HELENA — For retiree Bruce Smith of Bozeman, the brave new world of “Obamacare” so far hasn’t delivered the affordable health coverage it promised.
Smith, now paying $835 a month for a health insurance policy to cover him and his wife, was informed this fall by Blue Cross and Blue Shield of Montana that his policy is being canceled Dec. 31, because it didn’t comply with requirements of the Affordable Care Act, also known as Obamacare.
The new policy Blue Cross recommended for him? That will cost $937 a month, he said — a 12 percent increase — and have a higher deductible.
“I think I’m probably going to end up being stuck with this,” he said last week. “It was a rude surprise when I saw the new plan.”
Smith is one of at least 38,000 Montana people covered by individual polices who’ve received or will receive notices that their current individual policies don’t comply with ACA regulations, and that if they want to remain covered, must get new policies that do comply with minimum benefit standards.
State Auditor Monica Lindeen, who regulates insurance, gave companies until Monday to decide whether to extend the old policies — although Lindeen said extensions could cause problems in the marketplace.
Like Smith, people who’ve been told their current policies are canceled are finding they’ll pay more for a policy that has similar or perhaps even less coverage than they had.
But others say they’ve found better deals, and some have found a new policy at about the same price.
But just about everyone who spoke with the Gazette State Bureau said it’s been a stressful experience to hear their policy was canceled, and that they had to get a new one — after being promised by President Barack Obama that they could keep their current policy if they liked it.
“I got so mad that I went to my phone and started calling all the political people and giving them what for,” said Sue Spanke, of Missoula, who ended up finding a policy at a much lower cost. “And I’m a supporter of Obamacare as health care reform.”
Lindeen is advising consumers getting the notices to shop around and not just accept the policy their insurer is suggesting.
“(People) are not being dropped from insurance, but being assigned a different policy, but they do not have to keep (that one),” said Jennifer McKee, spokeswoman for Lindeen.
Some who’ve taken that advice have found better deals, such as Spanke.
Spanke, a self-employed artist in her 50s, is paying $350 a month for a Blue Cross policy with a $5,000 deductible. She got a letter from Blue Cross that said the policy was being canceled and a similar ACA-compliant policy would cost her $500 a month.
After she got mad, Spanke eventually called the state auditor’s office, which told her she qualified for a federal subsidy to help pay for a new policy, because her income is relatively low, and that she should talk to an insurance agent.
Spanke said she hadn’t tried the ACA’s new online marketplace, www.healthcare.gov, because she doesn’t like using the Internet and had read about the site’s ongoing problems. But her insurance agent did the work for her and determined she could get a policy, after subsides, for a mere $30 to $40 a month — and with a deductible of only $500.
“I went from a horrible policy that didn’t cover anything, that was breaking me, to the best policy at the best price I’ve had since I was in my 20s,” she said.
Not everyone has been as fortunate, however.
Smith, the Bozeman retiree, said his new policy recommended by Blue Cross has a deductible of $5,000 per person, while his current policy’s deductible is $3,000 — and the new policy will cost an additional $1,200 next year. The new policy would lower his co-insurance from 30 percent to 20 percent.
Smith said he has avoided shopping the online marketplace because of its problems, and that he and his wife probably aren’t eligible for federal subsidies to offset the cost of a 2014 policy, because their income is too high.
Subsidies are available for many people earning 100 percent to 400 percent of the federal poverty level, which is $15,500 to $62,000 for a couple. You must buy a policy through the online marketplace to get a subsidy.
Smith said he’s supportive of health care reform, but that as the ACA has unfolded, “it just seems to be sort of a monstrosity of complications.”
“It seems as though there are too many hands in the pot trying to sort this out,” he said. “I had hoped, and I still hope, it will be a step toward coming up with something useful.”
Dean Aldrich, a Kalispell veterinarian with four children, had been carrying a policy with coverage just for his kids, because he and his wife decided they couldn’t afford to cover themselves.
But Aldrich said the carrier canceled that policy earlier this year, that his family is now without insurance, and that he’s not yet found a new policy he considers affordable.
He said he shopped on the Obamacare marketplace for a new policy to cover the entire family and found that he qualified for subsidies – but it would cost $9,000 a year for a policy that had a $5,000 per-person deductible.
“So we’re looking at $14,000 that would come out of our pocket,” he said. “We had $9,000 last year (to cover our children). … The policies are not affordable.”
Aldrich can shop for a policy to cover just his children, but if he and his wife go without, they face a tax penalty next year. While it appears he could buy a comparable policy to cover just his children at a similar cost, including the penalty, he’s not impressed.
“I still think whenever the government gets involved in something and tries to do it halfway … it just doesn’t work,” he said.
Some who received cancellation notices and were offered more costly policies by their insurer said they preferred not to shop the online marketplace for a different policy.
Cyndy Rigler, who runs a mortgage company in Livingston, said she doesn’t believe the federally run marketplace is secure. She also said she’s concerned that policies bought on the marketplace may not cover the services she wants.
Rigler had a Blue Cross policy that covered her and her husband for $968 a month, with a $500 deductible. She said Blue Cross told her two months ago the policy is being canceled and that a new policy with a $1,000 deductible would be $1,437 a month — a nearly 50 percent increase.
Rigler turned to her insurance agent, who helped her get a new policy from a different insurer with a $500 deductible and a lower premium than she’s paying now.
Because her new policy takes effect Dec. 1, it doesn’t have to comply with ACA rules. However, if ACA rules apply a year from now, Rigler will have to get a new compliant policy then.
Jeanne Senecal, a realtor in Helena, said she and her husband, Dan, got a cancellation notice from Blue Cross, saying their policy will be discontinued and that a new, ACA-compliant policy would be an additional $3,300 for the year.
Senecal said she felt they had to renew the policy because her husband has a health problem that needs attention now. She said she’s especially upset that they’re paying more money for additional coverage required by the ACA that they don’t need.
Senecal said she and her husband don’t qualify for a subsidy, and that she wouldn’t shop the online marketplace anyway.
“We will go without insurance before we will buy into the government-run health care,” she wrote in an email. “I won’t go out there and give them my information in order to shop for the government insurance.”
Gary Mermel, a retired physician in Billings, said his family received cancellation notices for both of their Blue Cross policies — but that the final outcome under the ACA has been a big plus for his family.
Mermel, who has a pre-existing health condition, has had to have his own policy, separate from the one that covers his wife and two children. The family has been paying almost $1,700 a month for the two policies and last month Blue Cross informed them their rates would increase to nearly $2,100 a month for the rest of this year.
Mermel, however, said he’s been able to shop the online marketplace, find a policy that will cover his entire family for $1,200 a month, with similar benefits and a lower overall deductible — and not worry about being charged more or denied coverage because of pre-existing conditions.
Mermel said the final cost is likely to be even lower, because the family income is below 400 percent of the federal poverty level and they’re eligible for a subsidy.
“Before, the insurance companies had full control,” he said. “They were allowed to place people at risk (of financial ruin) and they no longer can do that.”
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