Only a fraction of the expected number of people have enrolled in health insurance plans through the online marketplace created by the Affordable Care Act. Estimates are that about 40,000 people signed up during October in the 36 states – including North Carolina and South Carolina – where the federal government is running the website.
In the Charlotte area, insurance agents and specially trained navigators say the website has improved since enrollment started Oct. 1. More people have been able to get through to compare plans and find out about eligibility for premium subsidies. But there are still only spotty reports of people who have actually purchased insurance at Healthcare.gov.
Many people have experienced technical difficulties and encountered higher premiums stemming from the new healthcare law. Still, some people have been pleased with their online experience. Although not representative of the overall rollout, here are a few success stories:
Andre Simmons, Gastonia
One of the few Charlotte-area residents who bought insurance through the online insurance marketplace is Andre Simmons, of Gastonia.
With a federal premium subsidy, he will pay only $17.74 a month next year. Based on income, he and his wife also qualify for federal help with other medical costs.
Simmons was laid off in June 2012 after 30 years with a Suffolk, Va., chemical plant. He and his wife, Briding, both 59, moved to Gastonia to live with their adult daughter. Simmons collects unemployment pay, and both he and his wife are going to school to prepare for new careers.
Today he pays a premium of about $300 a month for health insurance for himself and his wife. That’s a reduced rate. Because his previous employer was adversely affected by foreign imports, Simmons gets federal assistance with expenses for education and insurance.
Knowing that will run out at the end of the year, Simmons went online when enrollment opened Oct. 1 for the Affordable Care Act. He could never get the website to work properly. But in mid-October, he stopped in at Carolina Health Insurance Market in Gastonia, and an agent got through that day to compare plans and view subsidies.
Because Simmons’ current income is between 100 to 150 percent of the federal poverty level, the couple was eligible for a $1,150 premium subsidy as well as assistance with deductibles and co-pays.
For a “silver” plan with Coventry Health Care of the Carolinas, they will pay $17.74 per month instead of the “sticker” price of $1,168 a month. Instead of a $3,750 deductible, theirs will be zero. Instead of a $10 co-pay for each primary care visit, they’ll pay zero. And instead of $75 to see a specialist, they’ll pay $20.
Last week, Simmons made his first premium payment for coverage that starts Jan. 1. If he finds a job in 2014 and his income goes up, the calculations will change. But for now, he said: “I think it’s a great deal.”
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Forest Featherston, Charlotte
Forest Featherston supported the idea of affordable health insurance for everyone, but she hadn’t thought much about signing up until she heard complaints about the malfunctioning federal website.
“I went on Healthcare.gov out of curiosity,” said Featherston, 35, who owns a communications and marketing business. “I thought, ‘It can’t possibly be this bad.’”
She got right through and compared insurance plans, which is farther than many people have been able to get.
“A couple of times when I was filling out information I got kind of booted off. … I signed back in. It was no problem.”
Featherston didn’t have time to study the plans then. So she signed back on a few days later. She liked being able to compare multiple plans in one place. In other years, when she had to renew her insurance, she called different companies for quotes. “It just takes hours and hours.”
Today, she pays about $400 a month for an individual health plan. Even though she doesn’t qualify for a premium subsidy, she found a cheaper “bronze” plan on the federal website. She will pay a premium of $250 a month for a Blue Cross and Blue Shield of North Carolina plan with a deductible of $5,000 per year. She is waiting to hear from the insurer before she pays the first premium.
“I realize that I got really lucky,” she said.
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Hart Hutchison, Charlotte
Several weeks ago, Hart Hutchison and his wife, Anne, both 63, got a letter from Blue Cross notifying them that their health insurance policy would be canceled at the end of the year because it doesn’t meet the benefit requirements under the Affordable Care Act.
A similar policy, according to the Blue Cross letter, would cost the Charlotte couple more than twice as much – more than $1,600 per month instead of the $720 they pay now. “When you first hear that, it floors you,” Hart Hutchison said. “That means no insurance.”
