Lupus patient Jennifer Clare Burke knew she couldn't afford to lose her good insurance coverage. As it turned out, the Affordable Care Act just made it less expensive.
Meanwhile, there was the concern that even that more expensive rate might not be the full story. Because annual hikes to the monthly premium weren’t the only worry—there was always the possibility that there could be another change to my plan’s co-pay policy, as there was in 2010. From 2005 to 2009, I paid $15 for all office visits after meeting my out-of-pocket deductible. But starting in 2010, that number became $30 per office visit for my family doctor and $50 for any specialists—and with a chronic illness, most of my office visits involve specialists.
So, with age 40 looming on the horizon, I had resigned myself to rearranging my life still further, to the reality that I’d need to find, somehow, significantly more money to spend on my private health insurance—since it isn’t something I can live without.
Then Obamacare appeared.
I told Blue Cross to sign me up for the best coverage plan that would be available under the new Affordable Care Act regulations. As it turns out, that’s the Personal Choice Platinum PPO Plan. (There are also Gold, Silver and Bronze plans offering various scopes of coverage.)
Here’s what I discovered will happen when my current insurance plan dies on Jan. 1 and the Obamacare-regulated plan kicks in:
With the Personal Choice Platinum Plan PPO, I’ll pay $429.96 per month as a tobacco non-user at age 39. And when I turn 40 a few months later—the source of my financial dread? I’ll pay $435.41 per month.
That’s not just no huge increase after all. That’s fifty bucks a month less than I’m paying now.
It gets better.
Instead of paying my current $30 for a family doctor visit, I’ll pay only $10. I’ll pay $40 for a specialist instead of the $50 I now pay.
Over the past few years, I’ve had a deductible at the start of each year: $1,500 out-of-pocket expenses before insurance started paying. On the new Platinum Plan, I have no such deductible at all. Instead, I’ll pay the co-pays for my care as I need appointments (at the rates mentioned above)—and when those copays total $2,500 out of pocket (which will happen easily with me), then I stop paying co-pays at all.
What about prescription drugs? The medicine price tags for chronic ailments are no light matter. I buy all my prescription drugs at Rite Aid, which makes it easy to review how much I spend: So far in 2013, my out-of-pocket expenses for prescription purchases have totaled $2,819, including both my deductible costs and my copays. For context: Without any insurance, the prescription drug cost for 2013 at Rite Aid would have totaled $14,283, and for a chronically ill person who can experience a medical catastrophe at any time beyond the usual level of illness, the year is far from over. This is exactly why I have structured my existence around being able to pay the premiums for excellent health insurance.
With my new Platinum Plan, prescriptions are priced in three tiers. A generic drug’s copay is $5; a brand name drug purchase is a $30 copay; and a non-formulary brand is a $50 copay. That’s the pricing at retail pharmacies—but my new plan also offers a mail-order option to my door through Future Scripts that will enable me to buy a three-month supply of prescription drugs at the cost of a two-month supply’s copay.
What sorcery is this? Well—it’s Obamacare.
This is what Obamacare is. It’s not the flawed website the media has been dwelling on. It’s the more affordable care structure the website is supposed to point us to—and that a simple phone call did point me to.
I’ve never been big on the holidays, but I can tell you that when I hear about gratitude this week, I will be giving true thanks to a system that, after years of pushing me increasingly beyond my limits just to survive, now seems to be finally helping.
Jennifer Clare Burke has previously written about her medical experiences in depth for PW—in a 2012 cover story and in our book The Survivors Project—and also in fictionalized form in her novel A Life Less Convenient, online at alifelessconvenient.com.
The 2014 Philadelphia Spring Guide