With full implementation of the Affordable Care Act (ACA), January 2014 marks the beginning of a new era in health insurance in the US.
For the chronically uninsured and for those with pre-existing conditions, it's been a long and financially perilous wait for all of the ACA benefits to kick in.
For anti-government, conservative ideologues, the three-year waiting period gave them time to mercilessly attack reform that will provide insurance for millions of Americans, spread layers of misinformation about "Obamacare," hold dozens of meaningless repeal votes in the Republican-controlled House of Representatives, and hold the country hostage for 16 days in a multi-million-dollar government shutdown fiasco.
Today, December 23, 2013 is the cut-off date for enrollment in ACA insurance plans which begin January 1, 2014; the final deadline for ACA enrollment is March 31, 2014. Since the beginning of December, I have been shopping the healthcare marketplace on behalf of the ultra-small business that I work for–The American Journal of Medicine. On Friday, I submitted our final paperwork to our insurance broker.
This is the story of one small business' route to "affordable" care.
Our Journey
Our journey began long before the premier of Healthcare.gov, the much-maligned ACA enrollment website, and even before the ACA was signed into law in 2010. At the Journal, we had been unhappy with our health insurance plan through Aetna for years. Like clockwork, the cost went up 10-25% each year, forcing us to rethink coverage multiple times in order to live within our budget. We also were dissatisfied with the limited number of even more expensive alternative plans offered to us. The Journal's editorial pages have been pushing for Medicare for all for years and broke the stories about medical bankruptcy in 2009 and continued medical bankruptcy under Romneycare in Massachusetts in 2011. Consequently, we were ready for the public option back in 2009; today, we're just glad that the ACA made it through the Republican gauntlet and the Supreme Court. Unlike recent news stories about people and small businesses wanting to keep their existing healthcare plans, we were waiting with baited breath for three years to dump our plan.
The bottomline is that with Obamacare, the Journal — and the emplopyees– will pay less for healthcare insurance. Read about our ACA Marketplace experiences and lessons learned after the jump.
In early November, when the mainstream media was flooding the airways with stories about the "botched" rollout of the ACA website, I started poking around the plans and prices. Although the sheer amount of information on Healthcare.gov was daunting, the website worked fine–until I couldn't create a log-in and an account. Stalled at this juncture, I gave up for a few weeks until President Obama announced at the end of November that the ACA website had been fixed.
Shopping the SHOP
During the first week of December, I started shopping the Small Business Health Options Program (SHOP) in earnest. After entering the basic information– the state and county location of the business and the ages of our three employees– the site generated a massive spreadsheet (pictured above) of information, prices, options, brochure links, and telephone numbers for the 84 plans available for small businesses in Pima County, Arizona.
To sift through the options and prices and discuss them with employees and my boss, I downloaded the data to Microsoft Excel and printed them out. Even though I hid at least 30% of the 75 columns of data before I printed out the spreadsheet, it was four feet long when the legal-sized sheets were taped together. With colored highlighters and a long ruler in hand, I started to comparison shop. Initially, I looked at the basics– office visit cost, specialist cost, and deductible– and then I compared prices for the business, the employees, and the dependents we wanted to add. When a plan looked interesting and affordable, I went back to the computer and clicked on the plan details– co-pays, co-insurance, emergency room visits, urgent care visits, per person and per family deductibes, total-out-pocket cost, drug benefits, and special options like dental and vision add-ons.
After about three full days of intense studying Healthcare.gov, investaging insurance carrier websites, I narrowed it down to three to four HealthNet silver plans. I was about to contact our insurance broker, when she called me with the "good news". Our new Aetna contract was ready to sign for 2014, and of course, there was another price increase. I told her that we had no intention to renew our Aetna contract, that I had been shopping ACA plans, and that I wanted their help to finalize the details and get the employees signed up. Initially, she said that neither Aetna nor her firm were participating in the ACA marketplace. "We would actually have to sit down with each client and go through the website and the options with them." Healthcare.gov suggests that businesses work with insurance brokers or agents, but it is not required. After our conversation, I assumed I was on my own to figure out which plan on my short list was best for us.
What Will It Cost?
In the end, our insurance broker had a change of heart about helping clients with ACA enrollment, and in fact, they were instrumental in assisting in final decision-making and enrollment with HealthNet. In 2013, the Journal paid $1260 per month to cover three employees under our Aetna plan, and an additional $240 per month was paid by one employee to cover his two minor children. Other employees tried to add dependents to the Journal's plan in 2013, but it was cost prohibitive. In fact, to add one 60-year-old spouse the quoted price was $820 per month. (The Journal pays employee costs, but employees must pay the full cost for dependent coverage– a common practice.)
