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First, a little background. In May 2013 I relocated to a state which has not expanded Medicaid coverage, and where able-bodied adults are not eligible for Medicaid coverage.

I've been working part-time at a hospital since mid-June, and was therefore not eligible for health insurance coverage per the hospital's policy. Hospital policy does not cover employees until they are regularly scheduled for an average of 36 hours/week or more. So while I worked in health care at a hospital, I had no health insurance coverage through my employer, the hospital.

I'm lucky, though. I make slightly more than poverty-level wages, so even though Medicaid has not expanded in this state, I'm able to obtain coverage through the Affordable Care Act.

More on this story, below the orange squiggle.

In July 2013 I had rotator cuff surgery on my right shoulder, following an injury sustained in April 2013. Without the surgery, I was unable to lift my arm more than to level shoulder height to the front and side. After the surgery, I was informed that it was a good thing I'd had it; otherwise, my arm was not going to recover to normal range of motion or strength.

My COBRA payments consumed my first two paychecks entirely. They were something like $582/month, for an okay policy (with $1500 deductible and out of pocket max of $3000, or something like that).

After surgery, I opted for one self-pay followup visit with the orthopedic surgeon, but I did not take the recommended course of rehab, as I could not afford the COBRA after my boyfriend's layoff in late July. Instead, I worked on range of motion and strength on my own, with various aids. My recovery might have taken a little longer than professionally guided rehab, but I believe I've recovered full range of motion and nearly all of the strength I previously enjoyed.

So, since July 31, 2013 I've been going "naked," that is, without health insurance at all. This doesn't feel particularly good as a female, aged 48, with a strong family history of heart disease and cancer, and with parents who died of those diseases around age 60.

So on October 1, 2013 I was one of hundreds of thousands of people who tried signing up for healthcare exchange coverage through the Affordable Care Act (ACA). Initially, it wasn't particularly easy going. Getting onto the site was a challenge in itself; getting all the way through the questions was nearly impossible. And even with saving the data, logging back in later and attempting completion was fruitless.

In mid November, I discovered my previous account was likely one of many with corrupted data. So I created a new account. I provided necessary documentation of identity and income, and was able to compare different plans. I'd found that, luckily, being slightly above poverty level was going to cause the credit to kick in, so I could sign up for a plan at full coverage, or an even better plan for a small payment.

I finally selected a plan in late January 2014, after a couple more episodes of difficulty with my login. Since my preference is to resolve issues via livechat or online, rather than by phone, my solutions were a bit delayed. Whenever I picked up the phone to talk with a representative, my problems were resolved in relatively short order.

I received my first bill for the premium on Thursday, February 13, 2014. The bill was for $142.00, the expected amount. I sent my payment in the mail on Friday, February 14, 2014. I've selected a platinum plan, one that has a $500 deductible and $1000 out of pocket maximum limit.

As soon as March 1st rolls around, I'll be getting in to see a medical professional, and see about getting a few routine test/s and exams scheduled. I should get a colonoscopy, a cardiac calcium study, a mammogram, and a Pap smear, also lab lipid testing. The anesthesiologist strongly recommended I get a sleep study, based on his experience with my surgery and recovery. And I need to discuss a possible change of medication for two common chronic conditions, which are usually well controlled with medicine.

So yes, there will be deferred routine testing to catch up on. I'll be more expensive this year than is usual for me. But my new plan with great coverage is 1/4 the cost of my COBRA.

75% less! Not including the difference in deductible and out of pocket max!

That difference in cost makes the difference between me being able to afford health insurance, and not being able to afford health insurance. And that makes the difference between me being able to seek preventative health care, and getting no health care at all.

I estimate the ACA will likely result in lengthening my life by at least 10 years, maybe more. When I move, I'm considering a different state for my residence (Iowa), which has expanded Medicaid and which also has more extensive coverage requirements than Nebraska. That could result in life-extending or life-saving surgery for me, which could result in another 20-30 years of relatively healthy lifespan.

