The Patient Protection and Affordable Care Act (which was also called ACA or Obamacare) was passed on March 21, 2010. President Barack Obamacare signed it into law on March 23, 2010. People were able to sign up for “Obamacare” plans on Marketplaces starting in October of 2013. Those plans kicked in on January 1, 2014.
Because of Obamacare, Americans who previously were unable to afford health insurance coverage were able to do so – some for the first time in their lives. People with low-income qualified for subsidies that could be used to cover part or all of the premiums of plans found in the Marketplace. Medicaid was expanded (in several states) to cover more poor people.
In this blog, I will give a timeline of what it was like to attempt to get health insurance coverage before Obamacare. The timeline is based on my own experiences as an adult who was trying to find affordable health insurance that actually covered things.
* At the start of 2009, I had a job as a teacher’s aide in an elementary classroom for special needs children. I had good health insurance from this job that covered medical, dental, and vision care. It covered both me, and my husband. He was on Medicare, and did not need to sign up for Medicare part B because my health plan covered what part B would have.
Later that year, the recession hit and teachers were being laid off. I lost my job. Suddenly, our health insurance coverage was gone. Shawn was left with basic Medicare – which doesn’t cover prescriptions. I had no health insurance at all. COBRA was too expensive because it required me to pay not only the part of the premium I was having taken out of my paycheck, but also the amount that my employer was paying. I was unemployed, and it was impossible to instantly come up with that money.
* My husband and I contacted the insurance company where we had car insurance. They had a health plan, but it was too expensive to afford – and both my husband and I were at risk of being rejected because we each had pre-existing conditions.
* In 2010, I started getting unemployment benefits (which arrived sporadically and were not nearly enough to live on). I also had a part-time job that did not offer health insurance benefits. Shawn also had a part time job, that did not come with health insurance coverage.
* In 2011, Shawn found a health insurance plan online and spent two hours applying for it. One of their plans was (almost, but not quite) affordable – and the rest were too expensive. Eventually, the health insurance company left us a cryptic voice mail, and we had to play “phone tag” for a while before actually getting to talk to someone. The person on the phone asked us some health related questions… and then left us without an answer about whether or not we were covered.
* In September of 2011, the insurance company let us know that we had been approved for coverage. The plan did not cover vision care, or maternity, and we weren’t sure if it covered birth control. We waited to be sent more information.
The first thing the insurance company sent us was a packet about our dental plan. It was confusing to sift through and did not have any specific information. We had no idea what it covered, what it excluded, or whether or not my current dentist was part of their network.
After some more “phone tag”, we learned that my dentist was not part of their network. If I wanted to keep my dentist, I would be paying extra to see him. Or, I could attempt to try and figure out what dentists were in their network, and see if any of them were willing to take me as a patient. We were not provided with a list of dentists that were in their network.
Later, we received what we thought was information about our health insurance plan. I read through 42 pages packet that didn’t answer any of our questions and that did not list what was covered.
After reading another 30 pages, I learned that the health insurance covered 2 offices visits from “a participating provider” per year. There may or may not be a co-pay. I’d find out when I saw the doctor, I suppose. The packet did not have a list of doctors that were considered to be “a participating provider”, so I had no way of knowing if my old doctor was among them.
The packet of information said it covered preventative care. It did not include anything that specifically said what was covered, or what the insurance considered to be “preventative care”.
I had to call and speak with a representative of the insurance company in order to get some answers about what, exactly, their plan covers. Their website did not have any information about this incredibly important part of a health insurance plan. The representative told me there was no list that defined preventative care. She was certain, however, that birth control was not covered – and that they would never cover it.
This plan was absolutely worthless! It didn’t cover anything. We canceled it on October 28, 2011, and became uninsured again.
* We learned that Shawn did not qualify for Medicare Part B because he didn’t immediately sign up for it when I lost my job and the health insurance that covered both of us. Medicare Part B is a private plan, and we didn’t have the money to pay for the day that I lost my job. We certainly didn’t have the money for it while I was trying to get unemployment benefits. He was going to have to wait until the open enrollment period came back – and hope that he didn’t need any prescription medication until then. Or, he would have to pay full-price for that medication, out of pocket.
* I learned that California has a Family PACT program that functions as insurance for low-income people. It only covers family planning. Planned Parenthood told me about it, and it turned out I qualified because I was making so little money at that time. Planned Parenthood gave me the contraception of my choice for free. This was wonderful! There was no way we could afford to pay for birth control out of pocket while uninsured.