The Journal chose a $30/$50/$2000 Open Access silver plan offered by HealthNet because we wanted to keep the monthly cost down but still provide adequate health insurance. (Silver plans are designed to cover 70% of cost of care.) Bronze plans have the lowest monthly cost but the highest cost to plan members; as the the metals go up in value (bronze to platinum), the cost per month and the overall coverage increases. The HealthNet silver plan has a higher deductible than our old Aetna plan ($750 vs $2000) but other costs vary only slightly (ie, office visit $20 vs $30). Being a basically healthy group– after all we work for a medical journal!– we went for a lower monthly cost of the silver plan. Insurance is basically a bet. Are you betting you'll be healthy or sick in the future? Since we have no smokers, no diabetics, and no morbidly obese employees, we bet on health.
Contrary to news stories that report the dire financial consequences of Obamacare to small businesses, the Journal will save $200 per month under the ACA. There were cheaper silver plans through HealthNet, but those offered a limited number of doctor and hospital choices. For example, for $100 less per month, the Journal could have opted for the cheaper, less comprehensive HealthNet Community Care $30/$50/$2000 silver plan, but all employees would have had to give up their current doctors, would not be able to go to the University of Arizona Medical Center (AKA, UMC) for in-network hospital care, and would not have in-network access to University of Arizona (UA) College of Medicine doctors. For the additional monthly cost, our chosen plan allows employees to keep their doctors and have more choices including access to UMC and UA doctors. (As I said, although we bet on health, but we decided if anyone got really sick in our group, we wanted access to healthcare offered by one of the country's best hospitals— the University of Arizona Medical Center.)
As for dependent coverage, the employee with two little kids will get increased coverage– medical, dental, and vision coverage for the three of them– for the about the same monthly cost. Those of us who couldn't afford to add spouses under Aetna can afford the out-of pocket costs to add them to the 2014 HealthNet plan. Remember the $820 per month Aetna quote to add one spouse in 2013? That person costs $500 per month under the HealthNet silver plan– a $320/month savings. In fact, for approximately $1000 per month, two spouses and one college student were added to the Journal's plan.
Lessons Learned
1) The sheer amount of information and plans available to businesses in Pima County, Arizona was daunting. In the end, using an insurance broker helped sort out plan details, compare prices, and cut through some of the red tape with the final sign-up of employees. (According to the ACA website, the insurance companies pay the brokers– not the small businesses.)
2) The ACA website worked perfectly after the November fixes. In fact, the ACA website has tons of valuable, easy-to-read information about the Affordable Care Act and options. Compared to insurance company website, the ACA website was better organized and easier to understand.
3) It was easier to reach the ACA help desk on the phone than it was to reach a real person at any of the insurance companies I called. In fact, I never reached a real person at an insurance company, but on a Sunday, I chatted online with an ACA rep.
4) The Journal and the employees saved money by shopping the ACA Marketplace. Yes, we have a different type of insurance plan, but we believe that it will suit our needs. Small businesses that are concerned about costs can choose even cheaper plans than the one we chose and offer a valuable benefit to their employees.
In the end, the Journal had a plethora of plan choices and price ranges to choose from at HealthCare.gov and ended up saving money on its monthly cost. The employees saved money on medical coverage, added dental and vision coverage, kept our own doctors, added affordable coverage for previously uninsured or underinsured dependents, and have in-network access to one of the best hospitals in the country. What could be better? Medicare for all.
Yes, it was daunting even for me, and I have a Masters in Public Health and 30 years experience in medical research and health communications! I kept thinking about everyone else trying to figure this out on their own. Using a navigator or a broker is a good idea, in my opinion, because they can explain the nuanced differences between different plans.
Affordability is still an issue, I think. We will be paying $500+/month for Jim plus the dental/vision add-on for both of us. Although it is $300/month less that we were quoted without ACA, it’s not an insignificant cost. The question is: What will people forego purchasing because they are now buying insurance? Also, how many people will opt to be underinsured because they can’t afford the monthly cost for a more comprehensive package? That’s what happened in Massachusetts under Romneycare. More people were covered under insurance, but medical bankruptcies didn’t go down because so many people were underinsured.
My guess is that popular plans will rise to the top, and others will disappear. It’s ironic that one of the Republican complaints about ACA is that people will have less choice and will not be able to exercise free will in their insurance purchases. This couldn’t be further from the truth. 84 plans– just in Pima County– is too much choice.
We still need Medicare for all!
Thanks for walking us through the process, Pam. It sounds complex, but that’s because there are so many choices and it’s all brand new. I imagine during the next signup season, most people will stick with what they have or maybe keep the same provider and move up and down in coverage, so it won’t be so daunting. Also, everyone will be experienced consumers, and people will be able to compare with friends and coworkers to see what worked well and what didn’t.
It’s time consuming whenever you buy a new car, refrigerator or smart phone. No one should be surprised that this is a complex, time consuming process where, as you say, you have to decide how much you want to gamble with low initial cost versus the possibility of higher medical bills.