by Elizabeth Perkins
Health Policy Intern at Health Action NM
In a time when the term Obamacare still elicits mixed and often passionate reactions, new research suggests that shoppers are happy with their Obamacare-enable plans – even more so than those who get health coverage from an employer. The J.D. Power 2015 Health Insurance Marketplace Exchange Shopper and Re-Enrollment (HIX) Study, released on April 23, 2015, shows a significant improvement in plan satisfaction during 2015 as compared to 2014 (the first year plans were available). Satisfaction among new members and re-enrollees that purchased plans through the marketplace exchanges created by the Affordable Care Act (ACA) is equal to or higher than with plans not purchased through an exchange. J.D. Power reports cost to be the most significant factor influencing member satisfaction among Marketplace members.
As someone who has been uninsured, on Medicaid, on employer provided insurance, and having recently purchased an individual plan from the New Mexico Health Insurance Exchange (NMHIX), I like to think I offer a unique perspective on the successes and downfalls of each option. As a working adult with zero dependents it has been a long time since I have qualified for Medicaid (but I was glad the option was there when I needed it), and there are no upsides to being uninsured, so I will focus this discussion on employer provided vs Marketplace coverages.
When the ACA (or what many call “Obamacare”) went into effect at the end of 2013, I was working full time for a company who decided to obtain group coverage – a type of coverage that many large firms obtain. I was excited about this decision because I was uninsured at the time and I knew the ACA required me to obtain some form of health coverage. When I learned how much my monthly premium was going to be (and, mind you, I was only paying half, my employer paid the other half) I was shocked. I was also shocked to learn that my plan had a pre-existing condition clause!
Just my luck, I seriously sprained my ankle during a company softball game on the first day my plan became active. I found out about the pre-existing condition clause when I received a bill for $1200 dollars from the MRI despite having gotten a pre-authorization. I couldn’t believe that I was paying almost $200 per month (remember this is only half of the total premium) and the first time I tried to use the insurance it didn’t even pay for anything. I was irritated. Here I was, insured by a coveted employer based plan, and I was scared to use it due to the pre-existing condition clause (it only lasted 6 months, but it sure wound up costing me) and my $5,000 deductible. But what was I going to do? The only other option I had was the “Gold” option which would reduce my deductible to only $2,500 but nearly double my premium. I was stuck with what my employer had chosen to offer.
On February 18, 2015 I suddenly became unemployed, and would soon revert back to being uninsured. I was in the middle of some routine medical procedures, so I knew I needed to get coverage back sooner than later. I looked at trying to get coverage on my significant other’s insurance but the required paperwork and red tape that arose because we are not married was a lot to overcome. So, I decided to look at the NMHIX for coverage. I am pretty tech savvy and understand health insurance pretty well so I didn’t have much problem navigating the website, but I can see how difficult it must be for consumers who aren’t familiar with the system. However, my experience was great: I was clearly shown what financial help was available to help me pay for my premium (via a subsidy that appeared as a discount) and offered a wide range of plans ranging from $18-250 for my out-of-pocket costs.
I looked through the options using the website’s “compare” feature and chose a plan that I knew my current doctors would take. It had a reasonable premium and $0 dollar deductible. What?! I didn’t believe this could be true. I was paying half of what I was paying under my employer insurance – I couldn’t believe the plan really had no deductible (the cost that you have to pay before your insurance kicks in).
I decided to buy the plan and an accompanying dental plan and figured I would brace myself for when I found out what my real deductible was when I got my information packet in the mail in a few days. I received my information booklet in the mail that included a summary of benefits and my eyes focused on the section that said Deductible: $0, Out of Pocket Maximum: $2,250. I continued to read through the booklet trying to find the catch, but I found none.
I have only had the plan for about two months; I have used it, and encountered no issues. I have searched and searched for where the deficiency in my new Marketplace is and have so far come up empty handed; I cannot find one reason not to be satisfied with my new Obamacare plan. Hopefully, and it seems this is so, this is the experience that other shoppers have had as well.Health Action