There are plenty reasons to complain about Obamacare.
The website, of course, doesn’t work very well, at least not for everyone. But healthcare.gov’s flaws are just the tip of the iceberg.
Some insurers are tightening up their provider networks to cut costs. The prices of many health plans may increase next year. Beneficiaries potentially face canceled coverage if their policies don’t comply with the law.
These issues only tell part of the story, though. There are people out there — many of them here in South Carolina — who are happy with this federal law.
Here are a few of their stories.
Sally King-Gilreath pays $2,700 a month for health insurance through Medical Mutual for her family of four.
The 58-year-old Mount Pleasant lawyer is self-employed and can’t get a policy through her husband’s job.
“Due to pre-existing conditions, we have not been able to change policies for over 15 years,” King-Gilreath said. “With every year’s premium increase, I would try to find other coverage, only to be told that we were essentially uninsurable and to hold on to our current plan.”
But the Affordable Care Act changed the rules regarding pre-existing conditions. Health insurers no long can deny coverage to anyone with any old or ongoing health problems, including cancer, diabetes, asthma or obesity.
King-Gilreath has osteoporosis, high cholesterol, and a family history of heart disease. Both of her children have been diagnosed with attention deficit hyperactivity disorder.
“You could not find a policy anywhere that would cover ADHD in the individual market prior to 2014,” she said.
King-Gilreath picked a new plan through Coventry One and her monthly premium will drop to $1,700 a month in January. She used an insurance agent to sign up for the policy, instead of HealthCare.gov, because her higher-income level disqualifies her from the tax credits that will reduce monthly premiums for many people. Anyone who qualifies for a subsidy must use the marketplace website to enroll.
“It took me 5 minutes to apply for coverage and 24 hours to receive confirmation of acceptance,” she said.
Her new plan covers the services provided by most of her preferred doctors and hospitals with a much lower deductible.
“To my old insurance company, I say, ‘Good riddance,’ and this Thanksgiving I am especially thankful for the ACA and my new and better health insurance policy,” King-Gilreath said.
‘It’s really a good thing’
Kristin Vandeventer works part-time as a security guard at the South Carolina Aquarium and part-time as a ticket agent at the North Charleston Coliseum. Neither of her employers offers health benefits, so the 39-year-old West Ashley resident pays $202 a month for a policy sold by Midwest National Life Insurance.
The price isn’t very high, but the benefits her plan covers are slim.
“I haven’t gone to a primary care doctor in forever because I don’t think it would cover much,” Vandeventer said. “I went to the doctor one time I hurt my knee. I had to pay a hundred bucks for her to basically say, ‘Oh, just stay off it.’”
She successfully enrolled in a Consumer’s Choice Health Plan through HealthCare.gov on Nov. 20, which will cost her only $23 a month starting Jan. 1.
Vandeventer qualifies for a federal subsidy to help pay for a policy because of her income.
Her primary-care doctors visits and birth control prescription will be covered 100 percent.
“I’m going to start with a mammogram next year, which is going to be covered,” Vandeventer said. “My grandmother had a double mastectomy — (breast cancer) is something to be concerned about.”
The most Vandeventer can pay out-of-pocket per year in health costs is $500 under her new plan.
“I’m not that young, but I’m fairly healthy and I know that having insurance is just that — it’s having insurance. If something happens, you know it’s taken care of,” she said. “It’s really a good thing.”
‘My expenses will be more than cut in half’
When Ned Longshore was 8 years old, a doctor incorrectly inserted a plastic tube down his nose, ripping a hole just above his stomach. Acid reflux from the mistake destroyed the bottom third of his esophagus.
“I spent three years in and out of hospitals as a child and finally, after multiple surgeries, I had the damaged portion of my esophagus replaced by a piece of my colon,” said Longshore, 40, an attorney in Columbia. “I am pretty healthy now and don’t go to the doctor really any more often that anyone else.”
But that doesn’t matter to health insurers. Longshore’s medical history means his insurance bills have been hefty his whole life — especially when he started his own law firm in 2005.
“Finally, I found private insurance through the MEGA Life and Health Insurance Company, but only with a steep annual deductible and high premiums. I now pay more for my health insurance each month than I do for my home mortgage,” he said.
He pays $1,200 a month for that policy, but that will change in January. A Coventry One plan available on the new federal health insurance marketplace will cost him $297.82 a month with a lower annual deductible than his current policy.
“My expenses will be more than cut in half in 2014 which will be a lifesaver for my business,” he said.
Reach Lauren Sausser at 937-5598.
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