So while the ACA is not universal single-payer coverage, which I would prefer, it's still a heck of a lot better than what was available to me previously. And while it's not what it could be in this state, I still owe a thank-you to President Obama. I now understand the value of not allowing the perfect to become the enemy of the good.

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  •  Tip Jar (148+ / 0-)
    Recommended by:
    Elwood Dowd, Gooserock, GwenM, mikidee, theKgirls, Skyye, Lawrence, joanbrooker, rapala, Miniaussiefan, Kokomo for Obama, VPofKarma, illegal smile, hannah, allensl, on the cusp, Pinto Pony, looking and listening, kathny, DiesIrae, Limelite, kishik, MartyM, chloris creator, Matilda, jilikins, Overseas, mattinjersey, OhioNatureMom, global citizen, kefauver, manneckdesign, marykk, FloridaSNMOM, geordie, princesspat, Sylv, VinnieSaltine, blue aardvark, Byron from Denver, blue jersey mom, onceasgt, revsue, sillia, mollyd, OutCarolineStreet, Mayfly, karmsy, virginwoolf, Tortmaster, ratcityreprobate, clinging to hope, puakev, zoomzzz, davehouck, We Won, Sun Tzu, doingbusinessas, middleagedhousewife, Jakeston, MarkInSanFran, duhban, limae, rsmpdx, Gary Norton, remembrance, annan, maggiejean, kjoftherock, cybersaur, pixxer, Polly Syllabic, peagreen, celdd, sulthernao, unfangus, askew, buffalo soldier, HappyinNM, spooks51, Diogenes2008, Gowrie Gal, SingerInTheChoir, sow hat, Laurel in CA, emeraldmaiden, More Questions Than Answers, raincrow, joelgp, sotiredofusernames, estreya, gmats, Debbie in ME, pamelabrown, eeff, high uintas, minidriver, GeorgeXVIII, asterkitty, PatConnors, La Gitane, Recovering Southern Baptist, majcmb1, Fonsia, radical simplicity, SoCalSal, slapshoe, Calamity Jean, ArtemisBSG, nirbama, mofembot, Bill in Portland Maine, texasmom, newinfluence, LakeSuperior, murphy, deeproots, Thinking Fella, Habitat Vic, BlueMississippi, Gustogirl, greengemini, Tunk, seefleur, Deep Texan, NYWheeler, Nance, Vatexia, ColoTim, TXdem, wilywascal, Happy Days, worldlotus, asym, cocinero, drdana, doroma, ModerateJosh, petesmom, Sapere aude, livingthedream, smrichmond, chinshihtang, belinda ridgewood, Dustee, diggerspop, splashy, Assaf

    "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

    by AnnCetera on Mon Feb 17, 2014 at 04:25:08 AM PST

  •  Might I suggest (13+ / 0-)

    That if you're only just above poverty wages, your subsidy should cover almost all the cost of a silver plan and the cost sharing subsidies mean that the silver plan would be more generous for you than the platinum one.  That being the case, I would go on healthcare.gov and ask to cancel and change policies, as you can save much more even than you are already!

    •  Maybe after I move... (7+ / 0-)

      But in the meantime, the expense of the screenings I'm referring to is much higher than the savings I would enjoy. Sleep studies alone usually run $2500+.

      "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

      by AnnCetera on Mon Feb 17, 2014 at 04:48:58 AM PST

      [ Parent ]

      •  Preventive Services Covered Under the ACA (6+ / 0-)
        If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider.

        Covered Preventive Services for Adults

        Covered Preventive Services for Women, Including Pregnant Women

        Covered Preventive Services for Children

        http://www.hhs.gov/...

        "Tax cuts for the 1% create jobs." -- Republicans, HAHAHA - in China

        by MartyM on Mon Feb 17, 2014 at 06:27:19 AM PST

        [ Parent ]

      •  ACA is Not the Answer (0+ / 0-)

        I know I know. Everyone here seems to be in favor of the ACA, I'm not. At all.

        So, AnnCetera - your parents both died at about age 60 and you're worried about cancer and heart disease.

