A Winner With Obamacare Even With Pre-Existing Condition
by Barbara Nevins Taylor
Marilyn Parver is cheerleading for Obamacare. She discovered that even though she has a pre-existing condition, she’ll have better and cheaper insurance than she has now. “All I ever hear is the bad side,” she told us and then shared what she thinks is important for everyone to know.
Marilyn’s experience was the opposite of bad. The health insurance plan she found saves her almost $300 a month and she feels like a winner.
“I am 61 years old and easily as physically fit as any 50-year-old. My health is good but a pre-existing condition affected my ability to buy insurance,” she explains.
Twelve years ago, Marilyn discovered that she has a slow-growing brain tumor. There aren’t any symptoms but it requires regular checkups. While she lives in Kingman, Arizona. the doctor who monitors her annually, with an MRI, is at Johns Hopkins Medical Center in Baltimore, Maryland.
Her current insurance is expensive. She pays $1,000 a month for what she describes as “very limited benefits.”
Under this insurance, many of her visits to health care professionals require pre-approval and the answer is often, “No.”
She recalls that before she made a recent trip to Kenya, the insurer refused to pay for anti-malaria medication.
“They told me if I get malaria they would cover my treatment. I ended up buying the pills I needed in Kenya for $20 a month compared to over $300 in the U.S. without insurance.”
So she was more than ready for an alternative that provided more coverage and cost less and began her search on Healthcare.gov.
She found plans tailored for her state, but the online system couldn’t help her because she required coverage for an out-of-state doctor. She followed the prompts and called the phone hotline.
A customer service representative recommended that she deal with insurers in her state directly and offered to send her a list of insurers.
She was emailed 59 pages listing insurers and descriptions of plans offered in Arizona.
“My new choices were staggering both because of lower cost options but also because of better benefits. I picked the most appealing options and then called the insurance companies directly. They all have dedicated departments to deal with the new policies and they answered my questions quickly,” she says enthusiastically.
Marilyn narrowed her choice to two plans offered by Humana. The less expensive plan is $440 a month. But it has a 20 percent co-pay.
And that’s a concern because she worries about the possibility that she may need surgery to remove the brain tumor. “Surgery is expensive and even 2o percent of the bill would be painful,” she explains.
Her second choice was a Preferred Silver Plan that paid for everything after a $3500 deductible. Her monthly premium is $721. That’s less than the $1,000 she pays now. “My deductible is $5000 right now and I never reach it so I never get a break,” she says.
She’s thrilled with the range of benefits that the new plan offers. “Once I made up my mind it was super easy. I was signed up in 20 minutes.”
She’s also relieved because she’s paying less and getting more. She says, “With any kind of pre-existing conditions, you have had to pay a fortune for medical coverage. Now we have choices that are affordable.”
It’s worth it to note here that Marilyn used Healthcare.gov because Arizona doesn’t have a state health insurance Marketplace.
Republican Governor Jan Brewer did accept the expansion of Medicaid in Arizona so that the state will receive federal funds to provide Medicaid for those who qualify under Obamacare.
Remember you have until December 23rd at midnight to sign up for health insurance that will begin January 1, 2014. But the entire open enrollment period runs until March 31, 2014 for insurance that will begin after you sign up and pay your first month’s premium.
As the winner of 22 Emmy Awards and a slew of journalism honors and awards, I created ConsumerMojo.com to give you the straight story about complicated stuff. Tell us what you want to know and we'll get you the answers.
View all posts by Barbara Nevins Taylor