, The Affordable Care Act and the Thirsty Horse

I’m the horse in this scenario–and I don’t mean to be…


There are millions of uninsured Americans. As of last month, I’m one of them.

I started researching health insurance options months ago, because I knew I would soon be losing my coverage. I spoke with doctors and health care professionals, read countless articles online, read through the website—yet I STILL can’t decide what to do.


1. COBRA: Per our divorce agreement, my ex-husband was to keep me on his plan as long as there was no extra charge to him. He insures our children, has a family plan that can include an ex-wife. The hitch? He cannot have two people in the “wife” slot. He’s remarrying soon, so I’m off the plan. Which is fine. I appreciated having it these past several years.

COBRA would be $605 per month and it’s available to me for up to 36 months.  I’d be looking at $7260 for the year, which sounds outrageous–but actually isn’t. It’s a United HealthCare plan, with medical, dental and prescription coverage. There is no deductible and everything is 100% covered.

healthcare gov2. MARKETPLACE: I haven’t officially signed up for a plan because I can’t find one that makes sense. Many plans have deductibles of $4500 to $6350–just for me. One person. Nothing would be covered until I reached the deductible; not prescriptions, procedures, copays, etc.

At a conservative $200 per month (most plans are more), I’d be paying $2400 per year in premiums for…NOTHING. Or at least nothing until I hit $6350. I could easily end up above the $7260 COBRA option. Dental and vision coverage would be an extra several hundred per month. Some of the plans are 80/20, even after the deductible is met. Lastly, premiums paid do not count towards the deductible.

SOME PLAN NAMES ARE FAMILIAR; Kaiser, SummaCare, Anthem Blue Cross & Blue Shield and Medical Mutual. (These are Ohio plans)

SOME ARE NOT; Molina Healthcare and CareSource were two I’d never heard of. When I called around to local hospitals and doctors offices, many of them were unfamiliar with them, as well.

From my understanding, physicians and medical facilities can choose which plans they accept. Molina Healthcare and CareSource seem to be the more budget friendly options (i.e. cheaper than others), which might mean that they’re the ones that pay less than the going rate for medical services. There are plans that pay 60% of what other (more expensive?) plans pay. I can’t imagine buying health insurance and then finding out nobody accepts it.

And who can blame them?

Doctoring is a business, as much as any other business. Physicians and medical facilities cannot see a slew of patients that they’re losing money on. No business keeps its doors open by losing money each time they sell a product or provide a service. Doctors are no different. They have overhead and they can’t operate in the red.

3. CONCIERGE MEDICINE:   A newer concept, but one that promises to see massive growth in the coming years. Doctors can have admitting privileges at a local hospital, but practice privately. These private practice physicians charge a monthly fee. The national average hovers at $100 per month. They don’t bill by patient office visits, so there is no incentive for packing the waiting room. They can email patients, speak with them over the phone, do group office visits–lots of leeway in providing care. Using this type of physician is acceptable under the Affordable Care Act, as long as people buy a policy covering medical catastrophes, such as emergency hospitalizations, treatment for illnesses, etc. (I would consider this, but I have only located one such doctor in the Cleveland area…)

4. REMAIN UNINSURED: This is a viable option. Office visits at my primary care physician run about $85. (They’re less at some walk-in clinics.) It’s doubtful I’ll visit my doctor every month. Prescriptions? I do take a few monthly medications that I’d need to pay for–but they wouldn’t be covered until I reached my deductible under the Marketplace plans. And I don’t think they could kick me out of the emergency room, if I needed care…

5. PRIVATE HEALTH INSURANCE: There are plenty of insurers that sell healthcare plans to individuals. It’s an option I need to explore.

6. FIND A NEW JOB: It’s been suggested that I find a job with a company that offers health insurance. Not as easy as it sounds! Smaller companies can’t afford to offer health insurance and often staff with part-time employees. The job market is competitive, making it difficult to snag the jobs with benefits. Also, most companies have scaled back benefits and upped the portion employees pay. And the biggie–I really, really like my job!!

7. WORK LESS HOURS: I don’t consider this an option, would never do this–but many will figure out how to get Medicare or Medicaid, even if that means reducing their hours to fall into the low-income category. Healthcare would be free and they might make up the loss in income by applying for food, rent and utility assistance.

understanding aca

Does anybody understand the Affordable Care Act?