        1. Change your diet! We are what we eat, and in America that makes us Dead Meat, because the Standard American Diet (SAD) makes everyone who follows it SICK. I'm a mostly (but not entirely) vegetarian, as is my husband. We are in our late 50's/early 60's. We have no chronic disease. We changed our diets to more heavily plant-based about 10 years ago. Gee - no more indigestion or gut problems - ever! (Among other health indicators.)

        My problem with the ACA? No credit for eating "right". Many many studies have shown that environment has much more of an impact than genes. Statistically. Yes, your genes might be different. We are willing to bet on environment/diet for ours.

        2. Doctors know NOTHING except what Big Pharma and other for-profit members of the Medical-Industrial Complex have taught them. Sleep study? You must be kidding.

        3. We have gone "naked" for over 6 or 7 years now, at least.        We don't have and don't want health insurance. Having saved 10's of 1000's of $$$, we are happy to see the doctors or healers we want to (chiropractic, acupuncture, EFT practitioner, massage therapist, etc.) and pay out of pocket.

        The ACA is nothing more than a HUGE Giveaway to the Insurance Industry. I'm still working and self-employed. I'm not getting any stinkin' insurance that I won't use for doctors that I won't see, to prescribe drugs that I won't use or surgery I won't have. NO NO NO.

        4. I have been sick. The doctors I've seen weren't much help. Through research I've cured myself - most recently of "low thyroid" with daily iodine supplements. (See book "The iodine Crisis".) However - it took about 4 months to work (a lot longer to get sick), and most Americans want to do what they please, and then take a pill to feel better. Ugh!

        5. Our government is not interested in protecting us; it is interested in working with their corporate masters to kill us (slowly and painfully) for a profit. Doubt that? Check out The Fluoride Deception; either the book or the youtube video. I could go on, but I'll stop now.

        Wake up people!

    •  I should mention... (10+ / 0-)

      The dollar amount of the subsidy remains the same, regardless of which plan I choose. So if I choose a plan that costs the subsidy amount or less, my premiums are paid for in full. All I have to cover after that is deductible and out of pocket max.

      A plan that costs more than the subsidy amount requires that I help pay the premium. For the level of coverage I'm obtaining, it's going to be well worth it.

      "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

      by AnnCetera on Mon Feb 17, 2014 at 04:51:33 AM PST

      [ Parent ]

    •  CSR plans are the best thing, barely publicized. (5+ / 0-)

      Sorry, typing is rough, as I am in an arm splint, only have one mobile hand this week.

      Anyone up to 250% of poverty qualifies for cost-sharing reduction, but silver plans only. I have platinum benefits for silver subsidized plan. $115 a month, non-smoker, 56 years old, PPO, national network. Went to emergency room on friday after slip and fall on ice last week... will pay only 10% of plan allowed amount. Co-pay for specialist ortho doctor visit and better cast/splint fitting later this week will be $30. Decent.

      You have time to change plans.

      curious portal - to a world of paintings, lyric-poems, art writing, and graphic and web design

      by asterkitty on Mon Feb 17, 2014 at 10:10:28 AM PST

      [ Parent ]

  •  That people who work at hospitals have not been (34+ / 0-)

    able to afford health insurance is outrageous.

    So glad that you are now covered, and with a platinum plan, to boot.

    Tipping and reccing this diary.

    "A candle loses nothing by lighting another candle" - Mohammed Nabbous, R.I.P.

    by Lawrence on Mon Feb 17, 2014 at 05:09:32 AM PST

  •  I have a question my benefits person (10+ / 0-)

    couldn't answer. I just got a new job with benefits after having no insurance the past year and a half. I had started the ACA signup prior to getting this job so didn't finish, but I still haven't picked my work benefits plan.

    My question: if one's employer offers health care, can I still shop on the exchange and see if I get a better deal after subsidies? Or do I have to take the employer's insurance.

    Any knowledgeable feedback would be appreciated...

  •  Whenever you get a chance ... (13+ / 0-)

    ... on message boards, Facebook, twitter, talking with friends, or holding poster boards in a protest, get out the message that Republican Governors and Republican State Legislators in 25 states are, right now, starting to kill off their citizens because they've refused Medicaid Expansion.