Last week, he attended an educational seminar sponsored by Novant Health and met an insurance agent. He came out of the session with good news. “I’m smiling because it’s going to cost me a whole lot less,” said Hutchison, who owns a remodeling business and is an associate minister at Harvest Church in Charlotte.
Based on their income, the couple qualified for a federal premium subsidy of $1,236. With that, they could buy a “silver” policy with a $3,000 deductible for $292 a month. Without the subsidy, the coverage would have cost them each $764 per month.
The Hutchisons haven’t yet bought their insurance plan. They’ll try again when the website is working better.
Both he and his wife take medicines for medical conditions. Before the Affordable Care Act, insurance companies could charge more or decline coverage for people with preexisting medical conditions. That practice is now prohibited.
Still, he’s concerned about the impact of the new law on the country’s future. “We’re operating in the red already,” he said.
“I don’t think the new act is perfect … but something needs to change. The cost of insurance is exorbitant, and therefore it excludes too many people.”
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Colleen Cutlip, Waxhaw
Colleen Cutlip and her husband haven’t had health insurance for at least six years because their employers don’t offer it. But last week she went to a Novant Health seminar to try to sign up for insurance because the new law mandates that everyone have insurance starting Jan. 1 or pay a fine.
Not surprisingly, the agent she worked with couldn’t access the online health insurance site because of ongoing technical problems. But using other sources, the agent informed Cutlip, 62, of Waxhaw, that she and her husband, John, 52, could qualify for a federal premium subsidy of $1,000 a month because their household income is under $62,000.
Cutlip, whose doctors are with Carolinas HealthCare System, recently received a letter explaining that she wouldn’t be able to continue seeing those doctors if she bought the least expensive “Blue Value” plan offered by Blue Cross. And when she checked other Blue Cross plans, she said they were “astronomical,” even with the subsidy. Some of the quotes were for more than $700 a month for plans with deductibles as high as $7,500.
Through Coventry Health Care of the Carolinas, the other insurer participating in the North Carolina exchange, she found a policy with a $2,500 deductible that would cost $252.60 per month after the subsidy. “That to me is reasonable,” she said.
But Cutlip left without making a decision. And she’s thinking she might just go without insurance for now and pay the fine.
“In three years, I’ll be eligible for Medicare,” said Cutlip, who works part-time for a grocery warehouse. “I might go ahead and get my husband insured. He’s my bread winner. I need to keep him healthy.”
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Bob Cubbler, Matthews
Bob Cubbler has been buying individual health insurance for his wife, Janet, since he became eligible for Medicare four years ago. The Matthews couple pays $788 a month for a good policy that covers doctor visits and prescriptions. But this fall, they got a notice from Blue Cross that the premium would increase to $816 a month.
They weren’t surprised. Janet Cubbler has a preexisting medical condition that is controlled with medicine. “Every year it goes up,” Bob Cubbler said. That was true even before passage of the new law.
This year, he went to the online health insurance marketplace to see if he could get a “a similar policy and save money.” He said he tried 50 times before finally getting far enough to compare plans. Their household income is too high to qualify for a subsidy, but even without that, Cubbler found comparable “gold” policies for $450 to $550 a month, more than $200 a month less than his wife is paying now.
“We aren’t sure yet which one we’re going to take, but it’s going to be one of them, I guarantee you that,” he said.
Because the website hasn’t been working properly, Cubbler called the federal toll-free hotline to complete the process. He filed a second application and is waiting to receive materials. Then he’ll call again and buy a plan “as soon as possible.”
Cubbler has heard the complaints from others in the individual insurance market who received cancellation notices because their plans did not meet the new law’s requirements to cover certain “essential benefits.” But he said he thinks most of those people “would save money” on better insurance if they shopped around.
“I am personally in favor of the idea that if you’re going to buy something, there should be some minimal standard for what it covers,” Cubbler said. “People don’t remember (that the law’s proper name is) the Patient Protection and Affordable Care Act.”
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