I’ve read a lot of negative reviews from people regarding Obamacare now that we are in the midst of open enrollment periods. I will not claim to be an expert on the Affordable Care Act (also known as Obamacare). A lot about the new legislation confuses me just like it does the vast majority of the population. I’ve had to educate myself in relation to the immediate choice I need to make during my open enrollment period at work. When I give a review of what Obamacare has done for me it is not meant to be an endorsement. In fact, I am positive that for a lot of people it has indeed been a negative experience. I am writing to share my journey about how, so far, the advantages of the legislation has helped my family.
In 2012, I unexpectedly became pregnant at the end of January. By March 2012, I had paid out my health insurance deductible (at the time I was an individual on my policy because my husband and I were better off carrying our own health insurance). My deductible was relatively small, only $250. Of course, this is on top of paying co-pays. What ended up being my financial death was the coinsurance clause which said after you paid the $250 deductible you were still responsible for 10% of the final bill. Essentially, my first ultrasound I paid for out-of-pocket because it was $241 and I had not hit my deductible amount yet. From that point I would have to pay for 10% of every service I used during my pregnancy.
Sometime last summer, as part of the Affordable Care Act, several free benefits for women went into effect. Benefits such as (not a complete list):
- annual, preconception and prenatal care office visits
- screening for gestational diabetes
- prenatal and postpartum lactation support and counseling
- rental costs of breastfeeding equipment
- FDA approved contraceptive methods, sterilization and counseling
I happily walked into my gestational diabetes screening and discovered I would not have to pay 10% of the bill, it would be free! Unfortunately, I would have to pay around $2,400 out-of-pocket for my daughter’s birth (on top of prenatal expenses mentioned earlier) because the hospital stay was subject to the 10% coinsurance. You can read why my birth cost so much here.
As 2012 came to a close, I realized my unexpected pregnancy had cost me over $3,000 out-of-pocket and I paid $55 a paycheck for coverage on top of that. Remember that the $55/paycheck was only coverage for me, not my husband or daughter. I do not think this is such a great “deal” working for a Fortune 100 company. My thought was, if one of the top revenue earning companies in the United States does not provide decent insurance then who does?
In 2013, I moved to my husband’s insurance. We work for the same company but moving to a family plan and taking the subsidy for my policy and putting it into a tax deferred medical FSA actually saved us money. The policy stayed the same so I knew if I got pregnant again in 2013 that I would have a $250 deductible, co-pays and 10% of the hospital stay. Then it dawned on me, my actual prenatal costs should be a lot less this time around under Obamacare! My excitement was quickly suppressed when I realized my hospital bills would still be applicable.
Fast forward to early October 2013 and my company announced a complete overhaul of our benefits. Thanks to the Affordable Care Act my work has opted into a corporate exchange. This corporate exchange works just like the public exchanges you can access through state websites except it is limited to the participating companies. My work is in an exchange with other companies such as Walgreens. What does this mean? The exchange can take a large number of people throughout the country and negotiate a better cost based on more people participating in the plans.
The plans were broken down into four categories: Bronze, Silver, Gold and Platinum. In my hometown, we had 3 health insurance provides under each category. This gives my family a choice. My employers subsidy is called out for each level and each plan within that level. Bronze and Silver are high deductible plans. Gold is a deductible plan similar to what I talked about above. The Gold plan actually was $50 less a paycheck for family coverage! Alright, already off to a great start!
My husband and I opted to go Platinum. That is $31 more a paycheck. Why did we opt to pay more? There are no deductibles and no coinsurance. This means I can deliver a baby for a flat $250 co-pay and because of the Affordable Care Act, most of my prenatal services will be covered for free and those that are not, will only be a $20 co-pay. This is also applicable to my daughter’s sick visits or anything else that might unexpectedly occur next year. What this means to me is peace of mind!
I realize there are a lot of people experiencing unfavorable results. I read one account that a working mom who is a nurse and currently works 25 hours so she can work opposite of her husband, will be forced to go per diem instead because the hospital cannot risk her ever reaching 30 hours a week. Why? At 30 hours, her employer would have to offer her health insurance. This is obviously not a desirable result for her and her family. Please understand that I am only sharing my personal experience thus far and I do not pretend to be an expert on this topic. If you find any of my facts to be misguided, please let me know in a polite manner.
I would love to hear from our readers and their favorable or unfavorable experience with Obamacare!