    The latest information I have is that four of those states, including Pennsylvania, are still considering expansion. Get your Letter-to-the-Editor pens ready!  

    Rand Paul is to civil liberties as the Disney Channel is to subtle and nuanced acting. Ron Paul thinks he's a wit, but he's only half right.

    by Tortmaster on Mon Feb 17, 2014 at 07:47:59 AM PST

  •  Thanks for the diary. (24+ / 0-)

    I'm your age, in a state that DID expand Medicaid (California),  although I personally didn't qualify for it. I DID get a nice subsidy from the state, though. Enough that it really popped my eyes. Literally, the monthly premium amount I now pay for ACA-approved coverage, totaled-out for one full year, comes out to be less than I spend in a single, infrequent splurge at the damn pizza parlor.

    Amazing stuff.

    You know what's really amazing to me? It's the boost to my morale that's resulted from a substantive official boost or assist to my life, of the kind they offer citizens of other countries. I had been struggling so hard, for so long, and I'd been so alone. You know. ACA, for us, constitutes a break from the constant glorification of rugged hyper-individualism all around, the ethic of, "You're in this alone. If you're struggling, it's your own fault."

    Thanks so much for the diary.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Mon Feb 17, 2014 at 07:49:17 AM PST

  •  Signing up for ACA is a real chore. (5+ / 0-)

    It took me a whole month of calling at various times to get signed up.  You have to know how to answer the questions correctly to get the right answers.  I am still not sure that i signed up correctly!  (I have 3 kids, 2 are just graduating college - this created a lot of grey that ACA cannot deal with that well).

    Friday i made my last attempt.  They had my application number and finally the website allowed an enrollment.  (i think).  I was told to wait 3 days to call Anthem to make arrangements on paying.  I now have a customer id number!  

    All i can say is that i was very lucky that the enrollment processed on Friday as the website was taken down on Saturday for 3 days.  Saturday was the last day to get enrolled for March.

    I am happy we have the ACA but I understand the horrible press better now.  It really is a difficult process.

    •  It took me one hour to do everything online. (5+ / 0-)

      Sorry it didn't work well for you- but I think things are much better now.

      It was so much better than the old system of filling out tons of medical history for different insurance companies- and then them telling you that they couldn't possibly cover you.

      I will easily take this new system to the old "wait around for two months before we decide if we can insure you" process.

      Previously, it took me 3 months to find one insurance company that would offer me coverage.

  •  More solid proof, ObamaCare works. (5+ / 0-)
  •  Great story. So happy to hear this positive (8+ / 0-)

    news. I've also had a great experience so far. This afternoon I begin treatment for a long standing problem that my previous insurance didn't cover. Even better, I learned last week that my benefits are unlimited as long as there is an approved treatment plan.

    So yes, there will be a backlog of old problems flooding the system during 2014 but Obamacare is probably the best stimulus package that the Federal government could have created, moving money into the pockets of people who are actually going to spend it and not hoard it.

    I would have preferred to have left the insurance company execs out of the stimulus package (single payer!) but I'll take this as the best we can get ... for now!

    "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

    by annan on Mon Feb 17, 2014 at 08:57:57 AM PST

  •  Wish I could get in on that. (1+ / 0-)
    Recommended by:
    Calamity Jean

    Still trying to navigate through the ACA system, on parallel fronts, using both Healthcare.gov and the customer service system. Have been trying since October 1. Probably used 150 hours up on this project using the website, providing information on the phone, tracking down, copying, filling out, and/or mailing documents (that we later find out that nobody is yet paid to review for some kinds of documents), following up on follow up phone calls that we never received, and on and on.

    I was hoping to be able to hit the February 15th deadline for March 1st coverage, but now we're back into difficulties.

    I've now been assigned a "case worker" and am playing phone tag with them last week and this week.

    I know that the ACA has been very popular on this site, and I'm not trying to say that it's bad policy, but I just wish we could have avoided all of this and gone single payer. The actual interface to the ACA for the public has been a disaster, and this disaster is a direct result of needless complexity (and some very bad administration).

