One Of The Millions

As a self-employed business person, I am responsible for purchasing health insurance for my family.  This makes me one of the 14 million people in the United States who purchase their policies individually.  The recent news has been awash with stories about how a majority of these people are having their policies cancelled, due to the “Affordable Care Act” or “Obamacare”.   In September, I discovered that I am one of these people, and today, I’ll detail some facts about my situation as part of this group.

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I have been using Anthem BCBS as my insurance provider since 2007 when I left my job as an employee and began to operate my own business.  Every year, my policy costs have gone up, but my policy was fairly “affordable” to me, even through 2013 at $1130 a month, including dental for a family of four.  Of course, nobody likes cost increases, but it hadn’t been enough to make me switch policies, as I am happy with our providers that are covered, as well as our other benefits.  After years of hearing that I could keep my plan and my providers, even with all the new changes in the healthcare laws from the “Affordable Care Act”, I was quite surprised to receive a letter from Anthem with this in it:

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Now, I thought this was certainly interesting, and I thought this might be an opportunity to find a new plan with lower costs, for I was told repeatedly that with the ACA, my premiums would go down by up to $2500 a year. So, early in the morning (3am) of October 1st, 2013, I attempted to log into the website to check out these new, available plans.  Then, I tried later in the morning, and the afternoon, and the evening, and we know how that all went.  I was never able to create an account and log in successfully, and after two weeks of trying, I still haven’t been back.

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I was finally able to get the available plans once they were viewable without an account.  I’m not interested in the lower level plans – I’d like something that is as close as possible to my current plan.  To give a quick overview of my current plan – at least the things I am concerned with:

  • $1000 individual / $2000 family deductible
  • $1000 individual / $2000 family out of pocket maximum
  • 0% co-insurance after deductible
  • unlimited lifetime benefit
  • $30 office visits
  • $15 / $30 / $60 prescriptions
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On the site, I get through to the details for my location, select the gold plans, as I think they will offer similar benefits (the lower levels all have huge deductibles and lower benefits) and I get this:

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I discover that only two insurance companies are writing policies in my area.  No information whatsoever about the specific benefits these plans offer.  At least I do know that the prices for the higher plans are similar to my current cost, although my current cost includes family dental and basic vision.  It takes me a while, but I am finally able to dig up some specific information on these plans at .  Surprise, again, because the government prices for these plans is about 10-15% lower than the actual providers’ cost to me, both on eHealthinsurance and on the Anthem and Coventry sites.  I figure I will trust the numbers on the external site.

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Unfortunately, soon after, I discover that Anthem is not covering any of the doctors we use on these new plans, or one of the largest hospital systems in the area.  Neither on the exchange plans nor the plans available at Anthem’s site (which seems to be the same list of plans).   So, at this point, I am stuck with Coventry’s option, since they appear to cover a larger number of providers at a slightly lower cost, although this cost does not include dental or vision which would then make this plan equal to, or more, than my current plan.  This may be because they are new to the area and are trying to get customers.  Still, immediately on eHealthinsurance, I can see that the deductible has almost doubled.  Digging further, compared to my current plan, above, it appears I will be paying the same amount, yet receiving much less benefit in most cases:

  • $1750 individual / $3500 family deductible
  • $10000 family out of pocket maximum
  • 20% co-insurance after deductible
  • unlimited lifetime benefit (forced by ACA)
  • $10 office visits
  • $5 / $30 / 20% prescriptions (after meeting $250 drug deductible)
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At this point, we are all fairly healthy, using mainly office visits and prescription drug benefits.  At the least, now I will be out of pocket an extra $1500 before my co-pay kicks in.  However, should the kind of situation come up that you actually, really need insurance for, we will be on the hook for $8000 more a year then our current plan due to the 20% co-pay.  Is this situation horrendous?  Well, it could be worse, and it could be better.  Obviously, I’m not a poster child for my premium costs going up %400, but there is a discernible difference in plan benefits here, there is a very real chance I could be losing out on major money, and I am being forced to change.

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Hopefully, in the next year, my stock photo portfolio at Stocksy United will start selling more so these additional costs aren’t an issue.

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That’s my experience so far.  So, yes, people are out there having their policies canceled, and sometimes to much more detriment than I.  Read this article for one such guy:

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4 thoughts on One Of The Millions

  1. Good post Sean, most people spend to much on health ins. Trust me it’s money you will never get back. After spending 17 years in healthcare I can say you might be better off with the silver plan. If your family is healthy there is no need to reach for the gold plan. Keep in mind your yearly out of pocket expenses are caped. So you won’t go broke with the silver plan either. You can also use “Christian Care Meta Share” or “Samaritan Ministries” which is have done successfully for 3.5 years of self employment. There are legal and better ways to get medication for less as well. Thank-you for posting your findings, just keep in mind most people are over insured.

    • Yes, I go back and forth with spend less up front and more later, or more up front and less later. Always have. $12000 is a pretty hefty chunk to get to the benefits, though.

  2. You are trying to blame the ACa for Anthem for leaving the market. Anthem made that choice not the ACA, blame them. I know Anthem in most makets were raising their rate at least 20% per year. And your logic of it going up 400% is using faulty logic.

    • I’m not sure you read what I wrote. Anthem hasn’t left the market, and my rates didn’t go up 400% (that was referring to other news stories I have read and seen on tv for certain people).

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