Health Insurance Marketplace / Obamacare from a Married 20’Something’s Point of View in GA

By Damire Winn

All of this started when I received a letter in the mail from my current health insurance company in regards to ACA and the changes to come. In this letter they offered me the opportunity to keep my current insurance plan and pay $40 more than what I currently pay. Another option was to keep my current plan with the same premium until the end of the contract and then switch over to an ACA-Compliant plan.

After reading this, my first thought was “let’s see what my options are with the Marketplace.” The way it played in my head was based on what little knowledge I have about the Affordable Care Act, the price for the new insurance plans should be affordable. So the first step to discovering my options was to go on to www.healthcare.gov and create an account.

The process to create an account was beyond frustrating. Why? Because it took me a total of 2 hours to simply enter my basic information and create the account. After 2 hours I decided to give it a rest and try the next day after I cooled off to continue my application, in order to see what my options were. The next day I decide to give one more try. After all, the letter my health insurance company sent me had a deadline for me to provide my answer. So I logged in ready to continue my application and really looking forward to my “affordable” health insurance options.  Once logged in, you need to enter all of your taxpayer information. Now I have a considerably fast broadband Internet connection and for some reason each step took a minimum of 20 minutes to be processed. Again frustration started to build at an extremely fast pace.

After two and a half hours frustration won yet again. New plan! Call my health insurance company and have them find out for me. During this phone call, the representative explained to me that if I kept my current plan, all the current benefits would stay the same and they would add in maternity to the benefits. My current plan covers free preventive care, $35 copay for doctor visits, $50 copay for visits to a specialist, prescription coverage and vision. Keeping this plan means that my family (myself and my husband) gets the same coverage plus maternity for $314.  But I wanted to know more, so of course I asked about the new ACA-Compliant plans and their costs. He started to explain to me that there were four different tiers of health insurance bronze, silver, gold and platinum (the Cadillac of health insurance plans).

My husband and I are both in our late 20’s and we’re non-smokers, I figured with pre-existing conditions no longer an issue (I have lived with a thyroid condition since childhood), the premiums will be relatively low and maybe we will be able to afford a higher tier than bronze. First the representative explained to me that prices vary by state and that with the new ACA-Compliant plans benefits were still being worked out. The items plans covered in the past might not be covered under the new plans. He gave an example of the bronze tier insurance plan; he said that this plan covers preventive care only if your physician bills the visit as preventive care. In order to get prescription coverage he said that it has to be purchased separately.

So I asked him to tailor a quote to my situation, my state being GA, again both my husband and myself in our late 20’s and non-smokers. I wanted to know what my options were. The quote he gave me almost knocked me out of my seat. He said that for us a bronze tier plan will cost $662/month. After listening to him, I struggled to find the affordable part in the Affordable Care Act/Obamacare.

At the end of our conversation he suggested I take the offer to keep my current plan for $40 more than what I currently pay. With my current plan I already know what my benefits are and he said my current plan is an equivalent of what the Gold or Platinum tier will be in terms of coverage. Then he said something that I could not agree more with, he said, “Hopefully by next year the ACA-Compliant plans will actually be affordable.”

The reality of what ACA has created has sunk in and it’s not pretty. Now Americans will pay more for fewer benefits. How that made sense when they were drafting these laws is beyond me. As for the Health Insurance marketplace it has been two and a half weeks and the portal still has not been able to provide me with options. Needless to say my husband and I kept our current plan and will deal with ACA-Compliant plans next year, though we’re secretly praying that my health insurance provider decides to extend this opportunity another year just in case the prices have not gone down by the end of 2014.

Women’s Health: How to Make the Most of Your Options for Care

Apart from general health issues, women have multiple unique health care concerns throughout their lifespan.  Some of these concerns include pregnancy, menopause, breast and reproductive health, and though men and woman share a lot of the same general health concerns, they can affect women very differently.  Some of these differences are:

• Heart Health – 40% of women do not survive their first heart attack
• Mental Health – women are more likely to suffer from depression and anxiety
• Sexually Transmitted Diseases – the effects of STDs are more serious in women than in men
• Bone Density – women make up 80% of the estimated 10 million Americans with osteoporosis
• Lupus – women make up 9 out of 10 adults with Lupus

With all of this to consider, it is important for women to remain aware of their state of health with regular visits to the doctor and healthy lifestyle choices, but keeping all of these issues in check can be costly.  Between co-pays for doctor’s visits, the cost of lab work and the cost of the follow-up visit, a single check-up could run hundreds, if not thousands of dollars depending on access to health insurance and the level of coverage.   To help keep health care costs under control and understanding that women’s health needs are particular, Health Care Reform under the Affordable Care Act has declared a list of eight preventative health services just for women that are available with no cost-sharing or co-payment due upon visit to the doctor*.  These services became accessible to women on August 1, 2012 and include:

1. Breastfeeding: access to breastfeeding supplies as well as comprehensive support and counseling from trained providers for pregnant and nursing women
2. Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling
3. Domestic and interpersonal violence: screening and counseling for all women
4. Gestational diabetes: screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes
5. Human Immunodeficiency Virus (HIV): screening and counseling for sexually active women
6. Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older
7. Sexually Transmitted Infections (STI): screening and counseling for sexually active women
8. Well-woman visits: to obtain recommended preventive services

*Coverage by doctors within network. Check insurance coverage policies to confirm   Along with this increased standard of care it is also important for women to know that they have choices  when managing costs and their level of care.  For women with low-income that are possibly unable to afford health insurance, options such as Medicaid have been expanded to offer free or low-cost care, the Bronze plan is available within the Health Insurance Marketplace and covers 60% of health care costs with 40% of costs paid for out-of-pocket and Catastrophic Plans are available for those under 30 years of age and are considered healthy but want to have minimum coverage, “just in case.”  Eligibility for these plans depend on income and family size.  In addition, there are always Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) linked to high-deductable plans and cover most services such as lab tests, telemedicine services and prescriptions.   Simple tips for women that want to keep their health and cost for care in check are:

• Make healthy lifestyle choices such as healthy eating habits and dedicating to regular, moderate exercise
• Create a calendar for the year for all necessary, preventative “Well-Woman” services and include a budget for each visit
• Pay for affordable services out of pocket, such as lab testing whenever possible
• There is no longer any need to go to your doctor for a baseline of your health – pay for cholesterol, heart health, hormone and wellness tests out-of-pocket or with an HSA or FSA at your local affordable, direct access lab testing facility ANY LAB TEST NOW®.

Take Control of Your Health® and stay up-to-date on the latest in women’s health issues by visiting our site regularly at www.anylabtestnow.com, by “liking” our Facebook Page, or following us on Twitter, and Pinterest.