* The Epi-Pen that I carry around in case I have a severe allergic reaction expired. It was too expensive to buy without insurance coverage. I ended up ordering the same Epi-Pen from a Canadian company that helps Americans to buy prescription medication outside of the United States – for an affordable price.
* We started getting mysterious phone calls from the insurance company after we canceled our policy. Once again, we had to play “phone tag” before any of this could get resolved. We clarified that yes, we certainly did cancel the policy. We reminded the insurance representative that yes, we did fax them the necessary paperwork to do that.
The insurance company charged us for the first month’s premium of a plan that we didn’t even use – without telling us.
* We called the insurance company and disputed the bill. They charged us after we had canceled the plan, and before we could use it. It took a lot of determination, but we finally got the representative to agree to return that money to us. In the meantime, I convinced a representative to snd me a piece of paper that clearly listed what they considered to be “preventative care”. It turns out they really did have a list. The other representative lied to us when she said they didn’t have a list.
* I compared the “preventative care” list that the insurance company mailed me to the list of preventative care that Obamacare required. The plan that we canceled FAILED to include several things that it was supposed to cover. I also learned that the insurance company had a loophole to avoid paying for what little “preventative care” they covered. If care resulted in a diagnosis – they would charge the consumer for that care.
* On November 10, 2011, the insurance company finally paid us back for the premium that the charged us after we had canceled the worthless health insurance plan they tried to sell us.
* I got sick in November and needed to see a doctor. I was pretty sure I had a sinus infection (something I frequently get). I did not have any health insurance coverage (other than Family PACT, which only covered birth control.). The Community Health Center, that helps low-income people, was unable to help me. They wouldn’t answer their phone. When someone finally did answer, they insisted that I should go – not to the clinic in town – but to one really far away from where I live. This wasn’t going to work.
They refused to tell me what it would cost to see a doctor, other than they had a sliding scale. They required proof of income before they would tell me how much it cost to see a doctor.
I decided to try and get an appointment with the primary care physician I had before I lost my job and my health insurance. I’d seen her since then, and the visit cost $100 – for a five minute visit to take a quick look at a skin rash. It cost $100, again, for me to see a doctor for my sinus infection. The cost of the visit, and the medication I was prescribed, had to go on a credit card.
* In January of 2012, Shawn tried to sign up for Medicare part B. The open enrollment period had begun. It is a tedious process, and there is no guarantee of acceptance, because Medicare part B is private health insurance. There was no other option, though, because standard Medicare doesn’t cover much of anything – and excludes coverage for medication.
* In March of 2012, I tried again to find health insurance coverage. There was a company called Celtic Insurance, which had almost no information on their website. I called them – and started another round of “phone tag”. All I could learn from the website was that my doctor was not part of their network, that maternity was not covered, and that birth control was not covered. The HealthCare.gov website estimated that the health insurance plan from Celtic would cost $199.38 a month – but that was only an estimate.
* A representative from Celtic eventually called me and asked me a few health related questions. The representative told me I was denied coverage because of pre-existing conditions. She said my allergies were a pre-existing condition and that I could not qualify for their health plan.
I asked her to provide me with something in writing that said I was denied because of a pre-existing condition. The representative refused to do that, and refused to say why she wouldn’t do that. I made it clear that I needed that letter of denial because it would enable me to qualify for PCIP (the government run Pre-Existing Condition Insurance Plan that was set up as a stop-gap until Obamacare started).
* The representative’s supervisor got on the phone and said I had to apply through the website. So, I applied through the website. I figured this would generate an automatic written (or emailed) notification that I had been denied due to a pre-existing condition, and that this would allow me to try get enrolled in PCIP.
* In the meantime, I did some more research to see what I could learn about what Celtic Insurance plans covered. It excluded coverage for maternity, infertility treatments, allergy testing, and allergy shots. It did not cover dental or vision. This was yet another useless health insurance plan.
* Unexpectedly, Celtic Insurance approved me. Now, I was worried that they would immediately charge me for the first month’s premium. I already knew that this health plan was garbage, and I would have to cancel it. I was not given any information about what the premium cost, and was worried about getting stuck with an overdraft fee after Celtic tried to take money from my checking account for a plan they told me I did not qualify for.
