Republican or Democrat? Doesn't matter. This is just my story of traversing through the new Health Care Marketplace/Insurance buying experience....
For those of you who don't know me or haven't read my blog before let me start by saying that I have Breast Cancer. I was first diagnosed 10 years ago in 2003. Since then I have been diagnosed with Metastatic Breast Cancer, also known as Stage IV. This means that the cancer has spread beyond the breast. In my case, into my bones in several locations. I am one of the "lucky" ones because, so far, it has not spread to any organs. My doctor tells me as long as it stays just in my bones that is the best we can hope for. The treatment for this varies by individual and by what works for each person. Personally, I take an oral chemotherapy and don't have to get any other infusions at this point.
My husband and I own a small business and therefore have had to purchase our own healthcare for the last 7 years. Because of my cancer diagnosis, I have been insured through the Texas State Risk Pool. This is/was an insurance for people who could not get insurance any other way because of pre-existing conditions such as cancer. We have dutifully paid the higher premiums over that time and I am thankful that I had this insurance when the Stage IV diagnosis was given to me in 2010. I had 2 surgeries during the year after my diagnosis, radiation and other chemotherapy.
Fast Forward to 2013. The State Risk Pool sent letters out to all insured stating that the Pool would shut down as of December 31 because we would be eligible for health care now that the Affordable Healthcare Act was being implemented. That letter came in the summer of 2013. In the fall, prior to healthcare.gov going live, I received another letter reminding me that the system would be shut down and on October 1st I could go online and apply for insurance.
I did not go on to the website on October 1st. Honestly, I expected it to be bombarded by those trying to get insurance. I waited about a week. After 3 days of trying to log into the system I finally got on. I completed the application and was sent a "determination letter". Our income level is such that we should qualify for some of the "tax credits/subsidies" whichever term you wish to use. When I received my determination letter it told me that I qualified for a tax credit but told me that credit was $0. My next step, according to the letter, was to select an insurance plan.
Well, as many of you know, the website had a few glitches. Every time I tried to log into the system and select a plan it sent me back to my application. I was never able to see what plans were available for me. I finally went back on the website after the media told all of us how it was now fixed and working. I was able to log in, it showed that I did have a tax credit available (not $0 any longer) and I was able to search for a plan.
Given my history, I did not even look at the Bronze plans. I began sorting through the myriad of policies that were available in my area. Three of the companies did not list my current doctors in their plans, so I immediately ruled each of those out. I have had the same oncologist for 10 years. He knows my history and I am very confident in his abilities. I obviously do not wish to change my doctor.There were 3 "big name" insurance companies that all showed my doctor listed in the provider list.
Now that it was narrowed down to companies that I had heard of and that my doctor participated in, it was time to decipher the cost and benefits associated with each of those plans. I will be honest with you, I think I am a fairly intelligent person. I went to college, have a degree in business and am certified in my field. I should be able to decipher the information out there. But as I waded through the descriptions of each of the plans, I began to doubt what I was reading. There was a variance of over $400 per month in the premium amounts between the lowest and highest plans that I was considering. Each of them had different charges for seeing a specialist (oncology is a specialty). Surprisingly, the most expensive monthly premium plan was also going to cost me the most each time I saw my specialist. If they are all supposed to offer the same coverage then why was there such a discrepancy in the monthly premiums. It made me think that there was something that I was missing in the comparisons. I needed someone else to look at the plans and figure out what I was not seeing, I certainly did not want to enroll in a plan because of a low premium only to find out later that there were many other hidden costs that would cost me more in the long run.
I began to see if the plans were going to cover the chemotherapy medication that I currently take. None of them seemed to include my medication in their formulary. If they did, it was considered a specialty medication and would either not be covered or it would be covered at 50% and not included in the deductible. Let me just say that I picked up my medication today and a 2 week supply, before any insurance adjustments, is over $2,600. Under my current plan, thankfully, I do not pay anywhere near that amount.
So as I worked through all of this information I decided that I should call my doctor's office and see what they said about each of the policies. I wanted to get some information to see if they could discern if my medication would be covered, what their experience was with each of the companies that I was looking at and any other questions I could think of. So, when I called and talked to them I was told that "we have not yet determined if we will be accepting any of the insurance under the ACA". My mouth dropped and my blood pressure went up. I have insurance until the end of December through the risk pool, and my doctor is telling me that they won't be participating under the ACA???? Now what?????
Yesterday in the mail, I received a letter from the state Risk Pool stating that they would be extending the pool through the end of March since so many people were having a hard time getting signed up under the new insurance plans. Now my option is to continue for 3 months in the state risk pool or sign up for a plan that may not be accepted by my doctor. As a family we currently pay 24% of our GROSS pay towards insurance premiums. That does not include all of the copays and the deductibles that we pay for my treatment.
Tonight I sit here and wonder what will happen in 3 months when the Risk Pool is shutting down (again). Will there be a plan that will be available for me. I do not have the luxury of a group plan to cover my insurance and even if I did what confidence would I have that I would not be running into the same problem.
I have phone calls into several different places to help me figure this all out. I will keep you posted on what I find out
