With the one-year anniversary of the federal health insurance marketplace nearing, the 8 million Americans who signed up for coverage in its inaugural year have a crucial decision to make: Will they keep their current plan, for better or for worse, or shop around for a new one?
This time around, people will have have even less time to make up their minds. Open enrollment will last just three months this year (Nov. 15-Feb. 15), compared to the six months consumers were given in 2013 when the federal and state exchanges launched.
“Even if they’re deliriously happy with their plans, everyone who signed up needs to pay attention to the fact that open enrollment is coming,” says Karen Pollitz, a senior fellow at the Kaiser Family Foundation. “This is the time to review your plan choices, make changes if you want or don’t if you’re happy.”
We’ve spoken with consumers from across the country over the past few weeks to see how they’ve fared with their coverage since Affordable Care Act plans kicked in at the beginning of the year. Here are seven of their reviews:
“It is too expensive and that is a big problem for me and my family”
John Hinds, 50, San Luis Obispo, Calif.
Job status: Physica
His plan: Employer-provided plan, he contributes $390/month
My wife and daughter were on Aetna, but their plan was completely dropped with the new plan requirements under Obamacare. I got insurance through my employer but the caveat is that I have to be working full time, 40 hours a week. I was working a couple hours less than that each week so I had to find extra hours to work to be eligible for a health plan. But it looks like I’m going to lose those hours soon, so I was shopping around on Healthcare.gov. Together, my wife and I earn about $80,000, which is just over the $78,000 income limit that would have qualified us for a tax subsidy. Our quote for a silver plan was $1,000 a month. That’s 22% of our net income and we live very conservatively already. It just doesn’t seem right for a family or anybody to have their health care go from $250 to $1,000 a month under a plan that was supposed to help people. It is is too expensive and that is a big problem for me and my family. But it looks like we have no other choice.
“I’m not too crazy about Obamacare”
Deborah Sorensen, 63, Greendale, Wisc.
Job status: Unemployed
Her plan: Silver, $141/month.
I’m not too crazy about Obamacare. Yes, it’s affordable when it comes to the premium. But there are some things that my plan doesn’t cover that my other insurance always did. I have an ankle problem and I need a brace. If I want to get a new one, it will cost me $1,000 out of pocket. Inserts for my shoes aren’t covered either. They’re about $300. But I have to say, my prescriptions are more affordable now. Some of my prescriptions cost $100 for a 90-day supply on Cobra. Now they cost $15. They don’t offer vision insurance either. So I’m probably going to go to Costco. They have glasses for $250, which is cheaper than it was on my Cobra plan.
“It’s been a blessing from day one”
Reinette Batson, 60, Newport, N.C.
Job status: Bookkeeper (part-time)
Her plan: Silver, 17 cents/month
In 2012, I lost my job. I couldn't afford private insurance anymore, so I went two years without it. I’m diabetic, asthmatic, have high blood pressure, allergies and more. I had to get help from a free medical clinic in my town. They had a big push for people to sign up for Obamacare. I had a hell of a time filling out my application and getting my insurance card. But now that I have it, it’s been a blessing from day one.
Because I’ve been unemployed for so long and had so many chronic health problems, I qualified for a big subsidy. My plan for the year costs next to nothing — it’s 17 cents per month. I’m scared every day it’s going to end because I hadn’t had insurance for so very long. My copay is $5 for a regular doctor and $10 to $15 for specialists. My plan is so good that I’ve had nurses come up to me and comment on it. I know it’s getting a bad rap, but it’s the people who don’t investigate and take a chance that are giving it a bad rap.
“For people with preexisting conditions, it’s meant the most”
Malcolm West, 56, Devon, Penn.
Job status: Retired on disability
His family’s plan: Silver, $50-$100/month
I am on Medicare and Social Security Disability Income because I have Multiple Sclerosis. My wife works part-time because I’m in a wheelchair and I need a lot of assistance. She also has a pre-existing condition, a very mild case of Crohn’s Disease. No matter where we tried to get health insurance, we couldn’t get it at any cost. She was uninsured for five to six years. When the ACA came up we were excited, of course. We jumped at the chance to enroll. My wife is on the plan and we added our daughter, who’s 19. For people with preexisting conditions, it’s meant the most. People become financially devastated with MS because the drugs that are used to slow MS progression are hideously expensive, $30,000 to $50,000 a year. Our plan is accepted everywhere with our existing doctors, hospital and test facilities with a $0 deductible and excellent prescription [drug] coverage. My wife's prescriptions dropped from $130 a month to $4.
“Unless something changes drastically, we can last one more year, maybe two.”
Kim Murphy, 48, Elmwood Park, N.J.
Job status: Co-owner of a manufacturing plant
Her company’s employee plan: Bronze
There’s a lot of misinformation out there that the changes with Obamacare didn’t apply to small-business employees who had insurance through their employer. But our small group plan wasn’t ACA-compliant, so we had to buy a new one. And our premiums have almost doubled, from $98,000 a year to $195,000 annually. We have about 23 employees. We told them we could do no raises, no bonuses, but we would pick up the extra cost of their premiums. But unless something changes drastically, we can last one more year, maybe two. Then we’ll stop paying for family coverage altogether most likely. I’ve written to congressmen. I’ve invited them to come to talk to our employees. Nobody wants to talk about what the issues really are. Everyone just wants to call each other names and I’m tired. I blame both sides of the aisle. We’ve had people employed here for 20 years and they’re in their 50s, and I’m going to have to tell them we won’t provide insurance anymore. Think about how horrible that is.
“I didn’t want to pay for the things Obamacare makes you pay for that are against my beliefs”
James Heard, 57, Chicago, Ill.
Job status: Unemployed
His plan: Private insurer, $400/month
I lost my job last December after 30 years working in the TV industry. I didn’t have insurance but I did not even try to buy on the federal marketplace. I didn’t want to pay for the things Obamacare makes you pay for that are against my beliefs, like birth control and abortion, and be told which hospitals to go to. Whether I’m right or wrong, that’s the way I feel. I decided to go with a private insurer, Samaritan’s Ministries, which is based on cost-sharing, even though it would probably be a lot cheaper for me to go with Obamacare. I just didn’t want to be involved with it because I don’t think the government can run anything as efficiently as the private market from a fiscal or business standpoint.
“I was a walking time bomb”
Mark Sigoloff, 58, Springfield, Ill.
Job status: Loading dock operator (part-time)
His plan: Silver, $0/month
I make just enough to pay my bills and that’s it. I haven’t had insurance for 11 years and I haven’t been to a doctor in all that time. I had a bad feeling I was a walking time bomb. The week that I got the insurance packet, I noticed the right side of my face was numb. I was also losing the hearing in my right ear. I went to an urgent care center and my blood pressure was 240. They sent me to the ER. I had an MRI and a cat scan and that’s when they found the brain tumor. Luckily, it wasn’t cancerous and I’ve had radiation treatment for it. My blood pressure is down to 139. All I’ve had to do is pay a little copay for each doctor’s visit. I don’t think I’ve paid more than $50 out of my own pocket for all that.
Have you decided to forego signing up for health insurance this year and take the tax penalty instead? We're all ears: email@example.com.