I have rheumatoid disease – have had it since I was 14 years old and I am now 59. I also am a cancer survivor and the child of a colon cancer victim. My biggest concerns are the ever increasing and ridiculously high costs of medications. I am luck that I currently have great insurance and much of my cost of medications is covered. But the huge cost of my medications is passed back to me and my coworkers in the ever increasing premiums. This cannot be sustained.
Story #1 – Family unable to find affordable healthcare
I don’t have a story of illness and high prescription costs or anything like that, but I am an average healthy person with a healthy husband and one year old child that is unable to find affordable healthcare. What is actually most affordable for us is to go without insurance and pay out of pocket for any healthcare we need, including paying the tax penalty.
Even though we are healthy now, I am terrified of getting sick or anything happening that will land us in the hospital. Our family falls into the well documented Family Affordability Gap. Even though the lowest cost plan available to us exceeds the definition of affordability, there are no tax credits available for us. Luckily, we were able to get my son covered with Washington’s Apple Health in case of catastrophe (which counts as income that we must pay taxes on) but the pediatrician we chose and have loved since his birth is not covered under their plan and we continue to pay out of pocket for his regular visits.
In October, my husband changed jobs and we were relieved that we were almost in the clear and open enrollment was around the corner. My husband and I carefully looked at the options in coverage through his employer and the open exchange. After reading over and rereading and contemplating all the options during open enrollment, we decided on a plan that was more expensive than the minimum available (by about $30 a month) but appeared to cover everything for nearly $500 a month. (for reference, “affordability” for us is a plan that is less than $387 per month, the lowest available to us was about $470) No copay, no charge for most routine services like check ups, labs, etc. Sounded ideal for what we needed. The chart we reviewed on the open exchange had “no charge” listed in the column to the right of almost all the services. This seemed ideal and after searching and searching through all the different plans, we decided on that Group Health plan. It made sense to us to pay a little more for a plan that covered whatever we might need in full than to pay for a plan that would never be of use to us because we rarely need medical attention.
Two months in, we started getting notices that Group Health had changed to Kaiser. I started looking around the website trying to find that chart we saw or anything that would explain our benefits because my husband and I both wanted to get routine checkups and some blood work (what I would consider preventative care). Even signed in with my account I was unable to find anything. I sent an email asking for the information that was never answered. Life is busy, I simply don’t have the time to dedicate to chasing this down and I let it go for a couple weeks.
Now, three months in, I revisited and looked to see if maybe the website was updated. I was still unable to find any information about my coverage so I emailed again. This time I got a response and was surprised to see that the chart I was sent had “after deductible, member pays nothing” written in every column. This was not what I signed up for and I panicked trying to read the fine print. With a deductible over 7k per person, 14k per family, I never would have chosen a plan that had us paying out of pocket up until that number when we never spend that much on healthcare in a year anyway. After searching the internet to find the chart I originally saw when we purchased the plan, I found it. Every column says “no charge”, just as I remembered.
Now, of course, I see fine print that says the chart is explaining charges AFTER the deductible is met. I’m not certain that fine print was there when we purchased but even if it was, the chart is totally misleading, borderline scam. I feel that we were forced to purchase something that will never benefit us and we cannot afford. I plan to cancel and be without insurance until the next open enrollment because I don’t know what else to do. I am attaching screen shots of the two charts. The black and white one was sent to me after purchasing and multiple requests, the blue colored one is what we saw before purchasing (possibly without the fine print).
I’ve been a single payer advocate for years and I want to do whatever I can to facilitate this initiative.
Thanks for your time,
M. C., Olympia