Me & Obama(care) Or What The Hell Is A Deductible?

I am one of the privileged few who has been able to log on to Healthcare.Gov and complete the process. I even chose a plan. I am writing this short entry in the hopes that anyone considering signing up for Obamacare can have an honest evaluation of the process and not have to depend on what the politicians and talking heads say about it.

I began with the infamous website. The design of the website was encouraging. It wasn't stiff or overtly bureaucratic as one might expect a government portal to be. The colors were bright, the images crisp and modern, and the introductory video helpful in terms of defining what I could expect from the “marketplace” experience. The video- also draped in sleek modern graphics- told me that I could expect to compare different plans in the virtual marketplace; find "clear information” about prices/benefits; and search for definitions of what medical words like

premiums

,

deductibles

, or

co-pays

meant

. Every plan- a sweet soothing voice told me- would offer “comprehensive benefits” and no one could be turned down. It took me about two hours from sign up to enrollment.

When I arrived at the launch page I immediately set up an account. The information required was pretty basic and streamlined. Name, address, phone number, etc. So far, so good.

In terms of

who qualifies?

I noticed that there were specific groups that were purposefully left out, such as undocumented immigrants and incarcerated individuals. I will not make a judgment of these barriers here, but I do feel it necessary to point out that this program was not designed for

all

Americans.

Once I arrived at the privacy statement I slowed down a bit to read the fine print. Part of the terms and conditions state that if any of the information I entered, such as income or residency, did not match the information in the Heatlchare.Gov database

[1]

then I would have to provide "proof" of the changes. This proof could include information from inaccessible bureaucratic labyrinths like the Internal Revenue Service, Social Security Administration, and Department of Homeland Security, among several others. I worry about the accessibility of such information for a large cross section of the population who aren’t used to navigating government red tape. Even my "Eligibility Notice"-- which is a sort of

what’s next

kind of jawn—doesn’t make it clear how to obtain the information.

After entering my personal information the website asked me

whether I wanted

to enter my income to apply for a tax credit. I find this question to be of supreme importance for a number of reasons. Firstly, it was an

option

. Unless I am mistaken the Affordable Healthcare Act was designed so that folks who have typically not been

able

to afford or have access to health insurance can. Why is it an option? What if I had missed the significance of the question and pushed "no”? Then none of my potential plans would have included the subsidy that I qualified for and I consequently would not have known that the price I was quoted could have been significantly cheaper. Secondly, the language of the site offered me a "tax credit toward my monthly premiums". Thankfully, I understand what tax credits and premiums are, but I do worry about the accessibility of such language to people who aren’t as familiar with what they mean.

The tax credit itself turned out to be the most important part of the process for me. I entered my expected income for the year and was provided with an amount: $2,724. That amount was based on my income and basically covered the cost of my monthly premium for a year because I live under the poverty line.

Then I was presented with options for

how

I would like to receive that tax credit. Basically, I could either put all or part of the $227/mo. subsidy toward my monthly premiums or receive it all in one lump sum with my federal tax refund. The website did offer very helpful color-coded graphics to help understand these options as well.

I was a little disappointed that I had to choose how to use my tax credits

before

I saw the actual plans. I chose the

use all of it every month

option so when I was presented with my options in the

marketplace

section my monthly premiums were $227 less.

When I arrived at the marketplace itself I was offered a few different options for the

types

of plans I wanted: bronze, silver, gold, and platinum. They basically varied in deductibles, out of pocket maximums, co-pays, etc. I chose silver because I wanted low premiums (monthly fees) and cheap doctor visits.

When I went to choose my plan the confusion began. I think the goals of the website were met in terms of presenting my range of options in plans, providers, and costs, but it did not help explain

what

these costs were. My monthly costs and co-payments were clear, but I still don't quite understand what a deductible is or when I have to pay an

out of pocket maximum

.

I tried to use the "live chat" option as well. I was quickly connected to a representative, but it did not prove very helpful for me. I asked a lot of the same questions that I have presented here: What is the difference between a deductible and an out of pocket maximum? What am I going to be billed for? The reps’ answers sounded more like scripted responses when I could’ve more used a more free flowing dialogue. I finally searched the website for the definition of a lot of these terms, but again they sounded more like entries in an textbook for medical billing than a helpful one-stop-shop explanation of healthcare costs. Again, I imagine that this could get especially difficult for those not familiar with navigating the Internet or making sense of medical terms.

In the end I chose a plan that would provide me with $5 doctor visits, $25 emergency room visits, $4 generic prescription, $10 x-rays, $0 deductible (whatever the hell that means), and a $2,250 out of pocket maximum (see: Previous Parenthesis) for $0.13/mo. thanks to the $227/mo. subsidy/tax credit for which I qualified. My

Eligibility Notice

said that I am still required to send proof of my income to the Health Insurance Marketplace before I can be approved. It's not a done deal yet, but I am hopeful.

Overall, I am satisfied with my experience of Obamacare and Healthcare.Gov, but I am not sure that it quite meets its stated goals. I am a young College-educated person who is familiar with the Internet, kind of knows some health insurance lingo, and can easily access information from government records. However, it seems to me that the rhetoric of Obamacare has been that it will offer millions of Americans easy access to health coverage for the first time. It is easy, but it’s not

that

easy. If I did not have the education I have then I may have had some trouble navigating the bureaucracy and language.

If the goal of Obamacare is to get young people like myself enrolled in insurance programs, then I think Healthcare.Gov can work. If the goal is to get insurance to the most vulnerable among us who need it the most, then I fear it will fail because a lot of the same barriers that have always existed between the lower classes and affordable healthcare still exist. The subsidies will help, but the process may cost the program some enrollees. Personally, I still think the most vulnerable among us should be offered a public option that is as basic as if you have a social security number then you have

security

 in the form of universal health care no matter where you come from or how much “worth”. Obamacare seems to work for me, but whether it will work for everyone… only time will tell. 

UPDATE 12/5: After a bit of searching I finally found the

submit proof of your income

portal. Again, the live chat option was no help at all, but after a bit of digging around my profile I finally found it. I uploaded a pay stub electronically. It was relatively simplae and there are a myriad of options for the

type

of documents that are accepted. All that should be left now is the insurance company contacting me. I'll update everyone when I have news. 

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I never did figure out from where that information originated.