Obamacare and Me, California-style

December 16, 2013

By Herbert A. Sample

As a 50-something, self-employed California resident repeatedly denied health insurance through the private market, I was looking forward to getting covered by the Affordable Care Act.

Well, it looks like I have accomplished that, and I will have better, more secure coverage at a lower price than I ever could have found otherwise.

But getting there wasn’t easy.

Let’s start with what went right. According to a Covered California customer service rep, the Blue Shield policy I chose in early November is vetted, approved and ready to rock and roll come Jan. 1. That’s heartwarming because for nearly three years, health insurance for me has been alternately pricey, temporary or simply non-existent.

Covered California and Blue Shield should be content too. I’m not a “young invincible,” the age range of 19 to 34 that is an underwriter’s dream because they pay a lot of premiums but generate relatively few insurance payouts. Still, I’m in pretty good health and my ongoing prescription expenses are probably low for my age.

It’s been a long road to this point. After I left full-time employment at the Associated Press in early 2011, I had 18 months of COBRA coverage, which allowed me to remain on my former employer’s group policy. But I was required to pay the full cost of the premium. In my case, that was close to $600 a month – even for a 50-ish male in decent shape. But I didn’t want to go without coverage, so I paid it.

Before my COBRA coverage ended in mid-2012, I applied to five health insurance companies for an individual policy. Four of them, including Blue Shield, rejected me out of hand, citing what I thought were pretty mild pre-existing conditions. (I wasn’t alone; more than a fifth of individual applicants are denied coverage in California annually, according to the Kaiser Family Foundation.) The fifth insurer might as well have rebuffed me. It agreed to coverage – at $1,350 a month. I declined.

With COBRA finished, I bought a catastrophic policy good only for in-patient hospital care. But that lasted just a month because I discovered that it would derail my strategy to eventually obtain full medical coverage through the Pre-Existing Condition Insurance Plan. That program was set up by the Obamacare law as a bridge to the day when the new federal law will require insurance companies to accept all applicants without regard to their health status. But PCIP was open only to applicants who had been without coverage for at least six months. So I went uncovered from October 2012 through last March. Fortunately, calamity did not strike.

In April, I joined California’s version of PCIP at $381 a month. Three months later, the plan’s administration shifted to a federal agency, the price dropped a bit and some deductibles changed.

With great anticipation, then, I awaited Covered California’s open enrollment period on Oct. 1. Finally, I thought, a chance at affordable individual coverage without an insurance company standing in my way. But I didn’t immediately jump on my computer because, as my dad would say, don’t buy the first model of anything; let them work the kinks out first. So I waited until early November to start the process.

Maybe I should have waited longer.

What I confronted was a Covered California website that was still full of kinks – seemingly easy-to-spot technical and content glitches that should have been resolved months earlier. For example, the site was maddeningly vague on just what financial figures it required on the online application form. Was I to use income and deduction numbers from my 2012 tax return or should I estimate my income and deductions for 2013? Or for 2014?

Covered California’s customer service reps weren’t much help. One advised me to estimate my income. Another said to use line item figures from my 2012 tax return. Both said to choose the monthly income and deduction format on the online form because the annual format made their computers burp. This advice came, of course, when I could actually reach someone on the agency’s overloaded phone lines. A few times, I didn’t even get a busy signal. The call just dropped.

The website’s online chat feature was even worse. Several times, after I’d waited for as long as 45 minutes and my queue number decreased to single digits, the chat session abruptly ended by itself, forcing me to start over. At other times, after I switched from a Firefox to a Safari browser, the chat session links wouldn’t work. I asked a customer service rep about that and he said the website was optimized for Internet Explorer. I just about fainted. How daft of Covered California to design a website that works better on a particular browser, especially one that most people don’t use anymore.

But perhaps I’m being too harsh. For once I finished the financial portion of the application, shopping for a policy was comprehensible and quick. The site provided several choices, which I narrowed down to three that allowed me to keep my current doctors. I picked a “gold” plan with no deductibles priced at the same monthly premium (taking into account the subsidy) charged by my high-deductible PCIP policy.

To recap, before Obamacare I was all but uninsurable at a cost I could afford. Then I was paying $381 a month for a high-risk policy that had a $1,500 deductible and an annual out of pocket maximum of $8,125, including prescription drugs. Thanks to the Affordable Care Act, my new policy costs me $366 per month and has no deductible and an annual maximum of $6,350 in co-payments.

That’s a pretty good deal. I am still wondering just how ready Blue Shield is to integrate me and thousands like me into its system almost overnight. I’ve received no insurance card yet and its customer service agents gave me at least three different due dates for my first premium payment: Dec. 21, Dec. 26 and Jan. 6. Generally, they sound as befuddled as I am.

Still, the outcome of my Obamacare journey appears much better than when underwriting decisions were left solely to the whim of insurance companies – I hope.

Herbert A. Sample is a freelance writer based in Berkeley, CA. He can be reached at hasample@mac.com

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One Response to Obamacare and Me, California-style

  1. Frederick Pilot

    December 17, 2013 at 3:09 pm

    Mr. Sample raises a good point regarding monthly income estimates. Eligibility for Medicaid or advance premium tax credits for commercial plans is based on 2014 income — not 2012 or 2013. Since it’s still 2013, obviously that requires applicants to estimate their 2014 monthly income.

    It should be borne in mind that in the case of advance premium tax credits, those credits are reconciled when applicants file their 2014 tax return. If income exceeds the allowable tax credit, the excess credit is due with that year’s taxes. Conversely, if an applicant overestimated their income, the tax credit due is claimed back on the 2014 tax return. Here, it works similarly to the employee tax withholding exemption election on Form W-4 and for self employeds, quarterly estimated tax payments.

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