Washington, DC, United States (KaiserHealth) – As the deadline to acquire new health insurance under the Affordable Care Act draws closer, Chicago-area residents are nailing down plans for 2014.
The health overhaul law, the major portion of which went into effect Jan. 1, aimed to make insurance more accessible to millions of uninsured Americans through a variety of initiatives.
To make the process of buying coverage transparent and competitive, the law established new health insurance exchanges on which private companies offer competing plans that must offer the same essential benefits.
The law also set up a system of financial assistance to help low- and middle-income individuals and families defray the cost of buying coverage. Those who have annual incomes up to four times the federal poverty level can qualify for tax credits to reduce monthly premiums, and cost-sharing assistance is available for certain people to help keep out-of-pocket costs in check.
On Tuesday the Obama administration said 4 million people had enrolled in health plans sold on the exchanges, including about 700,000 people who selected a plan this month.
Most of those who don’t have coverage after March 31 will face a penalty of $95 or 1 percent of their annual income, whichever is higher.
Finding out what the exchanges have to offer has come with elation for some and confusion, frustration and disappointment for others. Here are five area residents’ stories:
Christine Williams, Mayfair
Almost everything changed for Christine Williams in 2002.
In February that year, she and her husband, Joe, were laid off from their jobs in marketing and communications. Six weeks later, she gave birth to twin girls.
Then, in July, on the day after the twins were christened, she found out via an MRI that she had a brain tumor.
“At that moment — in the insurance world — I became uninsurable,” said Williams, 48. An operation to remove the tumor was unsuccessful, she said, meaning she’d have to manage it the rest of her life.
Williams, who lives in Chicago’s Mayfair neighborhood, said she still had coverage at the time under COBRA, the federal health insurance law. But after it ran out, she found her only choice was with the state’s high-risk health insurance pool, called the Illinois Comprehensive Health Insurance Plan, or ICHIP.
Her premium alone was about $700 a month. Together with a private plan for her husband and daughters, the family’s premiums neared $1,550.
As the Affordable Care Act takes effect, ICHIP is being phased out. But the law also meant insurers could no longer deny Williams coverage because of a preexisting condition.
Now the Williamses are all on the same insurance policy. The family is paying about $100 a month more than before — the plan includes new dental coverage for the girls — but Williams sees that as a small price to pay for the freedom it grants.
Williams can continue to consult her doctors at three hospitals in Chicago and one in Baltimore, including a neurosurgeon, a neuro-ophthalmologist, a retina specialist and a cornea specialist.
The other big relief is being on the same policy with her family.
“However insignificant it may seem to someone else, having to have my own policy — and not by choice — was always labeling me a liability in my eyes,” she said. “There’s a peace of mind that comes with this. … I can’t put a price on that.”
Andrea Lubershane, Evanston
Andrea Lubershane, 64, of Evanston, Ill., has less than a year to go before Medicare, but she wanted to see whether she could find a better deal on the exchange than her existing private plan.
A part-time yoga instructor and bookkeeper and a full-time student, Lubershane had been paying $516 per month with a $1,750 deductible and was told the price would increase to $585 a month starting Jan. 1.
She tried last year to compare options on HealthCare.gov, but like many people she ran into problems using the famously glitchy website.
Eventually, Lubershane said, she talked to a representative by phone. The person described a plan that sounded suitable — she said she wanted to keep her own doctors — and then enrolled her.
But on Dec. 24, she said, she found out she had been placed in the wrong plan, an HMO that didn’t include her doctor or her hospital.
The mistake launched her on an odyssey that included calls to the offices of U.S. Rep. Jan Schakowsky, D-Ill., and U.S. Sen. Dick Durbin, D-Ill., representatives from the insurance company and a caseworker at the Department of Health and Human Services. No one was able to solve her problem, she said.
Lubershane, who documented her calls and other time invested, says that on Jan. 17 an agent for the company told her she was registered for two policies: the HMO she didn’t want and her original plan. He also said he could cancel the HMO.
On Jan. 28 she finally heard from a marketplace representative that she could buy the PPO plan she wanted. It had a $500 deductible and, with a government subsidy, a monthly premium less than she would have paid if she had continued her old plan. She declined to state the premium amount, but people eligible for the subsidy pay $270 to $580 a month for the plan she has, according to HealthCare.gov. She said she was told her new coverage will be retroactive to Jan. 1.
