Why I Love Obamacare

When the Affordable Health Care Act was first proposed by President Obama, there were many who thought it was a horrible idea. They were afraid it would cause emergency rooms to be over run, and the majority of people stuck with substandard health insurance. Their fears have not come true. For the most part Obamacare, as it was first called by it’s detractors, has proved to be no worse than any government plan. It has given much needed security to the thousands of Americans that were falling between the cracks.

In the beginning there was a lot of problems with the online sign up page. In the state of Indiana. I still find the web site to be difficult to use. It repeatedly sent me back to the sign in page. I find it much quicker, and less frustrating to call my agent who I met through this sight by scheduling a call and talking to a real person. The insurance my employer had provided when I was working was only good to keep me from being fined. It paid for almost nothing. After I retired, since I was not yet old enough for Medicare, I signed up with Obama care. My husband already had a policy though them. He had retired the previous year, and like me not old enough for Medicare. Since I couldn’t put him on my employer provided insurance we turned to the government plan. Together we qualified for a new plan. We qualified for an HMO on the Anthem Silver Plan. Our Blue Cross Blue Shield of Indiana cost us nothing. We pay a $20 co-pay and $15 for prescription drugs. I was able to add UnitedHealthOne Dental and Vision for only $39 a month. This is not cut rate insurance. It is one of the best insurance companies in the state of Indiana. Shortly, after getting my plan, I had to have emergency surgery. The insurance covered all but $230.

The amount of paperwork required to sign up is still a little taxing. I spent over an hour on the phone and then had to mail in several other pieces of information. Married couples are required to file together, which may seem like a small thing, but my husband really fought against it. I tend to agree that having your options taken away by the government is very unpleasant. In the long run though, the savings on Indiana health care are worth the hassles. I still hate the Obamacare sign up process, but it is much better now that I have my own dedicated agent and really only takes about 15 minutes to renew. I consider my insurance to be a life saver.

1 thought on “Why I Love Obamacare

  1. Love-Hate Relationship with Health Insurance

    Health Insurance is a necessity, especially now that it is mandatory for everyone in the US, but its benefits are not always in line with the cost and restrictions.

    As one of the lucky few who works for a large company in the state of Indiana, I shouldn’t have any complaints. The cost of my family’s health insurance is covered by both my employer and I (my bi-weekly payroll deduction is $192.00). The insurance company is Aetna, which is good for covering most medical expenses. My co-pay is set at $20.00 for doctor visits, and 90-100% is covered for hospital visits for any doctor or hospital that is in-network (non-network pays 80%).

    Each year employees are given an “enrollment period” and must review the different health insurance policies available. There are a few different options, one being an 80/20 plan which automatically pays 80% of each doctor or hospital visit whether you go with an in-network doctor for not. Another is a healthy choice option which requires each family member to have yearly well visits and fill out a healthy lifestyle questionnaire, but then also offers a health club discount. A third option is a health savings plan that pays 90% after you meet your deductible. After the month-long enrollment period we are locked into our choice for the year.

    As I mentioned earlier, I shouldn’t have any complaints with a health insurance plan that covers such a high percentage of my family’s medical bills. However, as with any health insurance plan, there are loopholes and special circumstances that dictate a lack of coverage.

    For instance, my husband sees a specialist who is not in network and he must pay the bill in full at the visit. He then fills out a reimbursement form and sends this in to the insurance company with the receipt attached. The insurance company reviews it, sees that it is out of network and their reimbursement rate is at 80%, and sends us a check.

    However, it is not really this straight forward. Our insurance company has a set rate for services that doctors within the network must abide by. They are not really paying the full amount of the bill, rather the full amount (minus our co-pay or 20%) of what they deem a reasonable cost. This works well if you go to a doctor or hospital within your network. But if a specialist within network is not available in your area (as is the case for us), the out-of-network doctor is not obligated to charge you the insurance company’s set rate for their services.

    Additionally, the amount reimbursed is based on the set rate of service our insurance company puts in place for in-network doctors. Thus, our reimbursement is only 80% of the rate accepted by in-network doctors, not 80% of the total amount paid. Also, there is the loophole of deductibles and until we meet our deductible for the year, the amount due to us will be applied to this and we never see a penny.

    This is where we see the true meaning of a “love-hate” relationship with our health insurance companies. While they cover most of our medical expenses and give us peace of mind, we are basically paying a huge amount of money just for the security of holding health insurance. On the other hand health insurance is a life saver when a serious medical condition requires extended hospital stays.

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