    It has become an infuriating, complex boondoggle for our family. And it is so frustrating to see everyone else get covered while we miss deadline after deadline as a family (with the end of open enrollment for the year creeping toward us) without being able to make any progress.

    And yes, I'm aware that insurance can be bought individually, without going through the system, by reaching out to insurers directly. Problem is, we're in Utah, and the individual plans offered direct to public are much more expensive than what's offered through the system (that's why we want to switch), and many of them aren't offered direct to public at all—go to insurer's materials and see, on policy after policy, "Only available on Healthcare.gov" in big, bold letters.

    If we pass open enrollment for the year and we never manage to get signed up, despite hundreds of hours and months of work and endless phone calls, I'm going to break something.

    For me this has become a definite black eye for the Democratic party and for the Obama administration.

    -9.63, 0.00
    "Liberty" is deaf, dumb, and useless without life itself.

    by nobody at all on Mon Feb 17, 2014 at 09:19:04 AM PST

    •  Huh, interesting that they are different in Utah. (1+ / 0-)
      Recommended by:
      FloridaSNMOM

      In MN, the same policies are offered on and off the exchange (at least with Preferred One) and the only difference is the availability of a subsidy: you can get that only if you purchase through the exchange.

      And the insurer said that we could go without a subsidy and get the same plan with a subsidy next year.

      Thanks Democrats! My Obamacare is permanent coverage no one can take away - and saving $3,000 is nice too

      by sotiredofusernames on Mon Feb 17, 2014 at 10:00:29 AM PST

      [ Parent ]

      •  I think you may be able to collect the subsidy (2+ / 0-)
        Recommended by:
        FloridaSNMOM, sotiredofusernames

        retroactively when you file your 2014 tax return -- not sure about that, but possible. Given the problems with exchange sign-ups in many states, the feds seem to be encouraging direct or broker purchasing. Keep an eye on the fine print a year from now when the new tax form comes out.

    •  What has been the problem, nobody at all? (2+ / 0-)
      Recommended by:
      worldlotus, FloridaSNMOM

      Maybe one of us has a suggestion that would work for you. I remember back in December there were various tricks that people used to get around roadblocks at healthcare.gov.

      •  Error message after error message, and failure (1+ / 0-)
        Recommended by:
        Cardinal Fang

        after failure. Early on it clearly had to do with the validation system—somehow my kids' SS cards were never recognized (they're real, and the SSA knows of them, but Hc.g didn't like their data) and my wife's immigration paperwork wouldn't validate either.

        But we got through that. Then it was just error messages of different cryptic kinds, in different places.

        We're still there. The customer service center gave way to the advanced resolution center, and now to a "case worker."

        But what they all do is the same on the call—ask a bunch of questions, put in a lot of data, have me hold a lot, and then every now and then say something like:

        "Nope, it's not letting me do that either. Hmm, I'm getting the same error as well."

        or

        "Good news, I didn't get that error. All fixed. Give it a couple of hours to propagate into the system and then log in and go ahead to the next step..."

        and of course a couple of hours later nothing has changed, or the login now doesn't work, or the application is gone, or...

        We have created, deleted, and recreated dozens of accounts and applications under guidance. Applied over the phone, then logged in to access and had problems. Sent documents both online and by mail, only to finally be told by someone that admittedly the contractor doing document processing doesn't have a labor pool in place yet to process documents.

        There's no one thing. I don't know why we're such a particularly difficult case. There must be other people like us. But presumably it's the combination of:

        - Two young children with newish SSNs
        - Four SSNs in the family each from a different state
        - One SSN issued for someone while on a visa
        - Two rounds of immigration credentials (special international status on the first group made the second group necessary)
        - Multiple employers, but all below the insurance threshold
        - Multiple people with self-employment income

        I suppose people could argue that this makes us "very tough" (the people at the center have said that) to document, but sheesh, this is 2014. We have a flex-labor economy (not our fault, we'd love to simplify, if only the labor market worked that way in our fields) and a mixed-background family. It shouldn't be that big a deal.