Lubershane said she spent more than 40 hours through the end of January to get the insurance she wants. Knowing all this now, would she do it again?
“I’m a person who lives by cost-benefit analyses,” she said. “With time and aggravation, I feel that the benefit outweighed the costs. But just barely.”
Ellen Szalinski, Uptown
Ellen Szalinski of Chicago’s Uptown neighborhood says she has based career decisions partly on the insurance that employers offered because private insurers had routinely turned her down.
Szalinski, 51, has a preexisting condition: She was diagnosed with depression in her 20s.
When she was laid off in 2011 from a full-time job with insurance benefits, her first thought was: “Oh my God, what about my health care?” When her COBRA coverage ran out, she qualified for ICHIP, but she has needed her parents’ help to make the $629 monthly payment.
Szalinski said she was excited to investigate the new insurance marketplace for an alternative but disappointed to find out that the electronic form gave her only one other choice: Medicaid, the federal-state insurance program for low-income residents.
She is newly eligible for Medicaid because Illinois expanded coverage to legal residents who earn up to 133 percent of the federal poverty level — about $15,800 for an individual.
Szalinski said that although it was a relief to have insurance she could afford, she has mixed feelings because “it’s on the back of taxpayers.”
“But this is not forever, nor is my unemployment or underemployment,” she added. “This is here for me now, whereas nothing else affordable would be.”
She said she is solidly behind efforts to improve the health care system but wonders about the specifics of the ACA: “Is my good fortune going to be bad for the country?”
Carlo Aparo, Northwest Side
The new plans being offered through the exchanges, which make certain guarantees under the Affordable Care Act, need young, healthy people like 33-year-old Carlo Aparo to keep costs down.
An actor, a videographer and a substitute teacher on Chicago’s Northwest Side, Aparo said he was curious to see whether he could get a better deal through the marketplace than his existing private policy. He was especially interested, he said, after he got a letter from his insurer in November stating that his plan would change Jan. 1 under the federal law.
Then President Barack Obama announced that insurers would be allowed to offer existing plans for another year, even if they did not meet the requirements of the new law.
And when Aparo spoke by phone with a HealthCare.gov representative to look for a new policy on the exchange, he was told that going over his tax information to review options would take up to 45 minutes by phone. Collecting the records and taking that amount of time wasn’t worth it to him, he said.
In the end, Aparo decided not to hassle with the exchanges and kept his old plan.
With a $1,000 deductible and premiums of $164 a month, it’s easy to see why that plan makes sense. A review of the 22 lowest-priced plans offered on the health insurance exchange for Cook County found that 21 have annual deductibles of more than $4,000 for an individual.
Aparo said he’s open to revisiting the marketplace down the line, especially if the costs and terms of his plan change significantly for 2015, when the requirements of the federal law are expected to kick in again.
Kathleen Kearns, Chicago
Kathleen Kearns, 57, was excited about the federal health overhaul even before she knew how important it would become to her.
The Tribune featured Kearns in June 2012 after the Supreme Court voted to uphold the Affordable Care Act. A self-employed graphic designer in Chicago who had to buy her own insurance on top of mortgage payments and contributions to her daughter’s college tuition, she saw relief in sight in the form of better, cheaper insurance.
Then, in September of that year, she heard these words from her daughter: “Mom, they found a mass on my brain.” Subsequent tests showed the college student would have to manage the tumor for life.
At the time, Kearns’ daughter was covered under her stepmother’s plan. But when the stepmother moved out of state, the young woman transferred to COBRA — Kearns’ own plan wouldn’t accept her — and Kearns added that $579 monthly charge to her own premium.
After searching the marketplace, Kearns decided to stick with her current insurance, which carries a $5,000 deductible and a $274 monthly premium. Although her income qualifies her for a government subsidy, she said figuring out how to get a better deal for herself was not worth the time, at least not this year.
But Kearns did find a PPO plan for her daughter through the exchange that was about $200 a month cheaper than COBRA (with a $1,000 deductible) and would allow a flexible physician network, which was critical for her daughter’s specialized care. Kearns says she also expects to receive a tax credit next year for her daughter’s plan, thanks to the government subsidy.
Just knowing her daughter will be covered at a reasonable premium means everything, she said. “It’s one less thing we have to worry about,” Kearns said through tears. “She’s only 22.”
– Provided by Kaiser Health News.