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Does it cover sticker shock?

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Saturday, Oct. 19, 2013, 9:00 p.m.
 

Rebecca was stunned when she opened her mail last week.

Her insurance carrier, Highmark BCBS, said her health insurance premium would rise 40 percent this year and her policy would be canceled on Dec. 1, 2014.

She had purchased the policy in 2009, after her husband had passed away from lupus, which he'd contracted 10 years before. His employer's insurance covered virtually all of the $1.1 million cost of his care during the last 66 days of his life.

With three children to raise, Rebecca knew how important it was to have good coverage. Her husband's company covered her for three months after he died. That gave her time to buy her own coverage with Highmark — though paying the $400 monthly premium would not be easy.

She worked two or three jobs to make ends meet — jobs that allowed her to be home when her kids got home from school. She was thankful to receive $1,300 a month in widow's benefits from Social Security, which her husband had paid into for years (she will soon lose these benefits when her youngest turns 16). Her combined income is $47,000 a year.

By scrimping and saving, she has been able to pay her mortgage and insurance, feed her kids and get the oldest two through college (thanks to several loans she is repaying).

So, she was stunned when she found out what her new insurance policy would cost.

The Highmark representative explained that her new policy had to meet all the requirements of the Affordable Care Act (ObamaCare). It would have to cover things she does not want or need — such as mental health problems, substance abuse and maternity care.

She asked the representative to help her choose a policy similar to what she had. The closest match he could find was a comprehensive PPO policy.

Her deductible would go from $1,200 to $1,500 per person, but her family deductible would increase from $2,400 to $5,000.

Her 90-percent copay would rise to 80 percent. Instead of being responsible for only 10 percent of her medical bills, after the deductible is met, she would be responsible for 20 percent. Her maximum out-of-pocket costs would soar from $2,000, after deductibles, to $12,000.

Her premium would go from $400 to $884 per month — an increase of almost $6,000 per year.

If she or one of her children were to get ill, as her husband did, her out-of-pocket costs would run about $24,000 a year.

Surely there are subsides for people in Rebecca's position?

Not in her case.

If her three children were younger, she would be eligible for a $6,000 tax credit. But her two oldest kids have just entered the workforce and their combined income disqualifies them.

If she covers just herself and her youngest child, her $47,000 income is still too high to qualify for subsidies.

She is too proud to accept subsidies in any event. She doesn't want taxpayers picking up the tab for her coverage. In fact, ObamaCare subsidies will cost taxpayers $1.9 trillion over the next decade.

Her only solution is to find a full-time job that provides benefits — if she can find an employer that offers them. Employers, too, are seeing their premiums soar.

Virtually everyone agrees our country needs to help the uninsured and those with pre-existing conditions get coverage and care.

However, ObamaCare is essentially forcing those who buy their own insurance to pay double or triple costs to cover those without insurance or who have pre-existing conditions — and a good many of these middle-class people will not qualify for subsidies.

The shame here is that there are creative ways for the government to solve the problem by establishing guidelines while unleashing market forces. This is demonstrated by Medicare Part D, a successful entitlement program that provides drugs to the elderly poor.

Under Part D, seniors are free to choose among a variety of benefits, costs and plans offered by private insurers. According to the Heartland Institute, Medicare trustees estimated a 2013 average monthly cost of $61 — the actual costs are HALF that.

In any event, lots of people are getting sticker shock as they learn how much their premiums will increase. And despite the president's promises, many people will not get to keep their current coverage.

Just ask Rebecca.

Tom Purcell, a freelance writer, lives in Library. Visit him on the web at TomPurcell.com. E-mail him at: Tom@TomPurcell.com

 

 
 


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