Paul Workman: Navigating coverage in the land of Obamacare
Lisa Valera and her husband Manuel sign up for Obamacare at the Community Service Society, Monday, March 31, 2014 in New York. (AP Photo/Mark Lennihan)
Published Tuesday, April 1, 2014 11:29AM EDT
It is with great pride, and perhaps a certain measure of arrogance, that we count universal healthcare as one of the finest benefits of being Canadian. I grew up with OHIP. It was a given in our lives; you go to the doctor, you go to the hospital, you get your gall bladder taken out or your tonsils, and never see a medical bill.
Doesn’t every modern country in the world look after its people in the same way?
When I moved to Washington a few years ago, I was faced with a dilemma: I had to find a health-care plan. It was never a big deal when I lived in Europe or India, because I was able to buy coverage that was comprehensive, affordable, and left me feeling secure -- that even if I stepped in front of a French bus, nobody would come chasing after me with a massive medical bill.
I did not feel the same about taking up residence in America; I’d heard too many nightmare stories of people who had lost their homes to pay for a child’s cancer treatment, or couldn’t get coverage because of a pre-existing condition -- even if they could afford it. (By way of confession, I worried about two things moving here: 1) that I would get shot during a robbery at a convenience store; 2) I would get hit by an American bus, and under the fine print of my carefully chosen and very expensive health care plan, I would somehow be denied coverage. Just slightly paranoid.)
After a week of research on the Internet I found a plan that was actually administered in Canada, which gave me a little more confidence: medical, dental, vision for about $13,000 a year.
And this you may find as strange as I did, the plan would not pay for an annual checkup. Wouldn’t you think insurance companies would be interested in “preventive medicine?” Wouldn’t that actually save money in the long run?
For that and other reasons, I switched companies, only to find out a few months later that my new plan didn’t meet the requirements that would soon go into law under Obamacare.
Suddenly, like millions of other American consumers, I was given a choice: I could either keep my old plan for a year or switch to a new one. I decided to switch.
And so here I am, as of April 1, 2014, among the six million Americans who have endured faulty websites and infuriating signup delays, a confusing array of 31 different health care plans that left my head spinning -- do I go for the bronze or the platinum -- still not sure that what I bought through the healthcare marketplace is nearly as good as what Canadians take for granted. (I think I know the answer.)
For those who are curious, I chose “KP DC Gold 0/20 Dental” which has zero deductible and an out-of-pocket limit for preferred providers of $12,700 (family).
Here’s the fine print: “The out of pocket limit is the most you could pay during a coverage period (usually one year) for your share of the cost of covered services. This limit helps you plan for health care expenses.” (My italics.)
In other words, save your money for that gall bladder operation? Thanks for that. You still have to pay 20 bucks to go to your doctor, 40 bucks to go to a specialist, 250 bucks for an MRI.
Not done yet: $500 per day for a hospital room; no charge AFTER DAY 4. My plan does not include acupuncture, routine foot care, cosmetic surgery or non-emergency care while travelling. And wait for it, the total monthly premium: $1,025.54.
Another confession: signing up wasn’t all that difficult; it just took time. The website at the DC health exchange was relatively easy to follow and didn’t crash whenever more than 10 people logged on.
Consider that, against “HealthCare.gov” which handled applications for 36 states and even on the last day of open enrolment was out of service for several hours -- just to heap a little more aggravation on millions of already frustrated consumers. I did have to wait hours on the phone to cancel my old plan and I received at least six letters from Obamacare asking for more documents, even though I’d already sent them by fax and a second copy by email.
No matter, I am signed up; just as LeBron James and Julia Louis-Dreyfus urged me do on Twitter. And did you know, or do you care that administration officials -- including President Obama -- gave at least 300 radio interviews over the last six weeks pushing the Obamacare message. And did you know, or do you care that a public service union in California made 99,935 robocalls in Spanish, 30,253 in Chinese and 20,569 in Vietnamese supporting Obamacare.
I’m still not sure about the fine print, or exactly what means co-pay, co-insurance, balanced billing or how much I will have to hand over the next time I need a prescription filled, but as a fully approved and paid-up “member” of Obamacare, I think I can at least keep my family doctor, which would be...nice.