04/17/2017

We Have To Earn $42,000 Every Year Just To Cover Our Obamacare, And GOP Plans Won’t Help

Douglas Tate, The Federalist

For this healthy couple over 60 years old, there is no substantive difference between Obamacare and the AHCA. In many respects, we may be worse off financially.

As Republicans’ effort to resuscitate their plan to “repeal and replace” Obamacare gains momentum, perhaps it would be illuminating to ask someone who is actually insured under Obamacare to share his or her perspective.

My wife and I are both older than 60. We are in excellent health, not under any prescription drug regimen, and physically active. We live in New Hampshire, which enjoys not only a variety of weather patterns, but a plurality of Obamacare insurance providers.

My wife and I have not benefitted from an employer-provided health insurance plan for more than three years. We have instead obtained our health insurance through Obamacare. To keep the insurance plan, doctors, and hospitals we liked for more than 14 years, our premiums under Obamacare increased 225 percent with deductibles increasing 325 percent.

We couldn’t afford the annual premiums of $22,000, so we were forced to change our doctors and insurance plan. While we managed to reduce our premiums, we lost significant choice in hospitals and were subjected to ever-increasing deductibles.

We Have to Pay $15,000 for Our Insurance to Kick In

We purchased our Obamacare through a broker because doctors convenient to our location who were accepting new patients only accepted broker-sourced insurance plans. Had we purchased our Obamacare via the “exchange,” our nearest doctor would have been more than 45 miles away, more than an hour’s drive. The exchange-sourced policies also featured extremely limited hospital availability.

While relatively healthy, we recently needed treatment from our physician. The treatment was minor, but it laid bare the realities of what is covered by one’s plan and out of one’s deductible. Thankfully, a helpful customer service person from our insurance company explained how Obamacare coverage really works relative to essential health benefits.

The key distinction is the difference between preventative and diagnostic procedures. Preventative procedures are covered directly by one’s Obamacare policy, and not subject to deductibles. Under our policy these are limited to mammograms, colonoscopies, appointments for gynecological exams and physicals, and cholesterol screening. Diagnostic procedures include all other procedures and tests and must be paid for by the patient until his deductible limit has been satisfied.

Given the focus on prevention to head off serious medical issues, including these procedures and tests is appropriate. However, if we were to avail ourselves of all these tests during a normal year, the imputed cost would be less than $2,000 for both of us. This includes the prorated cost of a colonoscopy, since we, thankfully, don’t need to experience that procedure every year.

After accounting for these annual preventative treatment costs, there is more than $13,000 remaining of our more than $15,000 annual premiums to cover a serious or catastrophic situation. However, the coverage associated with that remaining $13,000 is not available until we have paid approximately $15,000 in deductibles (i.e., roughly $7,500 per person). The impact of deductibles is particularly vexing if one becomes sick at the end of a given policy year, as the deductible balance resets to zero on January 1.

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