posts a blog www.myHSAblog.com.  If you are reading this and wondering about the math behind HDHPs and HSAs, I would invite you to read the article below.  Scott wrote this awhile back using his own family as the example of how the math works.

 Please read…..        

 “Hello! My name is Scott Borden I am a self-employed independent health insurance agent. I purchase health insurance for my family of 5. If I worked for a big company they would be paying for a portion of my health insurance. There are advantages and disadvantages to being self-employed. No help for health insurance is a big disadvantage.

Is there a smart way to purchase health insurance without breaking the bank?

There are millions of self-employed Americans out there facing the same situation. Over the past 10 years since I first found Medical Savings Accounts (MSAs), I have worked with hundreds of health insurance agents trying to get them to recommend the lower cost Health Savings Account (HSA) qualified plans to self-employed people and businesses. Still today very few health insurance agents agree with me. The most common complaint I hear from agents is that HSAs are too confusing and too complicated. People just don’t understand them. They are too risky. You name it, I’ve heard it all.

Are HSAs really difficult to understand?

I’ll let you decide…

Which health insurance plan should I choose for my family of 5 living in Kansas?

Plan 1: Blue Cross Blue Shield of KC Preferred-Care Blue Premium
Monthly premium $725
$500 calendar year deductible per person usually with a maximum of 3 deductibles per family
Co-Insurance – 80% up to the stop loss of $10,000
Example: $10,000 x 20% = $2,000 co-insurance out-of-pocket
Primary care physician $20 co-pay (some plans charge more for specialists)
Prescription medication $12 tier 1 generic (350 of which are now $4)
Prescription medication $35 tier 2 formulary name brand
Prescription medication $60 tier 3 non-formulary name brand
Emergency Room $100 co-pay then deductible and 20% co-insurance
Maximum out-of-pocket $2,500 per individual (NOT including co-pays)
Maximum out-of-pocket $7,500 per family (NOT including co-pays)

Plan 2: Humana Autograph Total + Rx HSA
Monthly premium $365
$5,000 family calendar year deductible
Maximum out-of-pocket $5,000 per family
Take premium savings ($360/month) and deposit into HSA
Use HSA to pay smaller bills
If I don’t spend my HSA ($4,320 in the first year), I KEEP IT!

Which is more confusing?  That wasn’t very difficult to understand, now was it.  Plan 2 simply requires a deductible be satisfied then covers all remaining expenses including inpatient, outpatient, physician visits, and prescription drugs for my entire family at 100% for the rest of the calendar year. 

Which would be the best to own in a healthy year?

The lower premium plan always saves money in a healthy year.
 
Which would be the best to own should I come down with a major disease?

In order to decide which plan “would be the best” we have to calculate which plan would cover the disease at the lowest out-of-pocket expense. Does my monthly premium play a role in this calculation? ABSOLUTELY!

With Plan1 we have to know how many physician visits, how many prescription drugs, how many outpatient treatments, how many emergency room visits, was surgery involved, etc. The policy claims “$2,500 maximum out-of-pocket per person” but unfortunately that didn’t include the co-pays. It is possible in this type of a situation to have literally thousands of dollars worth of co-pays above and beyond the “$2,500 maximum out-of-pocket”

Plan 1 summary:

       $8,700 annual premium ($725 x 12)
    +$2,500 “maximum out-of-pocket” (deductible + co-insurance)
    +$1,000 (hypothetical) additional co-pays for additional services
    + $0 assuming no additional expenses for the rest of the family
   = $12,200 TOTAL COST

Plan 2 summary:

      $4,380 annual premium ($365 x 12)
    +$5,000 family maximum out-of-pocket
   =$9,380 TOTAL COST

Once again – requires a little study and math, but not very difficult.

I own the Humana plan now with a $7,000 family deductible that costs me just over $300 per month. Once money starts accumulating in the HSA then feel free to go to a higher deductible which saves even more money. This grows my HSA even faster!

Unfortunately most health insurance agents don’t want to take the time to educate the public on a lower cost way of managing health care expenses. The lower monthly insurance premiums results in lower commissions.  Why should they work harder to make less?  As long as 95% of the public is willing to keep paying ridiculous health insurance premiums they will keep on selling them. 

If I hear one more health insurance agent saying HSAs are too complicated for people to understand I am going to… “

So, after reading the above…..Does it make sense?

Should I Shop For Health Insurance Online?

Great question and one I can answer from personal experience. 

I’m of the opinion you can do a lot of research on line when it comes to health insurance, but ultimately you should take you new found knowledge and use it in conjunction with an agent who specializes in consumer directed health care plans.

