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Health care plans a mixed bag for North Ga. residents

‘Obamacare’ helpful to those who get subsidies, costly for other residents

POSTED: December 28, 2013 11:49 p.m.

For Miranda Ingram and her husband, Marshall Criswell, the Affordable Care Act has done exactly what it was meant to do.

“We’re saving a ton of money,” she said. “Between the two of us, we were paying almost $400 a month between our two individual plans. With our tax credit, we’ll be paying around $100 a month.”

The Dawsonville residents are two of the approximately 500,000 Americans to register for health insurance coverage beginning Jan. 1. The deadline for enrollment has shifted through the month of December; the original deadline was Dec. 15, then was extended to Dec. 23.

Americans then were given an extra 24 hours, and now are still allowed to begin health care coverage Wednesday if they can prove they missed the deadline due to glitches through the trouble-plagued website.

The website went live Oct. 1 while the government shutdown was making headlines. Once the shutdown ended, attention turned toward the website’s inability to handle heavy traffic.

Though a flush of enrollees continue to overwhelm the famously glitchy website, the numbers signing up still fall short of President Barack Obama’s projections. Though new enrollment numbers have not been released, only a half million people had signed up in mid-December, far from the anticipated 3 million by Dec. 31.

Open enrollment continues until March 31. The goal is to register 7 million people for health insurance by then.

Ingram waited to try signing up until mid-December.

“I’d heard there were some issues so I waited,” she said. “When I finally did sign up, it was a breeze. No problem whatsoever.”

Insurance agent Clint Johnson with the Gainesville-based CMA Agency said Dec. 9 was the first day he could really help clients sign up for insurance through the website.

“That was the first day we were able to use the website that it worked somewhat proficiently,” he said. “Since then we’ve got about 24, 25 (people) enrolled.”

More than just 25 people have gone to see Johnson about signing up, but it’s not just website issues that keep them from moving forward with insurance through the ACA. Some have a big problem with giving their personal information to the website, notably Social Security numbers.

Another deterrent is the system uses a person’s credit report from Experian to verify their identity. Johnson said credit reports often include incorrect information, and in some cases have made it difficult for people to verify their information and sign up for insurance.

“When they get stuck in that loop, we write them off of this,” he said, gesturing to the website on his computer screen. Instead, he tries to find a plan directly through an insurance company.

A problem for many people is the inability to keep their doctor.

William Hannah from White County initially found a plan he liked through the website. It was with Blue Cross Blue Shield, and he received a tax credit to keep his out-of-pocket costs low. However, he was soon informed that Northeast Georgia Medical Center would not accept the plan.

“Now I’m enrolled in an Alliant plan, which has a lower deductible but higher co-pays,” he said. “It was the only company available to me in White County and the only health exchange insurer for which Northeast Georgia is a provider.”

Blue Cross Blue Shield has designated its Affordable Care Act plans as “Pathway X” plans, which offer access to fewer doctors than their other plans.

Another big problem of the law is it doesn’t always live up to the first part of its name: affordable.

“If they don’t qualify for a good portion of the subsidy, they’re paying more,” CMA Agency owner Ron Johnson said. “So for young people we’re trying to get on the product, they’re not qualifying for the subsidy (and) they’re seeing their rates go up.”

Johnson explained that he could sell high-deductible plans a year or so ago but those plans are being canceled because they don’t meet the minimum coverage requirements. A person paying around $80 for one of those high-deductible plans is now finding the cost is around $200.

“You take a young male, single,” Johnson said. “That young male doesn’t need maternity benefits, but now he’s paying for it ... and I can’t get him to buy insurance anymore. He doesn’t see the need of it.”

There are five separate options: bronze, silver, gold, platinum or catastrophic. The catastrophic option was only recently added; it’s the cheapest plan available and only covers life-threatening emergencies. The catastrophic and bronze plans are least expensive, but don’t provide as much coverage.

The penalty of $95, or 1 percent of a person’s annual income, for failing to sign up for a policy is often not enough incentive for someone to sign up for required insurance.

April Stevens, who gets health insurance through her employer, said the cost is outrageous compared to what she pays.

“My current out-of-pocket max is $2,900,” she said. “If I chose the cheapest plan with Obamacare, it would be $6,350.”

Her deductible would be $3,450 higher, and the premium is $121 more than what she pays per month.

“On top of the higher expenses, the coverage is just ridiculous,” Stevens said. “If I wanted coverage comparable to what I have with my employer, I’d be paying almost five times what I pay now.”

“There’s the good, the bad and the ugly,” Clint Johnson said. “The good is there are subsidized premiums for people who need help.”

He shared a story about a family of five that didn’t have coverage, the father with diabetes. What would have cost hundreds a month will now cost him and his wife around $20. The sticking point is the children remain uncovered as the system automatically sends their information to the state to see if they are PeachCare eligible.

For Ingram, saving around $300 a month for better coverage significantly eases her family’s financial burden.

Her husband was laid off a couple of years ago; he’s now self-employed, and she only works part time.

“It was a huge relief,” she said. “I was really concerned it might not be as good as advertised. When I got done and it said ‘You get a credit and here’s how much you pay’ ... that’s a significant amount of money (to save).”

The Associated Press contributed to this story.


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