Talking to a navigator, but my broker made more sense (PART 2)

The author with husband Craig and their four children: 'With Obamacare, you  pay extra for every child!'

The author with husband Craig and their four children: ‘With Obamacare, you pay extra for every child!’

By Jen Furer

One day, I went on a live chat with a navigator at healthcare.gov, but apparently the easiest way to find out prices and coverage options for my family was to fill out a Marketplace application.

The navigator informed me that by completing the application, I’ll receive a personalized report that tells me all the options I qualify for, including private insurance plans and free or low-cost coverage through Medicaid and the Children’s Health Insurance Program, also known as CHIP. I was also told that they can tell me if I qualify for lower costs on my monthly premiums and out-of-pocket expenses like deductibles, copayments and coinsurance.

The next day, I tried to log into the healthcare.gov website, but I couldn’t go through. I started to panic. I truly gave ACA the benefit of the doubt.

I called the healthcare.gov hotline. However, for the navigator to give me any information, I had to give them my social security number to see what my options are and to see if I was qualified for tax credits, Medicaid or CHIP. I then proceeded to ask to see the list of health care providers in the plan, and I was told I didn’t have access to it until I fill in the application.

Getting frustrated, I contacted my own health insurance broker. He explained that before Obamacare, the family premium wasn’t based on how many children you have. With Obamacare, every dependent has a separate charge. Before Obamacare, if you have a parent+child health plan, you pay the same premium if you have 2, 3, 4, 5, 6, 7 however many kids you have! With Obamacare, you now have to pay extra for every child!

There were a lot of pent-up anger and uncertainties. I cried out so loudly that my 12-year-old son came up to me and said, “Mom, if you need someone to talk to, I’m here.”

Almost every day I would post my “Obamacare woes” on Facebook because that’s how I vent my frustrations and hopefully get some answers.

The week before December 1, 2013, I was running out of options. I was confused and devastated because my existing AmeriHealth Plan has better coverage than the new ACA-compliant AmeriHealth Gold Plan. However, before ACA, my plan costs $16,000 less than the new ACA compliant plan. With all these changes, I needed more time to make a decision.

I called our primary care doctors and asked if they accepted all the plans offered in the Healthcare.gov Marketplace website. That’s when I found out that they do not accept the Value Plan. I went on the Kaiser Family Foundation (www.kff.org) and used the Subsidy Calculator to estimate if my family was eligible for the tax credit.

According to the website, if our family income falls within the 100 percent-400 percent poverty line, we will be eligible for a tax subsidy.

'My family has been profoundly injured by this law.'

‘My family has been profoundly injured by this law.’

So I played around with the numbers to see what falls within such poverty line for a household of six: If our income stayed below $126,000, we are eligible for a tax subsidy of $8,376, otherwise I need to pay the full premium.

Luckily, my private health insurance broker found a way around it. We were given an option to change our policy’s open enrollment period and anniversary date. So on December 2013, we renewed our pre-ACA plan and our rate only increased by 10 percent. I used to complain every year when the rate increased by 10 percent but last December I was so relieved that it wasn’t 100 percent.

The delay gave me extra time to figure out my options.

When browsing through the Marketplace, I watched a few of the featured stories of people who received huge savings because of ACA — young people in their mid 20s or early 30s who obtained health and dental insurance for less than $100 a month. However, none of the stories was from New Jersey or New York.

I started calling people I know. One of my relatives told me they ended up using Medicaid for now because when they applied online last December, there was some confusion with the paperwork. In New Jersey, if you qualify for Medicaid and CHIP, to be eligible to purchase a plan in the Marketplace, one has to call NJ Family Care to get authorization.

I recently spent hours talking to my insurance broker and I found out that there’s no avoiding ACA. There were talks about delaying the individual mandate for another three more years, which means individuals can still purchase non-ACA compliant health care plans.

However, according to my insurance broker, New Jersey insurance companies, with the exception of Oxford, are not allowing people to keep their current pre-Obamacare plans once they come up for renewal in 2014. According to one news report, Governor Chris Christie said last November that the state would leave it to insurance companies to decide if they wanted to continue offering transitional plans that did not fully comply with the Affordable Care Act, and most insurance companies declined to do so this year.

I have about eight months before I need to select from one of the many versions of health care coverage. I could end up paying the same premium I’m paying now but with 50 percent less coverage and a higher co-pay.

I would also need to re-evaluate if it’s cost-effective to keep my children in my plan. The law’s provision allowing individuals to stay on a parent’s plan until they are 26 sounded good until we found out that we are facing higher charges. With ACA, there’s an additional premium for every child. For children over 20, according to my AmeriHealth renewal documents, my premium is charged additional $5,000 a year per child and $3,000 for each child under 20.

However, if I decided to exclude them out of my family plan, according to the Marketplace they are eligible for Medicaid and/or CHIP (Children’s Health Insurance Program). However, their current primary care doctors don’t accept Medicaid or CHIP.

Who knows what will happen in November 2014 when it’s time to renew our plan?

At the end of the day, it’s all about understanding health care and why costs keep rising. There are pitfalls and unknowns to Obamacare that ordinary Americans need to know about. Even the so-called navigators cannot explain them fully. I’m still confronted by a lot of unknowns. One thing is for sure I will be reviewing every option before making any decision.



3 Comments

  1. […] Talking to a navigator, but my broker made more sense (PART 2) […]

  2. Kory Z wrote:

    I always spent my half an hour to read this webpage’s articles every
    day along with a cup of coffee.

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