Open Enrollment Ends Feb 15th!

Let’s talk health insurance for a minute. In particular, the Affordable Care Act (or ACA). Yes, I mean Obamacare. This discussion isn’t about debating the law, it’s about what the law means for the uninsured (which could very well mean you!). There’s a lot of media hype around this issue and things tend to get jumbled up in the mess. So let’s weed through the details and the opinions of the talking heads. Do you have health insurance through your employer? Yes? Then this doesn’t apply to you. No? Then pay attention.

This law allows people to get coverage at an affordable price who may not have previously been eligible. Like me. When the law passed in 2010, I was healthy. My insurance was provided through my job. In 2011 my Migraines became Chronic, but I continued to work. My employer-sponsored health care allowed me to seek out the best doctors, to try the newest medications, to take pain management classes and to be treated at a renowned Headache Clinic hours away. In 2014, I had to resign from my job in order to fully focus on my health. That meant my health insurance would be gone.

Just six months prior, the first Open Enrollment for Obamacare occurred. If this series of events had occurred one year earlier, I would have gone without coverage. I had a pre-existing condition. Most insurance companies would have either denied me coverage or jacked up my monthly premium to an unaffordable price to compensate for the risk they were taking. As someone with a chronic disease, my condition needs to be managed closely. That means having consistent health coverage is of vital importance. Without it, my health could deteriorate causing me to either pay tons of money out of pocket or forego care altogether because of the cost burden. That’s a decision no one should ever have to make.

I began my search for new insurance at www.Healthcare.gov and then used my state’s online exchange to find available plans. My number one goal was to have a plan that allowed me to see the same physicians, both locally and regionally, that I relied upon to help me manage my Chronic Migraines. My number two goal was a plan with a low deductible to keep my out of pocket expenses reasonable. Then my final goal was a plan that fit those needs and wouldn’t break my bank.

I narrowed down my options through the Marketplace website. It’s very similar to doing comparison shopping for a car online. You can look at the plans side by side, see the deductible costs, copay costs, find your doctor and see the monthly cost. Even though I had done my research, I wanted reassurance from a real person who understood the plans. I spoke to a representative who helped me find the plan that fit all of my goals. I was pleasantly surprised at the cost, especially since I knew I needed maximum coverage found in a Platinum plan. Not only was I able to get coverage, it was better than I had previously.

I’m not going to lie and tell you it was just that simple. We’ve all heard stories about how the website doesn’t work. I spent a few hours on the phone making sure it was processed correctly, but I have to do that with most of my insurance claims anyway. The time it took was a small price to pay for being able to continue my care. So what do you need to know about enrolling in the Health Care Marketplace? Here are some basics I’ve learned in going through the process.

  • Open enrollment ends February 15th . This is your last shot to get coverage for 2015. If you have a significant life event such as losing a job, changing jobs, getting married or having a baby, then you can get coverage at the time of the event. You can apply at any time for Medicaid or the Children’s Health Insurance Plan. At this time 10 million people have become insured under Obamacare (1).
  • You can apply for a subsidy that will help you pay for your insurance policy based on your income. A subsidy is likely to be awarded if your income is below $46,680 for a single person, $62,920 for a two-person household and $95,000 for a four-person household (3). Roughly 8 out of 10 applicants were able to find plans for under $100 after receiving a subsidy (1). Click here for the basic income guidelines.
  • The system for shopping and applying for healthcare differs by state. The majority of states offer web-based, paper and in-person processes. You can also call the Healthcare Hotline anytime 24/7 at 1-800-318-2596. To find out how to apply in your state, go to this link.
  • If you don’t have coverage in 2015, you’ll pay a penalty of either 2% of your income, or $325 per adult ($162.50 per child) —whichever is higher. There are certain exemptions from payment.
  • The Affordable Care Act allows children to be covered under their plan until they reach age 26. This has allowed 3 million young people to be covered under their parent’s plan (1).
  • Preventative care, such as mammograms, is now free under all health insurance plans. You won’t have a copay or even co-insurance charge (4).
  • You cannot be denied coverage for a pre-existing condition. Also lifetime caps on paying benefits have been eliminated. An insurance company can no longer drop you if your total health care costs exceed a certain amount.
  • Does this still sound like jibberish to you? Take a quiz on health insurance to make sure you understand the differences between co-pays, deductibles, co-insurance and more here.

If you don’t have health insurance, take the time to understand what it can do to help you in your situation. Whether you go online, talk to a representative by phone or make an appointment to sit down with a specialist, get the coverage you need to manage your illness at a reasonable price (see links below to do your own research).

Have you gotten coverage through the Marketplace? I welcome any comments, but please refrain from arguing the politics of Obamacare. Let’s focus on what it can do to help people in chronic pain.

  1. http://www.hhs.gov/healthcare/facts/factsheets/2014/10/affordable-care-act-is-working.html
  2. http://www.vox.com/2015/1/29/7878731/medical-errors-statistics
  3. https://www.healthcare.gov/lower-costs/qualifying-for-lower-costs/
  4. http://www.hhs.gov/healthcare/facts/timeline/timeline-text.html
This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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