Footstep Three

Now Thursday morning, I realized that since my wife now had what was considered "affordable care" (insert eye roll here) we needed to change the information on our application and hope for some miracle that we still would qualify for some aid.  After a few moments I realized I could not do that on the site so I had to call the ACA people and get a little help.  So I sat down with a cup of coffee, a magazine and settled in for a long wait as I dialed the number....... answered in under one minute.....really awesome actually.  After explaining I need to change my application they told me I would need a return call by a specialist to do that. Great, we set best time to call, then I decided to ask them if they thought I could get coverage on the marketplace due to my insurance being so crappy.  After giving them all my income and other relevant information the answer was no, since my wife's plan offered her a single person plan that covered her alone that was under the 9.5% affordability threshold (more on this later) we could not get tax credits or help on paying for our insurance on the marketplace.  We could shop there but have to pay full price and we not eligible for the nearly $700 tax credit/subsidy that we were originally offered since her employer offered "affordable" insurance.  I thought this cannot be right so after hanging up I called again.... again less than one minute wait...amazing... and asked the same question.  This time the lady said she didn't know and after quoting several things listed in the website that really didn't answer my question went and asked a manager. She then came back and said yes that my wife could still use her company insurance for her personally and our son and I could shop the marketplace and get full benefit from the tax credits there.  I thought great!  After hanging up I wondered if I then could just start a brand new application and not have to wait for the specialist to call me.  So I called back to do that, after explaining to the person what I was trying to do, they also went to ask a supervisor how to set that up, if just my son and I could be on the application or if we all three had to be on it and just set up different "groups".   After talking to her supervisor she told me that since my wife's company offers her single coverage under 9.5% of her total income (never mind she has a family who no other options for insurance other than purchasing it outright)so under the ACA her plan is considered "affordable" and that my son and I cannot get any credit in the exchange, we are free to shop there but get no help.

After I stopped chewing on a bag of nails (I think the new plan's dental tosses severe tooth damage over to the medical side),  I thought OK conflicting answers here. Let me just say the people I talked to were kind, wanted to help and when they didn't know something they went and tried to find the answer.  I can't ask more than that for the individuals, its just sad they have not been properly trained in the nuts and bolts of the process.  I did receive an email address to ask my questions and someone in authority would respond and I would have my hands on accurate information.  Great, a bit more time but hey at least I will get an answer right?

Not being one to just sit by and wait I also fired off an email to the Kaiser Institute... uber smart guys who have been studying this from the start, a "blue" blogger, (I chose blue since I figured someone who is drinking the healthcare cool-aid would be more apt to help than someone who feels it is the spawn of the devil.)  We are  now finally up to date on my journey, I decided to blog my steps hoping that if I can figure out how this all works and apply it to me then another family in the same situation would be helped as well.  I will be continuing to chronicle my journey as well as studying the Act in detail and hopefully being able to explain it and provide more than just the standard quotes and explanations that are present on the web to date.  Oh and by the way to point of this submission I have received no response to any of my email requests........or a return call from the ACA specialist.......

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Footstep Two

The same day we applied for coverage from the site (Wednesday of this week) my wife came home with her new insurance package from her employer.   We casually looked it over to see if anything had changed.  Low and behold they were offering a very low priced bronze plan that seemed affordable even on our low income.  For a mere $93 every two weeks we could have coverage for our family of three, looking at this quickly we thought hmmm take home is about $875 every two weeks sooo would we be ok somewhere just south of $800 every paycheck?   You know we do poor well and this only a temporary situation until I am able to work, or my wife gets paid her worth (or maybe sell our kid to the gypsies.... I heard there is a website for that.)  After much thought discussion and quick google of  the gypsy site we decided we could do it,....... would be a stretch but we could do it.

Let me insert at this point we manage our money well, we have slow internet, no cable T.V. no iphones, one vehicle with no payments, we don't go out and eat ever, no movies, no net flicks in fact nothing extra at all. This is not a poor us moment in fact we do poor very well.  We buy fresh produce, cook at home as family make our own everything like bread, ketchup and etc. We have found it fun figuring out what we really truly need as a family then finding if we can make it, and if not, how can we get it on the cheap without ski masks being involved.

So now back to it, once we realized we could afford it we breathed a huge sigh of relief, grabbing some coffee we started reading the plan.  That relief turned to shock then the shock, I hate to admit anger...  This coverage, if you can call it that, was set up to pay 60% of medical costs, not great but ok, one annual wellness visit per year, that part is nice, some discounts on drugs, ( sadly not the type I was contemplating after reading the rest of the plan), and um....well... that's it. Oh yeah and there is a $6,000 deductible.  So here is what the plan means in real dollars to us.  We can each go to a doctor once a year for free, get some discounts if they give us pills... and that's it, UNTIL we pay the insurance company $6,000.  There is no copay for doctors, labs, specialist or any at all, nada, none.  OK so if we were all the picture of health this may be ok.  But we are in the situation because I crashed, they are still trying to to figure out why my stem cells seem to be compromised and that means lots of doctors, specialists, tests labs and even hospital visits, ergo why our savings is wiped out.

OK so if I am reading this right we have to pay $6,000 or about 22% of our GROSS income, and if we budget that over the year and pay $500 at the first of each month and pay our premiums every two weeks we would have to shell out a smidgen over $8,400 or over 30% of our annual GROSS household income before our "affordable" insurance will even pay ONE CENT TOWARD ANYTHING other than the one wellness visit per person and some drug discounts.  Nothing for doctors visits, labs, tests, specialists or anything else.  Sooooo unless we spend between 22% to 30% of our gross annual income we have really no help from our insurance company at all. No bueno.  I don't know about the rest of the working poor but shelling out 22% of our gross annual so we can just get help going to a see a doctor is a non starter. Again if all we needed was one visit a year for a quick oil change and look under the hood we would be fine.  That is not the case for us and I would imagine lots of other folks.  Thank God I have options on the new Health Care Marketplace Right?

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Footstep One

This week (Wednesday morning) I took our first step toward getting health coverage that could actually serve us. My wife's employer does offer health insurance but our income level we could not afford it.  We had been watching the Affordable Care Act hoping that affordable healthcare would be a reality for the working poor like us. After waiting until hearing that the website was functional and was not crashing upon open we jumped in and created an application and to our joy got a tacit acceptance pending disclosure of the standard items needed for this sort of thing, actually a very painless start.

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