My biggest concern when I got divorced two years ago was how I would handle health insurance. Living with chronic illness I was fairly sure my only option would be going through the exchange at healthcare.gov. But, I’d heard horror stories about how expensive it still could be, and about the limited options in Alabama.
Because Alabama has chosen not to expand Medicaid (as many other states have) our rates tend to be a bit higher. So, I had no idea what I was in for.
Up until the ACA went into effect I’d had individual pay health insurance through Blue Cross Blue Shield. It was a good plan and affordable for me. However, as many found after the ACA went into effect my rate more than doubled. So, the only option was for me to be added to my (then) husband’s insurance plan. It wasn’t a big deal until his company switched to a new insurer that isn’t widely accepted in our area.
This brings us to the summer of 2017. I had no idea what to expect. I made the mistake of signing up online to get info about insurance and got about 500 spam calls in a few days trying to sell me insurance. The one or two that I actually spoke with were quick to tell me that given my chronic health conditions my best bet was going through the exchange. I really appreciated their honesty.
I headed over to healthcare.gov and began the process. I was a bit scared as I began the process before the divorce was final. It was confusing because I couldn’t go active on my exchange plan until I was no longer eligible for my husband’s plan… but I wouldn’t be ineligible until the divorce was final. We were given a timeline (which thankfully in AL is pretty short – about 60 days). I used that to base my start date/ eligibility date. And, while the divorce took a week or two longer than expected it wasn’t a big deal.
I called the (very nice) folks at healthcare.gov several times and they assisted me through the process and answered my questions, including quelling my fears over the eligibility date/overlap issues.
Health Insurance Options Through the Exchange
Insurance plans are broken down into four categories. The premiums generally go up as you go up in levels.
Bronze is the cheapest plan. You pay less in premiums but you pick up more of the cost through the year with higher co-pays and a much higher deductible (usually several thousand dollars). There’s likely also an HSA plan associated allowing you to pay for some of your medical expenses with pre-tax money.
Silver plans have a moderate premium payment, and moderate co-pays. The deductible is usually a lot lower than with a bronze plan ($500-1000)
Gold plans have high monthly premiums but lower deductibles (usually around $500) and low co-pays.
Platinum plans have the highest monthly premiums but low (or no) co-pays. These plans also have the lowest deductibles and out out of pocket expenses.
Terms to Understand
Premium is the amount you pay to the insurance company on a monthly basis. Think of it as a membership fee. In exchange for your membership your insurance negotiates lower rates on healthcare related items and will pick up some of the costs related to healthcare.
Deductible is the amount you pay before the insurance pays for anything. With Bronze plans you may have to pay several thousand dollars out of pocket before the insurance pays for anything.
It’s important to understand that during this time the insurance still helps you out in that expenses are still billed to the insurance and the insurance will negotiate lower rates for you than if you were actually paying cash.
Prescription medications may or may not count towards your deductible.
Co-Pays is the amount you pay for services after your deductible is met. This is usually a flat fee amount based on the type of service. For example, I would pay $25 to visit my GP or $40 to visit a specialist doctor. Co-pays on prescriptions often vary depending the type of prescription (generic vs name-brand).
Coinsurance is similar to a co-pay but instead of a flat fee, it’s a percentage of the bill.
Out of Pocket Maximum is the most you would have to pay in one year. This does not include your premium. Once your maximum out of pocket is met your insurance has to pick up 100% of the bill.
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My Insurance Choices
Alabama doesn’t have a lot of options. Supposedly, for 2019 we had two insurers to choose from – Blue Cross Blue Shield and something called BrightWatch. I’d literally never heard of the last one until I read an article about 5 minutes ago. In other words, they were not listed as an option when I chose my 2019 plan.
When I picked up my plan in mid-2017 (which was the same plan I kept through 2018) I was surprised at just how affordable it was going to be for me. That said, my income was/is NOT high. I was able to pick up a really great (Silver) plan with just a $500 deductible and reasonable co-pays for just about $75/month. I kept this same plan in 2018 with little cost change.
I’m not sure what my max out of pocket was but it was fairly low as I actually hit it in 2018, which made the last few months of the year quite nice as I walked out of the pharmacy without having to hand over any $$ for my prescriptions.
This was actually quite a surprise for me as I really didn’t spend a lot on healthcare in 2018. It was a light year with no health issues or any major maintenance costs (not even a colonoscopy).
How did ACA insurance affected my choice in doctors
My biggest fear with ACA insurance was the inability to get good care. I was afraid I wouldn’t be able to keep my specialists. I’d heard horror stories about Medicaid and how so few doctors accept it. And, I’d seen that some of my doctors didn’t accept certain levels of insurance.
