Obamacare, the Game: The Exchange Isn't the Problem, It's the Insurance Companies

Web access to insurance under the Affordable Care Act has been the redheaded step-child of Republican talking points as they drive to find a way out to put behind them the disaster of their Obamacare High Noon shootout with the Obama administration that shut down the government. What's the dirty secret that GOP inquisitors on Capitol Hill won't be telling you?

You can avoid healthcare.gov and go to a number of insurance shopping websites, insurance brokers, or the insurers themselves because they're all selling the bronze, gold and platinum plans as well, as the New York Times reported a few days ago.

Healthcare.gov is only a clearinghouse to direct you to private insurers' policies and websites. Online shopping webbers that have been working for years like Ehealthinsurance.com, Healthplans.com, and AffordableHealthInsurancePlans.org, among others can cross-shop the different carriers.

Each of the insurers has their own websites where you shop their plans for your state. Getting to the information was not a problem. Selecting the right plan for you, though, is still just as bad.

Simple single-payer this is not. The "free market," with of all its warts, is very much still with us. The exchanges have not fixed the insurance companies' shopping shell game, where the best plan for you is the pea and there are 18, 38, or 63 walnut shells of complex language and requirements hiding it.

For my search, the Bronze level in Florida had 19 plans that fit my family's needs. Gold had 23, and Platinum offered 21. That's a whopping 63 plans that I had to consider.

Healthcare.gov simplified it a bit, by explaining the general cost-to-benefits trade offs. The pricier the plan, the better the coverage. Well, sort of.

Some Gold plans offered more than Platinum plans at a lower cost. Platinum plans in Florida were vastly overpriced, with rates jumping 20 to 30 percent for benefits that were, by my reckoning, about 5 to 15 percent better.

Healtcare.gov and Ehealthinsurance.com both allowed side-by-side comparisons. Knock out those that offer too little, or are too expensive, and about 20 plans remained.

There are so many variables to each plan, though, that parsing out the last 20 can make your head spin:

  • This one has a great deductible and good general office visit costs! Oh, but their emergency coverage stinks.
  • This one has a so-so deductible but covers eye exams and has much better hospital coverage, but you pay 50 percent of office visits to specialists and it's $1,000 for an ambulance ride. Wow.
  • Okay, this next one has an astronomical out-of-pocket but pays for pretty much everything if you stay in network but won't cover you out-of-network. Period. Next.
  • There's a really great one! Low price. Great coverage. Oh, the insurance company doesn't have national coverage, and doesn't cover out of network, which is bad news for people like us who travel or go to college out of the state.

And so it went.

Florida's rigidly Red government passed on setting up an exchange, so we use healthcare.gov.
When I did run into two minor problems on the ACA site, I clicked on the "Live Chat" tab each time. I was connected to an agent in thirty seconds or less who helped me clear cookies, the minor sticking problem. I was able to sign up in 20 minutes.

Cigna was the easiest insurer website, and their phone customer service had about a three minute wait. Blue Cross of Florida, with literally dozens of post-ACA Florida plans, took the longest, just over five minutes to reach an operator, and a second phone call as the first operator wasn't well versed enough to explain the difference between five of their nuanced individual buyer plans.

Shopping for plans took a couple of hours, but that was due to the the dozens of complex plans. Most came from Blue Cross of Florida, which seems to take the three-card-monte approach to selling health insurance by producing tons of plans with such subtle nuances that they could hang them up next to the Matisse paintings in a museum as works of bureaucratic art.

Freelance writers are definitely individual buyers. We have been victims of the very costly and very arbitrary system for those without employer umbrellas to protect them.

For my family of seven people, four currently in college, in senior citizen-laden Florida, my pre-ACA Blue Cross of Florida policy that we have held for the last three years has made lots of changes to our insurance:

  • Our pre-ACA rates doubled since 2009
  • Big Blue, without spelling out that they could make these radical changes to the plan that I bought, shifted us from a 2,000 per person per year deductible, where they would pay claims after each person crossed that $2,000 line, to whopping $14,000 AGGREGATE annual deductible.
  • The out of pocket cost rose from a manageable $5,000 to a crushing $25,000 per year.
  • They collect a 25 percent surcharge for allergies, even though they never pay a nickel for them, as the $1,800 cost of my medicine a year comes nowhere near their $14,000 deductible.
  • Health insurers don't like keeping my four college students on a family plan. Single plans cost more, and make them more, so you pay for the privilege of keeping your kids on your plan.
  • Over the last few years we've been forced off of plans with good deductibles and benefits because Blue Cross of Florida has changed the terms of those policies, usually on pharmacy benefits, to make staying on them untenable.

The "insurance" card became a discount card. We received "discounts" from Blue Cross that knocked down what I owed providers, with that $14,000 always a number that thankfully we did not cross.

The good news for individuals like us is that, effective January 1, the ACA will end the insurers' ability to impose lifetime caps, "surcharges" for pre-existing conditions, and end the loopholes that companies have used to radically change terms of existing insurance to force customers on to more expensive plans with fewer benefits. Deductibles and out of pocket costs have dropped too.

The bad news?

The private insurers' Byzantine websites are awful. The plans are complex, and the rates are still too high.

A simple question: Do my doctors take this insurance?

Healthcare.gov hands off to the insurance companies with a button on each plan. It opens a new tab with a window where the insurance companies are supposed to provide lists of providers that participate.

Blue Cross and Aetna both worked fine, but Cigna had given the .gov site a dead link to providers that I also found off of another cross-shopper site, so it wasn't a Healthcare.gov screw-up. I spoke to Cigna's customer service rep who assured me that they were aware of it and were working to fix the problem on their end. I opened up a new tab and just Googled it myself.

Once I got to the Cigna doctor directory page, though, the plans which the physicians took hadn't been updated by Cigna for all most of their ACA policy offerings. I had to call the doctor, and then Cigna, again, when the doctor had no idea which "family" of policies the new Gold plans fit under.

After wallowing in the tar pits of health care plan comparisons, I narrowed it down to three plans, grabbed two Tylenol, and set them the whole mess aside for a day until my head stopped spinning.

Healthcare.gov has a nice "save" feature, that stored them for my review. The same was true with Ehealthinsurance, which had about the same quality of side-by-side comparison of plans.

Three days and a lot of reading later, I finally found a plan that cuts my deductible 100 percent, and lowers my out of pocket 40 percent. Rates in Florida remain high, but I still save about $1,000 for the year on premiums, and thousands of dollars more in out-of-pocket costs for prescriptions, MRIs, X-Rays and more.

So the ACA works. There are many ways to get to policy information, and to sign up.

Will Millennials, whose attention span can be measured in nanoseconds, spend the time to get themselves signed up when the insurers make it this hard?

Perhaps, rather than a website, the Obama administration needed to hire Microsoft to create an X-Box game: Healthcare Commando.

You and your badly wounded buddy have only hours to live. You can't get a hospital to treat you without insurance. You have to break into health insurance companies, blowing up machete-wielding Blue Cross bureaucrats, Aetna aliens, and Cigna Combat Forces, fending off kamikaze attacks by Ted Cruz and a mob of crazed Tea Party Republicans, to find the plan that will save your lives. It would become the most realistic game ever produced.

My shiny two.

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