        But it appears to be.

        Right now we're waiting on the case worker, who's supposed to go through our data in the system with a fine-toothed comb, then do some magic (they weren't clear on what—I presume modify the data in some way), and update us on the outcome of this process and what else is needed.

        -9.63, 0.00
        "Liberty" is deaf, dumb, and useless without life itself.

        by nobody at all on Wed Feb 19, 2014 at 08:29:25 AM PST

        [ Parent ]

    •  Insurance bought directly from brokers (0+ / 0-)

      If you are unable to go to an insurer in Utah who will enroll you on the exchange, including determining that you do or don't qualify for a subsidy, that is the State of Utah's failure, not a failure of Obamacare.
      I am in Idaho. Idaho has not accepted Medicaid. But the insurance brokers are eager to sign up folks via healthcare.gov, and advertise that they will do so. They have been trained to do this. They earn money signing folks up, so they do it well.
      As a trained, unpaid volunteer in-person Assister, I have seen many people try to sign themselves up and make drastic mistakes. Most confess that they could not do it on their own. That is the fault of healthcare.gov.
      If you are having great difficulty enrolling, it will be much easier to get out of your house and away from your computer, and find an Assister or broker who is equipped, experienced, and ready to help you. I recommend it. Most are paid to help you.
      And, they will see to it that you are insured by the deadline. 21fifi

      •  Tried multiple avenues— (0+ / 0-)

        including paper, by phone, and using a local agent.

        The problem is still in the system itself—something about our data causes either cryptic error messages that people haven't seen before, or worse, no error message but nonsensical results ("Hmm, everything I'm clicking on here is returning me back to my usual screen. That's odd, I've never seen that before. Let me try again...")

        We were working through the "advanced resolution center," but they finally determined that they couldn't help us. Apparently only "case workers" have the level of access needed to go in and do whatever needs to be done, or even to identify what the problem might be.

        So we're waiting on a "case worker" to get in touch with us now.

        -9.63, 0.00
        "Liberty" is deaf, dumb, and useless without life itself.

        by nobody at all on Thu Feb 20, 2014 at 10:54:34 AM PST

        [ Parent ]

  •  nekkid like you (6+ / 0-)

    i'm 62 and almost covering my nut with social security. i too was on cobra (following a divorce) but could no longer afford the $450 per month payments. the plan was terrific: my ex was employed by a school system and even though the plan was an hmo, it was a union negotiated hmo.

    nonetheless, i had to drop the plan when my money ran out in the middle of last year. mind you, i was treated for lymphoma some eight or ten years ago and my gene pool is not particularly heart healthy.

    i too can't stand to work out problems via telephone. but rather than complain, i kept going back to healthcare.gov until just before the deadline for a january start (ok: at the extended deadline. whatever!), i selected a silver hmo that costs me, out-of-pocket all of 14 bucks and change a month.

    i'm thrilled. i'm beyond thrilled. the plan is reasonable, although not the cadillac i was used to. still, it won't bankrupt me if anything awful happens.

    good on obama!

  •  I love to read posts like yours! (5+ / 0-)

    I know what it is like to go naked, mr.u and I did that for 9 months because COBRA was only $8 less than unemployment, we wiped out our savings. We were both 57 and it was very scary.

    The lady who does my taxed told me that she got coverage for the first time in over a decade. She was over the moon happy with it. I had been thinking about her during the roll out and hoping it would work for her.

    And daddy won't you take me back to Muhlenberg County Down by the Green River where Paradise lay. Well, I'm sorry my son, but you're too late in asking Mister Peabody's coal train has hauled it away. John Prine

    by high uintas on Mon Feb 17, 2014 at 10:00:31 AM PST

  •  if all goes (5+ / 0-)

    the way it should I'll be covered March 1st.

    I got a letter in the mail over the weekend.
    My Blue Value Bronze 5000 plan will cost me $199.98 a month. I got a raise Jan 1st, it will cover most of that !

