Affordable Care Isn't

Wow. It turns out that I applied and was accepted for health care under the Pre-Existing Condition Condition Insurance Plan just in time. Yesterday I made some phone calls to track down the insurance card I have not yet received, and discovered this website announcement by the Plan:

"Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide."

The explanation is that the Plan has a finite amount of funding from Congress, and they have to suspend enrollment to ensure that there is enough funding to support current enrollees (about 135,000 of us) through 2013, after which the Insurance Marketplace will be available as dictated by Obama's Affordable Care Act.

How did this happen? Well, according to the Plan:

"Based on program experience and trends since the start of the program, PCIP enrollees have serious and expensive illnesses with significant and immediate health care needs."

Even though the enrollment volume has been much lower than anticipated, the government underestimated the expense that would be realized by people having to actually use the Plan.

Remember, the Plan is not free to enrollees (although it it partially subsidized by the federal government). We have a monthly fee, which is higher than what many people pay for health insurance through their employer. There is also an annual deductable, which can vary by state (mine is $2000 in Arizona). Coverage does not include dental or vision, which we pay on our own. Enrollment has not been as high as expected, because some people still cannot afford this health care option.

My concern is this... The federal government has miscalculated demand, what the public can afford, and the expense of delivering subsidized coverage. What other unfortunate surprises await us when Obamacare is fully implemented in 2014-2015?

I'm Insured Again!

Back in June, I wrote about having to go without health insurance for 6 months in order to get insurance in Arizona. That was an unpleasant by-product of past health issues and the expiration of my COBRA 18 months after I retired from Hilton. If you missed that, here's the link.
http://runawayboomer.blogspot.com/2012/06/without-net.html

That was a scary 6 months, as you can imagine. Fortunately, I made it through without a health incident. I applied for high risk pool insurance in Arizona last month, and my application was approved. I had to provide documentation proving that I am a resident of Arizona, my previous insurance had been cancelled, and that I had been declined for individual insurance. Now, as of February 1, I am covered by a state program that exists as required by Obamacare. My cost is about $350 per month, and the coverage is fairly good. It's difficult to describe how relieved I am to eliminate this financial risk from our retired lives. Let's just say very. VERY, VERY.

There are a lot of things wrong with how medical coverage is handled in our country. I'm no expert, but I know that those of us who can pay are paying for those who can't pay. Insurance is so complicated that it costs doctor's practices a ton of money just to process claims and payments. But I do believe strongly that everyone who wants/needs coverage should be able to get it. I need it, and I can pay for it. If Obamacare (or something similar) hadn't passed, I would have been out of luck. Uninsurable. I am thankful for what is available to me now.

I heard something interesting on CNBC the other day about trends related to health care deductibles. Because costs are rising, many are opting for higher deductibles. That tends to make people more selective about how often they go to the doctor, and for what. At best, that cuts down on unnecessary visits and expenses. At worst, it could keep people from going to the doctor when they should. Only time will tell the long term effect.

The moral of the story is... Do what you can do to maintain your health. Eat right, keep moving, get plenty of sleep, and pay attention to what your body is telling you. If you have insurance, appreciate it!

Without a Net

In my transition from Illinois to Arizona, I have lost my health insurance.  The insurance I had in Illinois after my COBRA expired was a high risk pool sponsored by the state.  Having been declined for individual health insurance, I was eligible to apply for this safety net provided to full-time residents of Illinois.  My coverage was through Blue Cross Blue Shield, and we paid about $560 a month for it.  For Ron’s individual policy, we paid another $325 per month.  Each of us had a $2500 annual deductable.  Do a little math and you can guess that health care has been a substantial percentage of our expenses in retirement. 

Thirty-five states have high risk pools – Arizona is not one of those.  Now full-time residents of Arizona, I just sent in the cancellation notice for my Illinois insurance.  I applied for individual coverage in Arizona, and have been declined.  So now what?

The Obama administration’s Patient Protection and Affordable Care Act, AKA “Obamacare”, will be my safety net.  Although a very imperfect bill (yes, I read the whole dang thing), it will provide the option I need to secure health insurance in this long gap I am in before being eligible for Medicare.  Obamacare requires states without high risk pools to provide them to people who prove that they cannot otherwise obtain health insurance.

But…in order to be eligible for Arizona’s high risk pool, I have to be uninsured for six months.  This is a condition of entry into the plan that, frankly, I do not understand.  I prepared as well as I could for this period, by seeing my doctor and having a check-up, making sure my prescriptions are current, and having a colonoscopy.  All I need to do now is make it through six months without a major incident.  I am very scared that my situation has put me and Ron at great financial risk.

I’m writing about this for several reasons.  (1) If you have group health insurance through an employer – appreciate it.  You cannot be denied coverage, and most employers pay fifty percent or more of your actual health care costs.  (2) Your health is precious.  Any health issues become part of your history and until Obamacare is fully implemented in 2014, could result in you not being able to obtain insurance.  Finally, (3) You must consider and plan for your health insurance needs in retirement.  There are many resources available online that will clarify the situation and explain your options.

If the federal health care law is ruled as unconstitutional by the Supreme Court, I may be without my safety net for much longer than six months.  It doesn’t seem right that I can’t obtain health insurance, even though I can afford to pay for it.  Health care reform outside of Obamacare probably wouldn’t come soon enough for me.

Wish me good health!