One Week of Open Enrollment Remaining

These times, they are a’ changin’. I’m sure you’ve probably seen the buzz around wordpress regarding enrollment in health plans through the affordable healthcare act (though probably more widely known as “Obamacare”). Since only a week remains in the open enrollment period (the time in which you can sign up without being docked the tax penalty for being uninsured) you might find yourself scrambling to figure out what exactly you need to do next.

Be prepared for change.

I know many people (like myself) who have needed help with the cost of mental healthcare while uninsured and have gone to places like charities, local hospitals with financial aid programs, sliding scale clinics, and patient assistance programs through medication manufacturers. I knew that the affordable care act would impact these services, but (as I found out quite abruptly this month) most of them are dissolving in lieu of being replaced by low-cost state medicaid plans.

That means signing up for insurance by March 31st!

What this also means is that the insurance you qualify for or can afford might not include the doctors you have previously been seeing. Personally, I am having to start over again from scratch… which isn’t a good feeling, mind you, but the alternative is to not have any insurance at all and go further into debt.

I put up a big fuss about it the last couple weeks because it is hard to leave a team of healthcare professionals you trust. I know, I am in the same boat. Unfortunately, as I mentioned, everything is changing. I’ve talked to several doctors who intend to begin adding more plans they will accept in the future, so there is still hope of things evening out a bit more, but in the meantime we are living on the healthcare frontier. Rope and hogtie whatever doctors you can get your hands on at this point!

Consider all your options.

Can you afford to get coverage through a private insurer? Can you get insurance through your job if you qualify? Can you get insurance through your family? Can you get insurance through a partner? I’d be lying if I said I didn’t momentarily consider the notion of getting married for the sake of Corey’s benefits… but realistically I don’t think the situation is quite that dire.

All I’m saying here is that there might be a way to lump coverages together, and you might find that is a better option for you than spending money on a plan that may not cover the things you need covered.

Talk to your doctors.

If you’re planning on signing up before March 31st I strongly suggest you give your primary doctor, your specialists (including your psychiatrist), and anyone else (like a therapist) a call and ask what insurance plans they will be accepting. In some situations, it might be easier to ask which plans they aren’t accepting, as that list might be shorter.

You may even want to tell your doctor your current situation, as I’ve had doctors who had professional friends in other hospitals and clinics around town they could suggest to me (at places that would take my new insurance).

If keeping your current team is important to you, find out what insurance providers they work with and see if you can afford (or if you qualify) for one of those plans.

See what you qualify for.

This is the government website that will link you to each state’s official marketplace website. Going to your state’s website and creating an account will allow you to use your personal information and financial information to see what insurance providers you qualify for.

There are some issues with the system you might want to be aware of before moving forward (at least, issues I had with the Washington State Healthcare site).

First, the site doesn’t allow you to see all of the options, only the options you qualify for. I like to give myself a little wiggle room, a window of what I would feel comfortable paying, if you will. This website did not allow for that kind of search, and (to make matters worse), once I submitted my information I was automatically sent to a page that said, “great! you signed up! We’re sending you a coverage card in the mail!”

The website didn’t ask me if I wanted to sign up. I simply was signed up when my search only returned one possible match to the parameters I entered.

Honestly, I was a little pissed off. I mean, at least give me the illusion that I am entering into this by choice!

Anyway, I don’t know what happens if you qualify for several plans, but I imagine in that situation they give you a choice. That would make sense (fingers crossed) anyway.

Pick a plan.

Another problem I had with this system is that it can be difficult to find any in-depth information on what any given plan covers. Why would I pick a plan when I don’t know if it covers what I need? Obviously I want to choose the plan that is best for me and my own situation.

I think at the very least, these plans will show you the monthly cost, as well as the deductible for the plan. It is important to note that a deductible is the amount you have to pay BEFORE the insurance begins paying for your healthcare. For people like me (who have a lot of expensive doctor’s visits) you want the smallest deductible possible.

Sometimes doctor’s visits and medications don’t count toward the deductible (depending on the plan) but keep in mind that if you need lab work for lithium labs or any other blood screening this often falls in the category of pay the deductible amount before insurance will chip in.

On top of this, if you’re able to, I would do a little research to see the situation as far as their coverage specifically for mental healthcare. How many therapy visits are covered in a year? What percentage of inpatient hospitalization is covered? Does this plan require referrals (your primary doctor authorizing your need for mental healthcare)?

This research step is one area I really hope will be improved upon in the coming years for this system, as I am a big believer in not paying for a service that hasn’t disclosed to me how it works or what my coverage is. Unfortunately, I’ve had a very difficult time receiving answers about coverage, and if possible, try calling the insurance companies themselves. That’s who I’ve had the best luck getting through to.

Once you choose the plan best suited (hopefully) for you, you’re done! Of course, you can’t really begin setting up your new health care team until you get the paperwork in the mail with your insurance card and ID number. Remember, each plan is different, and some will require you call them before being authorized for mental health care, while others will require your primary care doctor to do it for you.

If in doubt, be prepared for higher cost services and fewer financial aid resources.

Ok, so let’s say you’ve read all this and feel appalled. Horrified. Maybe you’re stubborn (like me), or maybe you don’t like being forced into things (um, also like me!). What happens if you don’t sign up?

Well, for starters there is a fee taken out of your tax return, that’s 1% of your income for individuals who make over $10,150 per year, or $95 per person, per year (whichever is higher). You are exempt from paying this fee if you do not earn enough to file taxes (there are a few other exemptions you can check out here).

Realistically, as I have pretty much zero income I wouldn’t have to pay the fee, however the other consequence of being uninsured is that you are responsible for paying 100% of your healthcare costs. As I mentioned earlier, the programs that were in place to help people who couldn’t afford care are rapidly disintegrating, and for those that need regular care (like mental health care, for example) these bills can quickly add up and lead to all kind of exciting debt, possibly even bankruptcy. 

Have you ever had collections agents calling you five times a day to try to collect on medical bills? They are there all day, every day, reminding you of what you owe until you go completely mad. Trust me. It isn’t a life I want to relive, that that’s why, despite all the funky, backwards scrambling that is going on right now in regard to healthcare, I would rather be covered than not.

For more in-depth information on the consequences of not signing up for healthcare, you can visit the Government’s page about it. 

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2 responses to “One Week of Open Enrollment Remaining

  1. Wow, I totally and completely admire you for this post.

    You are incredible to lay it all out for your readers in such an organized and clear way. Health care insurance gobbledegook is SUCH a daunting topic, especially to those of us who live with mental illness.

    Thank you for taking the time to explain these points…Dyane 🙂

  2. Great summary of the changes, just in time to help people understand this. So sorry you are having to change treatment providers…..

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