* Later, Celtic Insurance let me know that they wanted $330.56 a month for premiums. I pointed out that this was a lot higher than the information on HealthCare.gov – which said the premium would be around $199.38 a month. The representative said they can charge me more because of my zip code. Apparently, they get “too many” people who live where I do and who sign up for their health insurance plan.
I suspect Celtic decided to cover me, and charge me a really high premium, so they could avoid sending me a letter that would have helped me get PCIP coverage. I was being abused because I dared to try and obtain PCIP coverage after they chose to deny me for having a pre-existing condition.
* Shawn and I went to see a health insurance broker who could help me find a better – and more affordable – health plan. The broker was wonderful! She knew what plans were available and made it easy for me to understand what they cost and covered. She gave me three quotes for plans that covered birth control and maternity. She was able to tell me exactly what the plans covered and what the premiums would cost.
* Now that I had better, more affordable options, I called back Celtic and canceled their expensive, garbage, plan. I was able to do that before they charged me. A booklet that said what their plan covered arrived after I canceled it. The booklet said Celtic was going to send a “test draft” to my bank for $0.00. I found that troubling!
I learned that Celtic’s insurance would not cover preventative care until after a person has paid 12 months of premiums. That’s an entire year of spending money for the plan – and spending additional money for the preventative care that the insurance plan refused to cover. They were also going to charge me for co-pay, co-insurance, and a deductible after I’d paid for the first 12 months of the plan. This is exactly the type of nonsense that Obamacare was designed to prevent!
* In April of 2012, I learned that I had been approved for the good, affordable, health plan that my health insurance broker helped me to sign up for. The approval letter did not say what the premium would cost. My broker called the insurance company to find out. She figured it would be about $134.00 per month.
That estimate turned out to be correct, although she did say it would likely go up to $138.00 a month after my birthday. I would end up in a different age bracket after that. At the time, insurance companies were allowed to charge older people more money for their premium than they changed to younger people.
* On April 28, 2012, my insurance company sent me a letter to inform me that my plan would start covering maternity as of July 1. 2012. This was due to a California law that required this coverage. My insurance company said that the cost of my premium would not increase as a result of this law.
* On May 25, 2012, we got a letter in the mail that said that Shawn cannot have Medicaid Part B. They said he did not enroll before the end of March, and had missed the deadline. They were lying! He did enroll before the end of March. The Medicare office simply chose not to bother to look at Shawn’s application. As a result, he was going without the coverage that he not only qualified for, but also that he enrolled in during the open enrollment period.
* On May 26, 2012, my health insurance company sent me a letter stating that they would start covering expanded preventative care for women as of August 1, 2012. This was due to an Obamacare rule. This made me really happy because I was using a long-acting birth control that I would not be able to afford if I made a few dollars more (and got disqualified from Family PACT) or if my insurance didn’t cover it. Once again, I was told that my premium would not increase as a result of this rule.
* My health insurance company raised my premium by a few dollars after my birthday. They could do that because they were still allowed to charge older people more money for the same plan that they charged younger people less money for.
* On June 11, 2012, my health insurance company sent me a letter that said they didn’t receive the payment for my premium on June 1, 2012. The letter was dated June 4, 2012, and we received it in the mail on June 11, 2012. The insurance company was lying – we paid that premium before it was due! I was told that if they did not get that payment by June 31, 2012, that they would cancel my plan. I hadn’t even had the opportunity to use it yet!
* On August 25, 2012, my health insurance company chose to “discontinue” my health plan. It wasn’t due to lack of payment – we had been paying them on time. The insurance company had been pressuring me to switch to a different plan, that was more expensive than the one I had and that covered less health care. They told me that if I stayed with my current health plan, the premium would go up (because people were leaving that plan).
My insurance company told me that if I wanted to switch plans now – I would have to do it between September 1, 2012, and September 30, 2012. There was little time to research my options. If I wait until after that, I would have to pass, and pay for, a physical before the insurance company would approve me for a new plan.
This was extremely frustrating! I thought we had finally gotten everything worked out – and it was being taken away.
* My health insurance broker advised that I stick with the current health plan until October of 2013, when the Obamacare Marketplaces would open. I followed her advice. She found me a new, more affordable plan, with better coverage than what I had. I was able to pay for the premiums because I qualified for a subsidy.