If you haven’t heard, enrollment for 2015 health insurance began over the weekend. If you’re blessed to have health insurance through an employer, you probably don’t care. But, if you’re self employed like me, Obamacare is a huge deal- especially since our current plan is being dropped by our insurer and the premiums for the plan that we’ll have to take for 2015 will be a 20% increase over what we pay right now. In 2015, we will pay over $1,600 a month for health insurance premiums. I’m almost 100% certain that as you read that, your jaw may have dropped or you may have let out a little gasp. Yet, still Obamacare works for us. Here’s why.
Before Obamacare, my entire family was 100% uninsurable. Both my hubby and my daughter have chronic migraines and I have asthma so serious that it requires an injectable medication that costs over $40,000 a year. No insurance company in their right mind would insure us so I had to align my financial services practice (that I hated, but that’s another story), with an insurance company that provided group insurance to it’s agents. Our group insurance wasn’t exactly cheap either, but we had it and felt lucky. If you’re healthy and insurable you may not know how blessed you really are.
Obamacare gave me the opportunity to start my own business because we knew we’d be able to get insurance. And, to be truthful, our premiums this year were no more expensive than the last six months of COBRA would’ve been, so we went with a Platinum plan right off the bat. We hit our-out-of pocket maximum in the first month. (You can read all about my COBRA woes over the years, in this series of posts: COBRA, you Suck (and so does our Healthcare System), I Wrote you my Check, now Give me my Drugs, and Why COBRA Sucks Part 3.
When you’re healthy and you’re buying insurance, you look at the least expensive premium because you know you’ll only need it in catastrophic situations. You pay less up front, because the risk we’ll only be incurred if you get seriously ill or have an accident. When you’re unhealthy, you have to look at health insurance another way. When I looked at plans, I added up all the premiums, then the deductible amount for our entire family and then I’d add the out of pocket maximum to come up with a big fat grand total. For 2015, that total will be $23,000. That’s our exposure no matter what happens. Why is that important? Let’s talk about this year.
If I add up all our medications, the out-of-pocket cost would be over $10,000 a month (keep in mind, I have a $40,000 medication right off the bat and my asthma medications aren’t cheap. My poor Rosie’s been in the Emergency Room five times for migraines– that’s another $15,000+ and she had a hospital stay that I’m afraid to even look at the explanation of benefits for fear that I’ll get complete sticker shock. All three of us see specialists on a regular basis so we don’t really get to benefit from the well-care provisions in our policies. All in all, I’m pretty certain that our health care costs, if we paid them out of pocket, would’ve been over $150,000 this year. So, the $20,000 we paid to the insurance company was actually a pretty good deal for us. It wasn’t for the insurance company- that’s why they’re dropping our current plan.
Obamacare works for us. Why? We don’t have a choice. We have to pay high premiums to have access to care. Our medications are essential. Our need to have high-quality care is as well. Guess what? That’s exactly what the government and the insurance companies were banking on- that enough desperately ill people would pay out the nose for insurance premiums because they’d have no choice. They were right. Was the risk offset by healthy people? Depends what you read. Unfortunately, the insurance companies are now finding out that taking the risk on families like mine is expensive. So, is insurance.
The Affordable Care Act isn’t affordable and it doesn’t matter if you’re a healthy person biting off a $400 a month premium for insurance you didn’t use in 2014 or someone like me that will pay $1600 next year. Our insurance is more than our house payment and with my hubby losing his job, I’m not sure how we’ll swing it but we’ll have to. It’s a terrible position to find yourself in but guess what? I can’t complain, because the alternative might be working a crabby job for even worse health care. I’ve done that before. (In case you’re wondering, we don’t qualify for a subsidy, but even if we did, Platinum plans are not on the Affordable Care website).
Our health care plan this year was phenomenal. Once we hit our out-of-pocket max, it paid for absolutely everything and nothing was disputed. It was lovely to not have to fight with an insurance company. Remember that expensive group insurance we had? It wouldn’t pay for some of my medications and my hubby had to wait an excessively long time to have his Botox injections approved. If we made a trip to the emergency room, I’d find myself praying that it would pay. In fact, the company still hasn’t paid some claims for Rosie’s physical therapy from 2013 when she had a hip injury (we are lucky we have an understanding children’s hospital as they keep sending us a statement but tell us not to pay). Our group insurance? It sucked.
Our Obamacare insurance? It’s been like a dream come true. We only had one instance all year, where we had to fight them on a claim and it was for a drug that no insurance company was approving (in case you’re wondering, it was a common asthma drug and we got it approved pretty fast once the doctor intervened). In fact, we liked the company so much we decided that we’re going to pay higher premiums to stay with them so we don’t get claims denied in January or have to go off some of our medications until their approved.
Obamacare, works for us. For now. But, I can’t help but wonder how much our insurance will go up year over year. That’s what scares me.
Do you buy private insurance? What’s happening to your premiums this year?