So I signed up for Obamacare—and got a big surprise

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.

By Jennifer Clare Burke
Add Comment Add Comment | Comments: 18 | Posted Nov. 26, 2013

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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 PWin 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.

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COMMENTS

Comments 1 - 18 of 18
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1. Anonymous said... on Nov 27, 2013 at 08:31AM

“Hmmm. Thanks to O we switched and saw our premium go up 200 bucks/mo for less coverage.”

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2. Anonymous said... on Nov 27, 2013 at 11:57AM

“Yeah, sure you did. You switched to LESS coverage, then your premiums went UP? Nice try, though. Even Kentuckians are doing cartwheels over the ACA.”

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3. Anonymous said... on Nov 27, 2013 at 12:19PM

“My premiums will be higher under Obamacare. Funny that PW will print a story that represents the minority experience regarding the issue of affordable healthcare. The truth is this is just another example of left wing bias. I will never forget the year when the RNC hosted their convention in Philadelphia and PW ran a cover of a big elephant with the words "Get Out". That year the RNC brought millions of dollars to the small business that advertise in this little rag of a weekly paper. It became clear to me then that PW places ideology over their advertisers, and some of their readers.”

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4. Anonymous said... on Nov 27, 2013 at 12:30PM

“^^Yawn. Prove that this story represents the "minority experience regarding the issue of affordable health care." For those of us who read this paper regularly, it reads like an update to a story of an ailing Philadelphian who first talked about her health issues in a cover story sometime last year. If it reads like "left wing bias," that's 'cause the truth always seems to, doesn't it?”

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5. Peter C. said... on Nov 27, 2013 at 01:26PM

“Lets get the facts straight. IBC has a large block of substandard or guaranteed issue products in force. These products are community rated which means that young and old pay the same rates. Based on the original author stating Lupus I am under the impression she may be have been in this block. If wrong I apologize. The guaranteed plans are OK mid level at best. Great if it is all you can get. So in reality if you are 35 to 45 in a product like this you were overpaying to start. The new ACA IBC Platinum PPO is a great plan and now being age banded would be less expensive for new coverage in that age bracket. Not even counting a subsidy. 45 and older which were "blended" into the old rate structure will not see the same savings. For those in the fully underwritten universe who may not be in the "guaranteed issue" block will see no savings unless they qualify for a subsidy based on the pre-set income parameters. FACT!”

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6. Anthony P. said... on Nov 27, 2013 at 02:30PM

“Great for her, but it's people like her that drove the cost of my family plan from $694 to $947. Unless you have pre-existing condition, are a female thinking about getting pregnant or need mental illness coverage...Obamacare is a big loser.”

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7. Frank Rizzo said... on Nov 27, 2013 at 02:35PM

“Nice puff piece. I wonder how much they were paid to make it up. Firms are being paid with taxpayer dollars to plant just these types of pieces.”

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8. sylvia said... on Nov 27, 2013 at 04:54PM

“I also have lupus, among other conditions.

I could never afford to buy my prescriptions at Rite Aid, up the street.

I buy them through Costco's mail order pharmacy, which saves me 50-75 percent. The mail delivery is free. Customer service is excellent.

By federal law, Costco is required to fill prescriptions for anyone, not just those who are members of Costco.”

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9. Martha Stone said... on Nov 27, 2013 at 05:56PM

“Thanks for posting about the intricacies of transitioning into Obamacare with a chronic illness. It will be helpful to other lupus patients. I hope the best for you and your family.
I am a health educator, and I've started a blog and Facebook page called Wellness With Lupus, where you can find a lot of information on living as healthfully as possible with an unpredictable disease. Please contribute, as I'm sure we can use your expertise.”

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10. Terry Gibson said... on Nov 27, 2013 at 06:54PM

“i think this is wonderful news to hear at Thanksgiving! It makes me so happy for you, Jennifer. Take good care of yourself.”

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11. Baron said... on Nov 27, 2013 at 08:41PM

“Funny, my relative has lupus. That person reports her coverage thru work has risen 13% this year, and it rose the previous year about the same percentage. So, let's get this right now: my relative with lupus must pay for this person with lupus? Makes no sense!”

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12. Anonymous said... on Nov 28, 2013 at 01:15AM

“This is the beginning of a Obama media campaign of anecdotal "puff" stories that may or may not be true. The truth is that for every positive experience with Obamacare there are thousands of bad experiences. The average person will be paying approximately double for their Obamacare insurance. Insurance companies can issue policies under Obamacare at any price they choose because the insurance companies are guaranteed a profit by taxpayer subsidies. Be prepared for rationing, its in the law.”

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13. Anonymous said... on Nov 28, 2013 at 06:07AM

“At the writer, that's the idea of Obamacare, make all of us pay for you.”

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14. Anonymous said... on Nov 28, 2013 at 08:46AM

“No surprise this paper's paper issues are now barely a 1/3 as thick as they used to be. This dying rag now has to print propaganda pieces to stay afloat. RIP...”

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15. Anonymous said... on Nov 29, 2013 at 09:27AM

“Signed up. Got the amount the Gov would give ME. Got to the end of the application where I review everything and AM STUCK> NOONE helps on the help line HAVE BEEN STUCK AT SAME SPOT SINCE October 21!!!!!! I call everyday.. no one can help me!”

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16. PrettyFootWoman said... on Dec 3, 2013 at 10:44AM

“To some of the commenters that seem to balk at the fact that we may pay for others to get health care...I would rather pay for someone like Jennifer to get life saving health care...then to give tax subsidies to the Oil Companies...

I pray that we can continue to help our fellow citizens...who knows there might be a day when I might need life saving care..

Good Luck to you Jennifer...”

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17. Bill Lenner said... on Dec 3, 2013 at 02:44PM

“Despite the big right wing social media pogrom to try to destroy Obamacare, the truth is getting out. Yes, pogrom is spelled correctly. Obama haters should be able to recognize it from it's original usage.”

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18. Doug Edwards said... on Feb 5, 2014 at 04:36PM

“My wife and I were paying $2,400/month and held captive by BCBS of NJ because my wife has MS. With healthcare reform, our premium is now around $750/month with no deductibles, no preexisting conditions, no cap on the coverage, so I'll never lose my home ... and guess what, it's still with Florida Blue, which is essentially BCBS. Thank you Mr. President! We are now saving over $1,600/month! It's true! Same doctors, better coverage. Except for the slow start, I have absolutely no complaints, in fact I'll never vote Republican again. Anyone against this change is either in a great job where healthcare is included, or is a complete idiot ... and don't believe the television commercials ... a woman with Lupus who is now paying $6,000/year, but supposedly had coverage for $50/month prior to this? Give me a break! Stretch the truth a little more! Who gets healthcare for $50/month to treat Lupus? ... and if true, why doesn't everyone get it?

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