Given the fact that real people will soon suffer as a result of this government shutdown, I felt it only appropriate to share a Facebook post. The author of this post begins to compare the plans offered under the Affordable Care Act in Maryland to an existing health care plan through an employer.
Yes, this is a cut and paste and all references to the person’s identity has been removed. I am not in health care insurance expert, so it made sense to use the direct account from the Facebook post. I inserted more comments from friends that asked questions. You will find these in parentheses.
The Facebook Post
“I’ve been seeing posts all week about how the Affordable Care Act (ACA) is not actually “affordable.” So since I teach health care insurance, billing and reimbursement, I thought it would be interesting to see how the ACA compares to my current employer-sponsored health care plan (individual to individual plan). I logged onto the Maryland Health Connection (the Maryland site for ACA Insurance plans), created an account and went shopping for an individual medical + dental plan.
Here’s what I found:
1. OPTIONS: The ACA was able to offer a plan with more access options that what I get from my employer. I have Kaiser + Cigna Dental PPO through my employer and do not have a choice of doctors with Kaiser. I do have a choice of dentists with Cigna Dental. The Maryland Health Connection offered me 26 options, and many (17/26) were PPO’s with a wide choice of participating physicians and dentists.
2. COST: My employer + employee contribution cost for Dental + Medical for 2012 was $6949. (Data taken from my employee benefits statement.) (Employer plan also includes a $250 deductible and $25 co-pay) The ACA Blue Cross PPO Plan I selected was $250 per month, with a combined Medical + Dental deductible of $2300/year. So the ACA Plan total annual cost would be $5300. The monthly cost would be $250. The insurance plan pays 100% of medical or dental costs once I have reached the $2300 out-of-pocket limit. (Wellness visits under the ACA have no co-pay).
3. TAX DEDUCTION: There is a tax credit available so you can deduct the cost of the insurance from taxes, but it is limited to “low to moderate income” so I’m still researching what that means. Low to moderate income in terms of Medicaid varies greatly from state to state, so I have to get more data on what that means in Maryland.
4. PATIENCE: The Maryland Health Connection website is slow and requires a lot of patience. When I finally got an account created, and logged in, it was very easy to use and gave me lots of information and choices. If you have ever had to apply for or access government-funded benefits (Medicaid, SSA benefits, etc.) this experience is not surprising. However, if you’ve ever had to find information on the CMS website for insurance billing information, the Maryland Health Connection website was a comparably enjoyable experience.
5. RISK FACTORS/COST DETERMINATION: Contrary to some FB postings, my income and pre-existing conditions were NOT part of the application. State, age, sex, and tobacco use status were the only criteria used to determine available insurance plans and costs.
So that’s all I’ve been able to find out for now. As my students and I get more information, I’ll share it. Love it or hate it, it’s good to know the facts.”
To my readers, I will be updating this blog as my friend uncovers more facts. I encourage all of you to share your experiences from states across the nation as you check your exchanges. Good, bad, or indifferent I will post them, with your permission and review, on my blog.
Members of Congress I know the easy route is to let ideology guide your policy choices. But can we please let some facts enter the decision-making process, particularly when so many people are economically and mentally affected as a result of the shutdown.