Affordable? Care Act

Affordable Care Act (ACA)? Last year, I moved back to Central Pennsylvania with my spouse to pursue more country space and less snow. My husband, Jay, had never made a permanent move before, and we are both nearing retirement - a time surely ranked with the most bittersweet of any life. I just have a question about the ACA, though. Has it really made healthcare more affordable?

We had good coverage through the ACA in New York State despite how difficult it was to deal with the bureaucracy and the insurance companies themselves. They often seemed confused over their own products. It seemed they would change the product “mid-stream” on us, causing more confusion. They would put in for these approvals for insurance policy changes with the State, and when they came through, your policy changed. They’d discontinue a coverage and institute another one, or do the same with your whole plan. Why? It was obvious they were seeking ways to make more money, reduce actual coverage and benefits, and deny more claims. What I concluded then was that the ACA has simply put the insurance companies in bed with the government to work toward their income goals. The idea of making things more affordable, and to prevent illness through physicals and screenings that are “covered” is not recognizable now, if it ever was.

First of all, if you get coverage where before you had none, you’re paying more money, which is why the health insurance industry wanted ACA. Healthcare wanted it too, so they would have more ways to get paid. Recently, I was shocked to find our physicals, with its supposed “allowable screenings” , effectively charging us for our physicals, because results not covered on that same blood “panel” are not included as an allowable screening, are “diagnostic” and therefore chargeable. The short of it, is that our “covered no-copay” physicals have cost us $259 so far. They charge you for drawing the blood for the “covered” tests because apparently there’s nothing in the federal rules that says they can’t. They use deceptive practices like getting you to come in for a blood test you think is for your annual physical as “maintenance for your chronic disease” which, of course, is chargeable. Tricky, tricky. Caveat emptor. Let the buyer beware. It still works, and the ACA has given more wonderful opportunities for the creative-billing types to rake in the cash.

Each state’s health exchange is different, Pennsylvania (PA) allows for a broker (another entity that makes money off of this) to help you select a plan. The plans themselves are pretty tricky. The one we ended up getting in PA is terrible coverage. It was cheaper than what we had in Buffalo NY, but the “metal ratings” of Gold and Silver are completely different between states. “Silver” has good coverage in NYS, but is barely catastrophic coverage in PA.

And maybe not even good at covering a “catastrophe”. Two and a half months after we came, Jay passed out and fell, hitting his head on cement. According to the insurance and hospital, a two day stay was billed just shy of $400,000. Why do we ignore this blatant absurdity in our healthcare system? Of course, after things were “paid” and costs reduced to “allowable contractual amounts” our out-of-pocket was about $7,000 for the incident. That means that money we hoped to save for retirement had to be spent on this “affordable healthcare”. How is that affordable healthcare? I like to say to people, “I pay a monthly charge to an insurance company so we can pay the actual costs of our medical care in full, instead of more than that.” I truly and firmly believe this to be the case. We pay to get no coverage from this product, but escape the absurd joke our healthcare has made of its charges. Is that laughter I’m hearing?

The plan is very inexpensive to be sure. It started at $225 per month, then they lowered it. Get that - lowered it to $86.86 per month. Why didn’t I do anything about THAT red flag? Caveat emptor.

In the 15 months since we moved to PA, our healthcare has cost us over $11,000, not including dental, which, BTW, works the same way - to reduce the amount you owe to “contracted allowable amounts” and charge you the actual cost of the service out-of-pocket.

So, why are we complaining? We could have gotten the $1,000 per month plan and been out $15,000 now instead of $11,000. Right? And it would have come with the same denials, long holds on the phone to the insurance company - just the same.?

Caveat emptor America. You get what you pay for too. Or, maybe a little less…