    :=)

    this will be the first time I have ever paid for insurance for myself, over the years I worked at places that offered it, but I never paid for it myself before.

  •  Please use an assister! (4+ / 0-)

    On healthcare.gov under the circle with Enroll Now, click "Find local health help" to find a Navigator, certified application counseling organization, and other entities that offer in-person and other help.  

    Don't keep trying on your own if you are having troubles.  Open enrollment ends March 31 and you should enroll as soon as possible.  

  •  congrats to you...I'm also from Nebraska and (3+ / 0-)
    Recommended by:
    AnnCetera, worldlotus, FloridaSNMOM

    trying to enroll my college age son.  I enrolled him via phone and we had the system go down on several times but at least with them inputting,the system glitches didn't have me going crazy.

    "Forever is composed of nows." Emily Dickinson

    by Leftovers on Mon Feb 17, 2014 at 10:44:01 AM PST

  •  ACA premiums (2+ / 0-)
    Recommended by:
    jvance, AnnCetera

    The US did not have to reinvent the wheel. Every other industrialized/civilized country on the planet has a better system with better outcomes.
    IMO, the ACA is much more complicated than necessary and the geographic variation in premiums is breathtaking, to say the polite least. Whether, it is better than the commercial system we had before is yet to be seen, given how much power it preserves for the for-profit healthinsurance cartels.
    See kaiserhealthnews.org for the 10 least expensive and 10 most expensive markets in the US.

    •  The complexity is political (3+ / 0-)
      Recommended by:
      AnnCetera, worldlotus, FloridaSNMOM

      The Obama people felt they had to design it this way, thinking that since it was basically Heritage Foundation / Romneycare, the Republicans would support it. (Fools. . . .) And they were afraid of all the states' rights people up in arms -- which indeed happened on Medicaid, and would have been even worse if they'd tried to federalize the premiums and plans to make them uniform across the country.

      So yes, it's far from ideal. But it was what they considered would be possible to get through Congress. We won't know if they could have done better, unless the Democrats regain enough seats in the House to try tweaking it in good directions.

    •  It's better overall (2+ / 0-)
      Recommended by:
      AnnCetera, FloridaSNMOM

      but yes it's a truly Byzantine law.  It's the American way - the worst of public and private sector just sort of jammed together, with an application process so complex it might as well have been designed to hide benefits from those needing them.

      Case in point - this diarist going for a Platinum plan because she didn't know she qualified for reduced cost sharing on a Silver plan.

      Economic Left/Right: -7.38
      Social Libertarian/Authoritarian: -8.00
      Two steps to the right of Trotsky.

      by jvance on Mon Feb 17, 2014 at 11:27:39 AM PST

      [ Parent ]

  •  Great news! (3+ / 0-)
    Recommended by:
    AnnCetera, mmacdDE, worldlotus

    I suggest you not have a mammogram, though. We've known for a while that mammograms for women under 50 do not improve outcomes, and the latest study from Canada backs this up. Plus, mammograms are no fun.

  •  Rec list?!? (2+ / 0-)
    Recommended by:
    worldlotus, FloridaSNMOM

    Wow, I really didn't think this was that noteworthy. Thanks!

    "Fast, Cheap, and Good... pick two." - director Jim Jarmusch

    by AnnCetera on Mon Feb 17, 2014 at 01:17:33 PM PST

  •  Coverage is indeed affordable! (3+ / 0-)
    Recommended by:
    worldlotus, FloridaSNMOM, AnnCetera

    WONDERFUL!  

  •  Health Insurance Cost. (3+ / 0-)
    Recommended by:
    worldlotus, Leftleaner, AnnCetera

    How much should it cost a husband and wife and two children for affordable care in Wash Co Md.? I have tried to learn from the federal site , and the state site. So far I have not found any answers. They are my daughter and family. They said they could not find anything could afford , and are paying the penalty and going without insurance.  
      it seems different here from the stories of people being able to quit jobs , and people paying premiums of $142.00 and less per month.

