Last year I wrote an article about getting a new health insurance plan through Obamacare.  My take was that while the Affordable Care Act fell far short of what I would have liked to see in the way of health care reform, it was in no way worse than what it replaced.  Here's a quick follow-up.

My Obamacare policy's coverage was hit-and-miss, which made it an improvement over the policy I had before, which was miss-and-miss.  I wound up having to go to one of those "not quite an emergency room" urgent care centers only a few days after my new policy was issued, and for my $230 appointment I wound up having to pay $60.69 — worse than the $0 I would have had to pay in some countries, but better than the $230 I would have had to pay under my previous plan.  A few months later I was able to get an appointment with a specialist without a referral, which would have been $330 out-of-pocket and which instead cost me five dollars.  Prescriptions generally cost three dollars apiece, though I was prescribed a compounded medication that cost me $170, and when I applied for a reimbursement, my application was rejected.  I also got no help at all in paying for physical therapy.  The biggest win came when I had some blood work done.  In 2013 I got a blood work bill for $884.94 and had to pay the whole thing myself.  In 2014, with half as many tests, I figured the bill would be about half as much.  Instead, it was ONE THOUSAND SEVENTY-NINE goddamn dollars.  But thanks to my policy, I only had to pay three — a 99.7% discount.  My total cost for ten months' worth of premiums was only $455.90, so the policy paid for itself more than twice over with that one charge. 

The problem?  Because Obamacare is a Rube Goldberg machine, it was not the case that my policy was actually $45.59 per month.  In reality, it was $360.59; it's just that Obamacare was kicking in $315 of that.  But that figure was based on a wild guess back in February at what my income might be for the whole year.  If I made more than my guess, I would have to pay back some of that subsidy, which would have been fine.  But if I made less than my guess, I would have to pay back all of it.  At least, that's what I was told: if I didn't hit a certain benchmark, I would be hit with a bill for $3150.  Towards the end of the year I had to scramble a bit to scrape together some money before December 31st (and, yeah, this is at least in part what my crowdfunding campaign was about).  And then, on November 15th, my policy was canceled.

What followed was a colossal game of phone tag.  I called my insurance company to ask what was going on.  After talking to several unhelpful people and on multiple occasions being "transferred" to a hang-up, I eventually got hold of someone who said that my policy had been canceled on instructions from Covered California (as our Obamacare exchange is called).  Trying to reach someone at Covered California was even more ridiculous.  The first couple of times I called, I waited on hold for over an hour before I had to attend to other things.  Then I started reaching a recorded message that, after a longwinded and unskippable explanation of how Obamacare works, said that call volumes were too high and that therefore I would not even be placed on hold but should instead call back some other day.  I tried to log into the Covered California web site; I received a message saying that my account was unavailable, and that I should call a certain number for assistance.  That number connected to a recorded message saying that I should ask for assistance via the text chat link on the web site.  I tried it.  I was connected to a tech support person who said that the live chat people no longer had access to account information and so I should just call the main Covered California number, i.e., the one that wasn't answering.

A letter came in the mail from Covered California — it was dated November 15th but arrived at the very end of the month.  It said that my policy had been canceled because I hadn't made enough money in 2014.  Note that on November 15th, the year 2014 still had 46 days left in it.  It was the same thing that had made signing up in the first place such a pain in the ass: Obamacare just can't handle the fact that some people make money in unpredictable chunks rather than at steady intervals.  Eventually I was able to get hold of one of those "navigators" and show him a pay stub for a sale I had made that put me over the line I needed to cross, and he got into the system and restored my eligibility.  But my policy was still canceled.  Furthermore, I had to get a new policy by December 15th or I would be locked out of the exchange for 2015, meaning that I would have to find a policy on my own with no subsidy, raising my costs tenfold.  I called my insurance company, and the best policy they could offer me would have seen my responsibility for charges increase 117% while my premiums went up 156%.  A different company offered the same coverage for a mere 75% bump (to $79.80 a month), so I decided to take that.  Now the problem was actually finding a way to communicate that decision to Covered California.  On December 8th I got through on the phone, and asked for my account to be restored.  By December 12th that still hadn't happened, and when I got through to Covered California again, I could hear the representative suppressing a laugh of disbelief as she explained that four days was nowhere near enough time to unblock an account.  I said that I needed to get in by the 15th, and she said that, no, if I wanted a policy by then, I would have to sign up right there on the phone with her that very moment.  It was very lucky that I had already done my research and knew which policy I wanted — I guess I could have asked her to pull up and recite all of my options, but even if she had agreed, making that decision on the spur of the moment would have been kind of nuts.  (For the record: as of this writing I still haven't heard back from Covered California about my password reset.)

So why is my new policy around two-thirds the cost of the one I didn't take?  The difference, the Covered California rep warned, is that my new policy is an EPO: I can only go to doctors on a particular list, or I have to pay everything myself.  The other policy, like the one I had in 2014, was a PPO.  It also had a list, but I could still see an "out-of-network" doctor and have half my "in-network" coverage.  In theory.  In practice, I found that there was no difference, because out-of-network doctors just wouldn't book appointments with me.  "Sorry, we don't take that insurance. >click<"  I actually got the same response from many of the doctors who were on the list I got from my old insurance company's web site — I wound up having to call up and ask an insurance rep to find me a doctor who she could confirm was still in-network.  She gave me a name, and I made an appointment.  This doctor was located in San Francisco, meaning I had to take a train just to get to his office, and then he turned out to be superannuated and weirdly racist, insisting that the key to good health was for me to "settle down with a girl from my own cultural background" (?!?).  So that was kind of shitty.  But it would have been shittier if I'd had to pay more than five dollars plus train fare.  Which I guess means it's still progress?

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