I’m not criticizing it. It’s just too new and too complex to be easily understood. Any large-scale change begins with uncertainty, chaos and unknown variables. Health Care Reform is no different. This is simply the starting point…

The Affordable Care Act will likely see changes and revisions in the coming years. It will adapt to address problems, to fix areas that see failure. It won’t just affect the uninsured–it will end up affecting everybody in more ways than we can think of now. It will affect those working in medical professions, hospitals and doctors offices and those providing the medical community with products and services. It will affect economies in every community in our country.

Have I got something wrong? Anybody found a better solution?  PLEASE COMMENT so that we can learn from each other. I’m no expert. Just another person trying to figure this thing out…

I’m also (STILL) the damn horse. A little parched, but not ready to stick my head in the trough.


8 thoughts on “, The Affordable Care Act and the Thirsty Horse

    • I know, Diane. The biggest decision for now is whether to pay first COBRA premium to buy myself time. I still have a couple of weeks to do so. Once I let that option go, I’m never getting it back.

      Something that occurred to me; pay the first months COBRA. Make a slew of doctors appointments, including a physical. If all is well, I take my chances and let the coverage go. If something shows up, I keep the damn COBRA until its resolved.

  1. Be careful what you choose, there are some offices and hospitals that have already stated that they will not accept the Medical Mutual insurance under the ACA. The problem is that this ACA is changing daily because they still don’t have it all worked out. It is very expensive for horrible coverage. My advice is that if you can afford COBRA for a while, I would do it until they work this out and if nothing else it buys you a little more time to investigate what you want to do.

    • Thank you Lori!! That’s the conclusion I’ve come to. Either I suck it up and pay for COBRA, or I remain uninsured and am a self pay. (I still have a couple of weeks to make the first COBRA payment…) The self pay option works fine, unless I wind up in the hospital or sick–in that case I’m in trouble. For sure, remaining uninsured is risky.

      Regarding the Affordable Care Act; SOMEBODY is going to have to pay for it. Doctors, insurance companies medical facilities or hospital systems. Or those with health insurance will see their cost rise, when their companies premiums rise and companies pass those increases along to their employees. Or the uninsured will give Marketplace a try and likely pay premiums for insurance not accepted anywhere. Cleveland area hospitals are ALL cutting back heavily, laying off–trying to prepare for increased costs to them. Not good for the economy, or for the general public when any of us (insured or not) need medical care and we cannot get it because facilities are short staffed, experienced doctors retire to avoid the mess, there is one nurse caring for far too many patients, etc. It is going to take three years for the new laws to fully take effect and for increased costs and penalties to hit. Right now, we can only guess, try to predict the ACA’s effect on us–and everybody is scrambling to ensure that the cost of it all doesn’t fall to them. Just as I’m looking at my options and trying to figure out how to get a good plan without paying a ton of money. The thing I’ve come to realize is that NOBODY is going to skate this one…it’s going to be a bumpy ride for a while, I think.

  2. Let me know if you decide on anything, as I too, don’t have insurance and have been dragging my feet trying to figure something out for myself. I went on the Marketplace website and am eligible for extra help, but what I still need to pay every month, I can’t afford and then I will still need to pay out of pocket for deductibles, etc., and then none of my doctors are on the cheapest plan… yadda yadda yadda. Bullshit, if you ask me. So I think I will take the penalty, and do a lot of praying that I stay in good health until they blow up ObamaCare and get this country back on it’s feet! What the hell!

    • Yep. There’s good reason so many of us are dragging our feet!! The idea to provide healthcare to all was/is noble and good. But the whole thing illustrates why most politicians are NOT businessmen. Few (that I know of) have built thriving, empires from ground up.

      My first thought years ago when I heard about this, “”Oh boy…if the License Bureau is any indication–I can’t see the government managing healthcare reform.”

  3. Well mama, you are in luck because I will be writing a research paper on the ACA (as long as I can find reliable, scholarly, unbiased information…), so I will soon be an expert 😉 …

    • Awesome! I’ve got a binder of notes, websites, reference materials. Been collecting things for months. Even have a few presentations we might attend. I’m happy to pass everything along–and YOU can figure this out for me!!!

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