    •  It depends on income and location (1+ / 0-)
      Recommended by:
      AnnCetera

      If there income is too high for a subsidy, they have to pay more. And as a family the premium would be a lot higher.  You can get a subsidy if your income is under 4 times the poverty level.  They size of the subsidy decreases as your income goes up.
      This  Site explains how to figure it out.

      Be bold. Be courageous. Americans are counting on you. Gabby Giffords.

      by Leftleaner on Mon Feb 17, 2014 at 02:50:39 PM PST

      [ Parent ]

  •  This is just the kind of detailed, human story (3+ / 0-)
    Recommended by:
    worldlotus, FloridaSNMOM, AnnCetera

    that makes all the difference. Keep telling it everywhere you can!

    "When in doubt, do the brave thing." - Jan Smuts

    by bunnygirl60 on Mon Feb 17, 2014 at 01:35:52 PM PST

  •  ACA (1+ / 0-)
    Recommended by:
    smileycreek

    I have been signing up folks with incomes 100-250% of FPL on exchange for 2 months. At this income range, you get a premium subsidy and your deductible, co-pays, co-insurance, max out-of-pocket are reduced. BUT, if you sign up for a Bronze, Gold, or Platinum plan, you only get premium subsidy, and actuarial values of those plans do not change.
    Unsubsidized Silver plans have 70% actuarial value, you pay 30%, insurance pays 70%. Platinum plans have 90% actuarial value, Gold 80%, Bronze 60%.
    When enrollment eligibility report says you get premium subsidy AND cost-sharing assistance, premium subsidy can be used for any metal plan. Cost-sharing assistance applies to Silver plans only. If you have premium subsidy and cost-sharing assistance, at 100-150% of FPL, you get a Silver plan with 93% actuarial value, at 151-200%, you get a Silver plan with 87% actuarial value! at 201-250%, it is 78%. Always sign up for a Silver plan if Enrollment Eligibility Notice says you get a premium subsidy AND cost-sharing reductions. 21fifi

    •  That is incredibly useful information. (0+ / 0-)

      You might consider writing a diary explaining some of this.

      Welcome from the DK Partners & Mentors Team. If you have any questions about how to participate here, you can learn more at the Knowledge Base or from the New Diarists Resources Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.

      We all owe it to the American people to say what we’re for,
      not just what we’re against.
      ---> President Obama, 2014 SOTU speech

      by smileycreek on Wed Feb 19, 2014 at 12:47:45 PM PST

      [ Parent ]

      •  A diary about signing folks up for Oamacare? (0+ / 0-)

        I am not sure what you mean. I read where Ann Cetera had probably qualified for a Silver plan with premium subsidies and cost sharing, but then chose a Platinum plan that likely had less value than the Silver plan.
         I tried for 2 days to comment, changed to a different email address, and then was able to comment.
        Do you mean you want more specific information about how it all works?
        Or are you interested in understanding how the people I am signing up feel about having insurance?
        I don't know how to write a Daily Kos diary.
        21fifi

        •  There is considerable interest in (0+ / 0-)

          first-hand accounts around here, especially on a current topic like the ACA. There's interest in all aspects of it, from policy to promotion to patients.

          If you do feel like you have more to say about your experiences, go back to the orange welcoming box above for information on how we can partner you up with a mentor who can show you how it works.

          We all owe it to the American people to say what we’re for,
          not just what we’re against.
          ---> President Obama, 2014 SOTU speech

          by smileycreek on Wed Feb 19, 2014 at 10:37:06 PM PST

          [ Parent ]

    •  No subsidy (0+ / 0-)

      When you file taxes for 2014, in 2015, if you have an exchange plan without a subsidy, IRS will determine if you were indeed eligible for a subsidy,based on your 2014 income reported to them.  If you were eligible for a subsidy, IRS will give you your rightful subsidy with your tax return.
      On the other hand, if you underestimated your 2014 income when you applied and received a greater subsidy than you were entitled, the IRS will take the subsidy that you were overpaid from your 2014 tax return.

      And a note about penalties. If you live in a state that did not accept Expanded Medicaid, you are subject to no penalty if your income is 138% or below FPL. 21fifi

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