Beware! Heathcare Marketplace Horror Story

It seemed like a great idea.  I would finally have the coverage I needed, because I wasn’t eligible through my job yet.  I loved the idea of subsidized health insurance, because private plans would have cost me more than my electric bill.  Had I known my town was so opposed to the new plan, I wouldn’t have gotten quite as excited.

It was a struggle to get signed up in the first place.  The brand new system had some kinks to work out, but I managed to get covered by February.  The first problem I noticed with this plan was that the subsidy would be based on my 2013 income.  I get an annual raise in February, so I knew I would be getting more money and be eligible for less support.  Instead of accepting a cheaper policy that wouldn’t use up the entire credit, I opted for a really nice plan.  The plan was over my subsidy amount, so I would pay $24/mo, but it had a great prescription plan, no deductible and my out-of-pocket max was $500 for the year.  My boyfriend pays about $24 for his plan through work, but it has a $3000 deductible.  I was feeling pretty good about my choice.  In case of emergency, I was all set.

Well, there were no emergencies.  I ended up paying $24 each month to get my prescriptions which all ended up being on Walmart’s $4 list (a total of $12 for me if I needed ALL my meds that month).  Already the plan was costing me money, but I was covered just in case.  I had to choose a different doctor as my PCP, because my normal doctor was not on the list for BCBS.  Not really a problem, because there was a doctor right across the street who I could see for $35 with my insurance.  Excellent.  That’s less than half what I would have paid for my regular doctor.

Back in September, I was having panic attacks triggered by my thyroid medication being too high (levels fluctuate, so it’s necessary to be retested every 4 months to be sure the medication matches the need).  I was afraid I was having heart problems, but talked myself into a visit to my doctor instead of a trip to the hospital.  Turns out the doctor I chose from my insurance had permanently relocated to another town.  There was a PA at the clinic who could see me under my policy, but they did not take walk-ins and I couldn’t wait for an appointment.

I decided to face the consequences of putting my old doctor’s visit on my credit card.  It’s there for emergencies, and this qualified.  With my EKG, thyroid labs, and everything, the visit cost me around $300, and the doctor wanted to see me for a 1 month and 2 month evaluation (one of those would involve another thyroid test, so we’re looking at about $200 more at a place that doesn’t accept my insurance).

At my 2-month exam, I asked the woman in the billing office what plans were accepted at this clinic since it would soon be time to reapply for insurance coverage.  She actually laughed!  She said, “If it’s part of Obamacare, we don’t take it.”  Ouch.

So let’s tally up my expenses for the year.  I had a thyroid test before my coverage kicked in, two more later in the year, four appointments, and my premiums. That’s about $900 in medical expenses for the year.  What did I get from my insurance? About $80 worth of medicine.  Good job!  Way to save me some money.  But wait; you didn’t.  Because $264 of that was spent on insurance, and the rest of it I would have paid anyway since my doctor doesn’t accept my plan.  It’s not your fault, Obama.  It was a great idea, but I live in a red state and my town will do whatever it takes to dig in their heels.  You can mandate insurance, but you can’t make the clinic accept it.

So this year, I’ve chosen a plan that meets the requirements for insurance, doesn’t use the entire subsidy, and won’t cost me anything so I can go back to pretending I don’t even have it again while still being legal.

Oh, but we’re not done being screwed around.  Remember how I got that raise at the beginning of the year?  Well, I just filed my taxes for 2014, and for the first time ever I owe money to the IRS.  $18 isn’t much, but I know exactly why I owe it.  I used the entire subsidy while earning more income for the year.  How lovely!  I got my annual raise this month, so I’m just dying to see how it turns out next year.  Maybe since I am not using the whole credit, I won’t have to pay them again.

My advice to you: if you know your income will be higher in the following year, and you claim all your deductions on your W-4 (because you want all your wages on payday), don’t accept the entire health subsidy.  Unless you know for a fact that your town is awesome and offers plenty of clinics where you can use your plan, it will continue to cost you into next tax season.

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2 Comments Add yours

  1. I am so thankful hubby is retired military. For about $18 a month our entire big family is covered for practically everything (except dental). We only pay a $12 copay for visits and a few dollars for prescriptions -no cost shares or deductibles. Most everyone takes Tricare Prime, so that’s not an issue. If we go to a military base everything is completely free. When I hear other people talk about their healthcare, whether it’s the new stuff or the old stuff, I’m just so thankful I don’t have to deal with all the hassle.

    Like

    1. mortbane says:

      Exactly! Best medical coverage I ever had was as a teenager when my parents had just gotten divorced. Technically, I qualify for Medicaid under the new expansion, but Texas opted out of that. It becomes a vicious cycle though. If you are very sick and can’t work, you aren’t going to be able to afford the doctor visits, but you can’t start working until you’ve gotten help.

      Liked by 1 person

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