AFFORDABLE HEALTH CARE? AFFORDABLE MY YOU KNOW WHAT!

Today is the last day of Open Enrollment in one of the Governments Affordable Health Care Programs. From what I can gather, this doesn’t mean that if you lose your current coverage sometime this year you cannot buy in, but you will not be able to get something that might have the premiums subsidized by the Government. Currently I have health insurance with the company that employs me but due to various factors I am suddenly looking into all kinds of options that may be available.

Let me take a step back a moment and start somewhere near the beginning.

I have been working since I was old enough to get ‘Working Papers’.  For almost 25 years I have been doing the same job. For different people but the same job non the less. I am a Salesperson. I work for what is known as ‘Salary plus Commission’. Of course the salary is too little to live off of otherwise why would we strive for that Commission?  My wife too has been working just as long as I have in varying jobs, but we have, almost always been a two income family. In the beginning we had health insurance but didn’t really take that much interest in it, or what it covered. After all we were young and most young people don’t need to worry about these things until you start having children and you start seeing some grey hairs on your head. As we get older, we don’t heal as quickly, like a machine parts begin to wear out, etc. etc.

We grew up listening to Ted Kennedy spew on and on about Health Care for Americans but honestly I didn’t listen much. I thought that he was just trying to get us to forget about Chappaquiddick (Google it). But now I am close to 60 years of age and find myself caught in the quagmire of the Health Care System.

For seven years now, my wife has worked as a Special Education Aid in a local High School. She is a Certified Teacher and has not worked as one for years but thanks to the School System that she is in, we were able to drop insurance through my company (and at the time it was considered a good policy) for the coverage offered, with no premiums, by the Board of Education in the District she was working in. This was a GREAT policy and the price was right, and then some. No longer in November did I have to pay attention to what my employer was offering because no matter what it was, my wife’s was better.

Not so quietly the Affordable Health Care Act was passed but still we did not have to pay attention because there were no changes in her District. But now that has changed. Last year, the District cut my wife’s hours to 25 hours a week. This was done so that they would not have to offer Health Coverage, but for the first year they did, although we had to pay a premium ($36/paycheck). We lost income but still had amazing coverage. I began to pay attention to the coverage offered by my employer as we both saw the writing on the wall. My company offered three different policies with different premiums ,copay’s and deductibles and I began to read up on them. Good thing because when my wife’s contract came in June, it came with a letter explaining that she would have to find Health Insurance elsewhere. We were expecting it but were floored just the same. I quickly called my home office and explained that we needed coverage beginning in September of last year. I discovered that the policies cost a lot more and the coverage was a bit less.

Let me jump back here a moment. In April of 2013 I was injured on the job and, through Workman’s Compensation, I needed to get two surgeries on my knee. To this day I still have pain, get re-injured on occasion and have been home since before Thanksgiving 2014 because of Workman’s Compensation and the nightmarish laws governing it. So my income is way, way down. And my days in this field may be winding down because of my knees. (Which is why I was looking at what the Affordable Health Care Act has to offer). Someday when this is all settled, and if there isn’t a gag order on the case and settlement, I will fill you all in on this little crap that our government has put together called Workman’s Compensation and/or Disability. I will say, we all pay in to the system but G-d help us if we need to use it.

Okay now here we are today, the company that I work for has dropped to one policy offered. Take it or leave it. Oh it meets the minimum A.H.C. Act guidelines so there is not much there to even raise a stink about. Remember I wrote minimum. The family premiums are high (oddly enough not as high as what A.H.C. quoted me) but now in order to have a copay (even for prescriptions) we must meet a $3000 deductible. After that the copay’s are based on varying percentages spelled out in this booklet that reads almost like an I.R.S. form. I will give you an example, a prescription that I was taking that cost $30/month in my wife’s Health care, now cost me $252 under mine, and that includes a discount card that I called the manufacturer for. My wife just couldn’t renew a medication because instead of costing $50/ month on last years policy it now cost $287 and the manufacturer offers no discount cards and there is no generic for it.

Back to A.H.C. Based on everything that I plugged into the website, we are not eligible for a reduced monthly premium,(Unless one of us loses their job), so the premiums are higher then what I have now, the deductibles are higher and so are the co-pays.  If one of us does lose our job sometime this year, the way I read it, we wouldn’t be eligible for reduced premiums because we joined after today, the last day for open enrollment. But we would be fined if we don’t pick something up. Either way, we (the People) are screwed.

A.H.C. makes it so that you can afford the premiums but not the deductibles so you may have insurance but cannot afford to use it. Most of my doctors don’t participate in any A.H.C. plans and neither do the hospitals. But hospitals do need to accept it in the Emergency Room.

One last item, but very important. Speaking with most of my accounts, as I have known them for almost a quarter century, none of them, let me repeat that, none of them are hiring any full time employees ever because of the Affordable Health Care Act. As people retire or move on they are being replaced by part timers.

Now everything here may not be exactly accurate but not on purpose, I am just sifting through the pages and pages of A.H.C coverage’s. Excuse me, I need to get a Tylenol this is giving me a headache.

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