If you have not shopped for health insurance on-line or shopped for it in awhile, chances are, when you go on-line to beging looking for plans that satisfy your needs, you may be overwhelmed.  With any luck, after awhile and a fair bit of sifting through your options, you may feel pretty confident in a plan that you like, but I would recommend that you refrain from pulling the trigger without speaking with an agent.

First of all, let me be VERY clear; I am not an agent, have never been one, and it is fairly unlikely I will ever become one.  No one in my family is an agent, and none of my close friends sell health insurance (although a couple of them sell other insurance products).  Although I do know some very good agents in the CDH/HDHP/HSA space, I am not recommending any specifically here.   

Unless you were formerly an insurance agent yourself, you may be leaving a lot of valuable information on the table by not using an agent to help you make your final decisions when it comes to your health plan.  Here are some compelling reasons for using an agent:

• It will not cost you one cent extra.  Agents make their money generally from a percentage of your premium, so there are no fees that would add to the cost of you using an agent.
• I always recommend using an agent who has strong knowledge of and is an advocate of high deductible health plans consumer driven health plans.  The reason why is that these plans carry a lower premium and subsequently a lower commission to the agent.  If they are an advocate for HDHPs then they are looking out for you FIRST and their comission second.  Don’t get me wrong, HDHPs are NOT for everyone, however a good agent who a CDH advocate will look at the lower cost options first before steering you toward a CDH plan.
• An insurance agent generally can find out for you in advance, based on your medical history, whether you will be accepted or rejected for a specific plan.  You want to avoid being rejected for coverage if possible, because rejection, like a felony conviction follows you around for a long time.  It may not hurt you, but certainly will not help.
• Crummy plans.  A good agent will help you understand the gaps in a specific plan and let you know what the risks are.
• Supplemental insurance.  Sometimes you are better off purchasing supplemental policies to cover gaps in a specific plan rather than purchasing some platinum covered plan that covers everything.  An agent can advise you on things like accident insurance that might cover things like a broken arm or critical care insurance which might help you in certain instances cover the gap of a large deductible.
• Math.  A good agent can help you understand the trade-offs between a higher and lower deductible in terms of long term savings and potential tax benefits.
• Mandates.  An agent can help you understand what kinds of goodies are baked into your plan for your state and how that might affect your costs. 
• Answers mister.  Shopping for insurance on line is apt to create as many questions as answers.  My experience with shopping for anything on-line is that answers to specific questions are cumbersome and hard to come by.  I hate sorting through lists of FAQs.  Heaven forbid, trying an on-line chat, which has all the intimacy and clarity of attempting a civil conversation while  sitting at a table of 16 people listening to some blaring half-baked band in a two-hundred table banquet hall of a downtown Marriott Hotel.  A good insurance agent can give you the answers you need with clarity and concision, and that is tough to get on-line. 

In my case, I found what I thought I wanted and then contacted an agent provided by a friend.  Turns out the agent knew very little about consumer driven plans and even less about HDHPs.  I may as well have been ordering my plan up at the drive through window at McDonalds.   I got no advice and ended up with a plan that caused me a lot of stress.  Since then I have learned that there are agents out there with significant knowledge.  That know how to really evaluate individual situations and apply logic and best practices to the development of a good plan.

I know there are plenty of other good reasons to use the services of an agent and maybe a few will comment on this article.

So by all means, do your homework on-line.  Get educated about the types of plans out there and some of your options, then find a good agent who wants to be your advocate and help you with a long term strategy.  Your decisions will be better informed, and you should be able to sleep better at night.

COBRA Before HSA

 

If you’ve  read this blog before you know I am not a big fan of COBRA.  As a plan of last resort to bridge your insurance between jobs or between insurance plans, it should never be discounted, but until recently, I have recommended to find another alternative to COBRA just as fast as possible.  While I generally advocate high deductible health plans with health savings accounts  (HSA)as a reasonable and prudent decision for most, recent legislation makes COBRA worth a much closer look. 

The problem traditionally with COBRA, was that if your employer was subsidizing your insurance,  and if you then left your job, you had to pick up 102% of the cost of your plan’s premiums.  Which for many folks is untenable and for more, unsustainable.  New legislation, however, provides that Uncle Sam will pick up 65% of your COBRA premium, so a plan that until a few months would have cost say $1,000 per month, now costs roughly $350 per month.  This represents a huge savings and likely makes COBRA competitive, if not better than plans you could purchase in the individual market.

A smart consumer still needs to do their homework and explore all their option, but COBRA, which, frankly was a joke to many folks, is now a contender.  If you are thinking about the COBRA option, make sure you understand the process for initiating its implementation.