October 1 arrived on Tuesday, the first day to evaluate and enroll in one of the Affordable Care Act’s plans. The 17 States that have their own exchanges, along with the Federal exchange, were quickly swamped as millions of people attempted to get on and determine what the ACA meant to them personally.
There have been a number of hitches and glitches ranging from inability to get onto the system, create log-ins, and in some cases the information on the premium rate or tax credit was inaccurate. I have experienced this personally as I’ve sought my own answers to health insurance questions.
I’m a self-employed, independent insurance agent in Dallas, Texas.  I currently have an individual health insurance policy through Blue Cross Blue Shield of Texas. It’s a high deductible plan using a Health Savings Account. A synopsis of my plan is below:
- Annual deductible is $2,500
- It’s currently set up on a PPO basis
- 90/10 co-pay until my out of pocket maximum is reached
- Monthly premium is $462 (includes dental coverage)
- Dental coverage pays a maximum amount each year of $1,000
My plan provides for an annual physical which includes standard lab screenings and a colonoscopy if needed, but no EKG or chest x-ray. It does cover vaccinations such as whooping cough and flu shots; I got both this year.
There are several questions I was hoping to answer by this time including:
- Would I be able to match the coverage I have with my individual plan?
- What differences would there be between the plans available through the Federal Exchange and my current plan?
- Would a Health Savings Account option be available?
- How would the HSA model compare to a non-HSA plan?
- Would I be able to maintain a PPO plan or would I need to convert to an HMO plan?
- What would it cost?
So far, I have been unable to answer my questions to the level of detail I’d like. I have some preliminary information, but it amounts to about only 40% of what I’d like to know at this point.
My current health insurance policy renewed last month. Prior to it renewing, I received a letter from BCBS Texas stating my policy would run through the end of November and be replaced with a new policy on December 1. The new policy will be adjusted on a cost basis using the new plan pricing. Since my renewal was prior to the release of the ACA plans and their accompanying premium levels, I was unable to determine how the new pricing models and coverage will compare to my current plan.
While I’ve not been able to successfully get onto the www.healthcare.gov to create an account and compare plan coverage and premium levels, I have found some information through the BCBS Texas web site.
- I apparently do not qualify for a Platinum plan that matches my current 90/10 co-pay. I don’t have an answer as to why, but am discussing it with BCBS.
- There are HAS options available. They are only available with the Bronze Plan which has a 60/40 split and a $6,000 annual deductible. I’d have to pay 100% for all office visits up to the deductible including the annual physical.
- My cost for this plan is $425 a month, a $37 a month savings, but increases my co-pay by $3,500 annually. It also moves me out of a PPO plan to a HMO plan.
- I could get the Bronze PPO plan with a $5,000 deductible, but it would not be an HSA plan and it would cost me $560 a month.
- The closest plan available to my present coverage is a Gold plan with an 80/20 split, a $1,000 deductible, a $3,000 out of pocket maximum and a $30 doctor office payment. Its monthly rate is $968.
All figures listed do not include tax credit assistance. I’m in the process of reviewing all the plans both ways to see how helpful the tax credit is in reducing the monthly premium.
The bottom line: in order for me to obtain a policy that’s not on a par with my current plan, but the closest one I’ve found so far, I’ll pay over $500 a month more for health insurance. As a small business owner who’s self-employed, this is a huge increase in cost that I’m not sure is worth it.
My plan is to verify with BCBS this is truly all that’’s available to me. In the next few days, I’m hoping to finally get on to the Federal Exchange site and see all my options there and compare them to my current coverage and premium. I’m also reviewing all this with my broker who handles my current policy. She and I will be talking in greater detail in the coming weeks and I’ll let you know what I find.
What have you found so far? Is the coverage the same, better, or worse and how does it compare on a cost basis? Share your thoughts, experiences, and questions with us in the comments section of our blog or on our Facebook and Google + pages. I think we’ll all learn something from each other and hopefully, we’ll all find an affordable health insurance plan!