I’ve not had any issues with any of my doctors accepting my insurance since I’ve been on the exchange. In fact, because I’m now insured by Blue Cross Blue Shield (which is the most widely accepted insurance in my area) it’s actually easier to find doctors.
The last few years before my divorce, while on my husband’s insurance I hadn’t had a general practitioner because I’d had trouble finding one that would accept my insurance. I’d been using a walk-in clinic as my primary care.
Once I got on a BCBS plan I was able to get the general practitioner I wanted – a doctor that my mom had been using for a few years. I’d met her when taking my mom in and really liked her. So, that’s been a really happy update that came with the insurance change.
Changing to a high deductible HSA plan for 2019
My income in 2018 was weird and a little higher. I expected it to stay on an upswing into 2019 and made the mistake of figuring my estimated income based on that theory. As such, when I looked at insurance plans for 2019 my premiums went up A LOT.
I was going to have to pay close to $300/month to keep the same plan I’d had previously. There was no way I could afford to keep my same plan.
This time around I really had to look at all the options.
I sat down and ran the numbers. Because 2018 had been a healthy year I didn’t have any reason to expect that 2019 would be different. If I stayed fairly healthy I likely wouldn’t meet the high deductible, but even so. Adding the deductible with the lower premium, I’d still pay slightly less than I would if I chose to stick with the same plan.
And, if it was a healthy year I’d pay a lot less than I would if I chose to stay with the Silver plan. The difference really came down to feeling like I just couldn’t afford that high monthly bill. So, I downgraded to a bronze plan with an HSA.
What’s an HSA?
I still don’t feel I understand HSAs well enough to explain them. (Please feel free to comment and clarify/correct me). HSA stands for Health Savings Account. The idea is that you can put money into it pre-tax and use that money towards your healthcare needs, including OTC meds, and many medical related items and services.
If you have insurance through a job, they will often contribute to this account for you. Or, you can have money come out of your paycheck pre-tax and deposited into this account. I don’t have a regular job, so I’m really unsure how this is going to play out for me and I really won’t know until tax time 2020 rolls around.
For now, I did set it up and have been contributing. But, my contributions are going in after tax (as per my CPA) because my insurance is set an individual account and not through my business.
You can invest the funds in your HSA and treat it as an investment account. This is great if you don’t need to use the money it. The max on my HSA was about half of my total out of pocket expenses for this year.
How the high-deductible plan worked out for me
If only this year had played out as I’d hoped. But, it didn’t. If you’ve been following me you know that 2019 has not been a great year health wise. In mid-February I got hit with some unexplained headaches, that resulted in quite a few very expensive tests and doctor visits. Frequent trips to the chiropractor also wracked up some pretty hefty bills.
So much for not feeling I could afford that high monthly payment. Instead I’ve payed out over four grand in medical bills in just the first few months of the year. Thankfully, things have calmed down but I’ve still not fully hit that high deductible.
Here’s another wrench in all this. Because I’ve spent so much of this year sick, I’ve not worked as much which means my income hasn’t been as high expected. So, chances are unless I see a drastic change during the last half of the year I’ll probably get an additional tax credit on the premiums I’ve payed for this year. In other words, had I had any idea what my income would actually be for this year I could have easily afforded to keep my old plan.
Would I do a high-deductible insurance plan again?
Honestly, I don’t know. I’m still considering it for next year. In healthy years it really is much cheaper. And in unhealthy years it’s still about the same cost overall or potentially cheaper (or it should be – I really don’t want to test it fully to find out).
This last week, I discovered another difference with this new plan. The Silver plan was a PPO plan that required I use an in-network GP and that my GP provide a referral for me to see any specialist. While this was a pain to set up initially, it wasn’t a big deal overall. But, those referrals do expire and as I discovered this past week, the specialists aren’t great at letting you know.
With my current Bronze HSA plan, I no longer need those referrals.
I will definitely do a full evaluations when open enrollment comes along again and I’ll be sure to update this post at that time to share the outcome.
Overall, I’m really glad I have the option of insurance through the exchange. Had I been able to keep the insurance I had prior to the ACA I’m not sure I could still afford it now even if rates had not risen the way they did following the ACA. My rates were already going up due to my increasing need for healthcare.
All in all, my experience has been good with my insurance through BCBS the last few years. They are the most widely accepted insurance in my area. I’ve never had any real surprises with bills or issues. And, the few times I’ve needed to contact them they’ve always been very responsive. I really have no complaints.
Do you have insurance through the healthcare.gov exchange? If so, what’s been your experience? Please be sure to share your comments below.
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