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February 27, 2017

Affordable Care Act Platinum Plan

Since its inception, I’ve received insurance through the Affordable Care Act. It was enacted almost at the same time the I went on disability and lost coverage under my employer. I was still in the process of applying for Social Security Disability and knew that it could be years before I was eligible for Medicare.

During open enrollment in 2016, I knew that I wanted to keep the plan that I had the previous year. This required no action on my part. The plan would just roll over.

However, I received in the mail a notice saying that the plan I was currently on would no longer be available in 2016. Therefore my insurance carrier informed me that they were placing me in the next best plan. I didn’t really pay attention (totally unlike me).

Then I got my new card in the mail. The dreaded words HMO were on my card. Oh hell no! That was not going to work for me. I previously had a Platinum PPO plan. Living in DC at the time gave me access to exceptional healthcare options, an HMO was not going to cover anything I did out of the local area. Getting in-patient treatment at Jefferson University Hospital had been vital in my migraine journey and I desperately needed a plan that allowed me to do that.

After a 20 minute call to Carefirst and two people later, I confirmed that the new HMO plan I had would not cover what I needed. I talked to them about my needs and they found me a PPO Platinum Plan with no deductible. The cost? $445. My previous cost was $331, over a $100 difference. Yuck. However, I know I needed that coverage.

Those not familiar with choosing a plan under the Affordable Care Act are probably outraged at hearing the extreme jump in price that I realized in one year. But I had other options, ones that were less costly. There were bronze and gold level plans I could have chosen that were either cheaper or only slightly more expensive that what I was previously paying. I could have even chosen a platinum plan with a deductible and save $50 a month. After analyzing these options, I knew the no deductible, platinum PPO plan with the same insurance carrier would get me the coverage I needed AND cost me less in the long run. This was my choice.

You can be sure that my options during open enrollment at the beginning of 2017 was scrutinized to the fullest extent. To my surprise the same plan existed and my monthly premium actually DECREASED by $25.

If you want to learn more about the Affordable Care Act, visit www.healthcare.gov. Open enrollment is closed for 2017, however if you experience a life-changing event (lose of job, change in marital status, birth of a child) you can enroll at any time.

Scared about how the new administration may change or repeal the Affordable Care Act? Me too. However, anything that passes through congress cannot change the plans that are already in place for 2017.

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