(The most important part of this newsletter is that I’m going to ask you to send me your premiums, if you’re buying coverage on the ACA exchange this year. Skip to the end if you want to learn more about that.)
The 2020 holiday season will be unusual. People who would normally be attending mandatory holiday parties for work will be spared the smell of their boss’ cheap wine breath. Others will be missing their families, stuck alone in their homes. Tens of millions of people will be out working, as if nothing has changed, except that each moment on the clock puts them at risk of contracting a deadly virus. But one thing is the same: This is the time of the year where most people with private health insurance will choose their plans for the next year. Despite the raging pandemic, and all the evidence it provided that this is a terrible way to do healthcare, we are doing it again.
If you’re employed and your job offers health insurance, you’ll probably be choosing between the options your employer gives you. If you’re not so lucky, you might turn to the Affordable Care Act exchange to buy a plan, commonly known as getting Obamacare. This lets you purchase a health insurance plan that may be heavily subsidized by the government, depending on your income. Open enrollment, the period during which anyone can buy an ACA plan if they want to, begins in November and ends on December 15 (though some states have extended that window, so check your own state’s deadlines). So if you need to buy a plan for next year, do it soon! And if your income is on the low end, make sure to check if you’re eligible for Medicaid instead.
One of the major themes I’ll explore in this newsletter is that much of how we provide healthcare and coverage in this country is completely misaligned with how people actually live their lives. For example, when you buy ACA coverage, you’re asked to estimate your income for the year to calculate how much you should be eligible for in subsidies. No one really knows for sure if the job they had last year will be there next year, or if it’ll pay the same, but it gets even harder for people with fluctuating incomes—freelancers, hourly workers, and so on. If you get it wrong and earn more than you think, you might owe the government money at tax time. There are things like the family glitch, leaving many families with no option for affordable coverage. There’s the absurdity of providing just a six-week window at the end of the year to buy insurance; if you miss that deadline, and you don’t have a qualifying life event, you can’t buy coverage for a year.
And then, of course, there is the actual quality and overall cost of these plans. After all these hoops you’re asked to jump through, you might only be able to afford a plan with $14,000 deductibles and $500 co-pays. It’s insulting, and it’s no surprise that millions of people, even those who would be eligible for income-based subsidies, don’t bother looking into it. The product is just bad. So, let’s talk about how bad it is; that’s what we do here.
First, let me tell you about my experience buying ACA coverage this year, since I’m asking you to tell me about yours.
Baby’s First ACA Plan
This is the first year I’ve bought my own insurance on the ACA exchange, here in Washington, DC. It was fine, but it’s a very different experience for me, because Substack is subsidizing most of the cost of the premium—a significant reason I was able to do this newsletter at all. (I won’t qualify for any government subsidies based on my household income.) If it weren’t for this generous subsidy, I would be ready to do crime based on the cost alone. Instead, I can pick a plan that has lower deductibles, because I’m not on the hook for most of the premium. I get frequent migraines and take four medications for them—Aimovig, Nurtec, Migranal, and naratriptan—plus an SSRI, so having no drug deductible was a big bonus. (Nurtec, which is around $900 without insurance, and generic Migranal, about $3,000, aren’t listed on the CareFirst formulary, so I look forward to finding out whether I will be allowed those.) I had two choices of providers—Kaiser Permanente or CareFirst—and I went with the more expensive CareFirst plan in the hope that I could keep seeing my neurology nurse practitioner, who I would die for.
I spent a long time frowning at the tiny text in this chart, which outlines the various costs and co-pays of CareFirst’s DC plans, and scribbling down numbers on a notepad, and… I really have no clue whether I made the right choice. (Also, the chart was actually for last year’s benefits, which I didn’t realize until after I picked a plan.) It doesn’t matter too much: I’m hoping to move to the West Coast early next year, at which point I’ll have to do all this again in my new state, but ideally I would like to have any idea at all what I’m doing.
One of my many flaws is that when I have to make important decisions based on probabilities and numbers, my brain seizes up like a split sauce, and there’s no emulsifying it back together with more butter over a lower heat. This makes me worse at gaming, my favorite hobby; instead of calmly strategizing about where to go and who to blame to win as the Impostor in Among Us, for example, my instinct is to wing it, avoiding the difficulty and the high stakes of the dilemma. I get the same feeling each year when I look at my health insurance options. I know I can make certain calculations to determine which is the best choice, but equally, I know I’m going to do them wrong somehow, so my instinct is to give up.
But should this personality flaw doom me to paying too much for healthcare? I don’t know how much I’m going to have to go to the doctor or whether I’ll get cancer or appendicitis because I’m not a fucking wizard, so I wouldn’t know if I made the right choice until it’s time to make the same decisions next year regardless. All of this is supposedly done this way so we can have Choice, between providers and plans and doctors, but I don’t feel like I had much choice at all. I feel like I was told to choose between being shot or stabbed, and that I was an idiot for not knowing which was better.
One more thing before I get to the point: The confirmation paperwork I received from DC HealthLink told me that I had to confirm my citizenship status, with a list of documents I could provide. I am not a US citizen, but I am a permanent resident, which makes me eligible to get health insurance on the exchange; anyone with an “eligible immigration status” can buy insurance on the exchange, according to the DC HealthLink website. I called DC HealthLink to check that I could just send them a picture of my green card, even though the angry little red box says I must upload proof of citizenship, and the representative said: “Yes, your green card confirms you are a US citizen.” (I wish!) It’s totally normal for Americans to be confused about the difference between having a green card and being a citizen, but it’s less than ideal when the government itself is confused about that difference—and when they’re sending letters to people telling them they need to be a citizen to get healthcare when they don’t. I hope no one in DC has ever been discouraged from getting their health insurance because of this mistake, but I don’t feel confident that’s the case.
Send me your ACA premiums
Two years ago, when I worked at Splinter, I asked readers to send me details of what they were paying for healthcare on the ACA exchange. It was eye-opening, so I’m doing it again.
If you’re buying your insurance on the exchange this year, here’s what I’d like you to do:
Send me an email (by replying to this email or emailing firstname.lastname@example.org) with a screenshot of your ACA plan details—the premium, after any subsidies, and the deductible. None of these screenshots will be published and you should redact any information you don’t want me to see. This is just the easiest way for me to see all the details, and to prove you really did buy a plan on the exchange.
Tell me about yourself—your job, if you have one, and where you live, but also why you picked this plan and anything else you think I should know. I’d especially love to know if you’re buying ACA coverage if you lost your job because of the pandemic.
Tell me how you feel about it—like the process of buying the insurance, and whether or not you feel good about the plan you bought. Did it make you mad, or are you just relieved to have coverage? (Maybe both?) Worried about the deductible, or drug costs? Let me know.
That’s it! Get in touch if you have any questions.
I’ll publish what you send me next week. Good luck out there; remember, you’re doing the best you can.