difficult child was able to enroll in Obamacare. Hooray!

Discussion in 'Substance Abuse' started by Kathy813, Nov 30, 2013.

  1. Kathy813

    Kathy813 Well-Known Member Staff Member

    My difficult child called this morning and was able to enroll. She got a silver plan for $81.00 a month. It has good coverage and low copays. She put the service rep on speaker (with her permission) and so I got to hear the options, too. The next step up was $160 a month which she can't afford. She also went ahead and enrolled in a dental plan that was separate from the health care plan for $10.99 a month. I believe her deductible was $1000 for health care but that was separate from her doctor visits with copays of $20. Also, preventative care has no copays and is separate from the deductible.

    I believe my difficult child will also qualify for help with the copays based on what I read on the website so I plan to follow up on that, too. I am so relieved that she will finally have health insurance.

    difficult child did the first part of the application on the website with no problems but when it was when she came to going into the marketplace that she got stuck but it gave her a number to call. She had about a five minute wait and then the woman we talked to was very nice and helpful. It took about a total of 30 minutes after she got on the phone. I would say that the whole process start to finish was 45 minutes.

    Last edited: Nov 30, 2013
  2. Signorina

    Signorina Guest

  3. busywend

    busywend Well-Known Member Staff Member

    2 thumbs up! What a relief for you!
  4. comatheart

    comatheart Active Member

    Fantastic! !
  5. DDD

    DDD Well-Known Member

    That's terrific news, Kathy. Soon you will be able to exhale. :) DDD
  6. Nancy

    Nancy Well-Known Member Staff Member

    I was glad to read that on the watercooler thrad. What do you mean about help with the co-pay? You know we are in the same position with difficult child. She is now covered under that special plan with ourpublic hospotal and it's been a godsend. Although I think they are dropping that plan Dec 31. Everytime we call they tell us she will get somethingint he mail shortly. So we checked rates for her and of course she will get a subsidy because of her income. But she will still have to pay for doctor visits and that's what will kill her, she has no money left at the end of the month. If you don't mind me asking, what is the plan called your difficult child got? I want to check and see if we have the same one here.
  7. Kathy813

    Kathy813 Well-Known Member Staff Member

    Nancy, here is a link to the explanation of help with copays and deductibles:


    Here is a very important part:

    I did ask the customer service rep about the deductions and she didn't seem to know what I was talking about but did say the insurer would take care of that if eligible. From what I could gather from this article, it will be done automatically if they qualify which my difficult child would since her income is only 191% over the poverty level.

    I need to investigate this further but I did see it mentioned on the healthgov website also.

  8. Nancy

    Nancy Well-Known Member Staff Member

    I've been on that site many times but the subsidy is the only assistance available as far as I know. When you go to this website:
    http://www.thehealthsherpa.com/ and enter your zip code and income level it tells you what the price is and what the subsidy is. There is no other help for copay that I know of, but maybe I'm wrong.

    For example, the lowest plan my difficult child can get would cost her $158.84 but she would get a subsidy of $139.49 and only have to pay $19.34 but her deductible will be $6,000 and her out of pocket will be $6,000. That means she will still have to pay for all doctor visits.

    Are you aware of other help out there for their actual cost of dr visits?
  9. dstc_99

    dstc_99 Well-Known Member

    So glad to hear it all worked out!
  10. Hopeless

    Hopeless ....Hopeful Now

    Glad it worked for her.
  11. Kathy813

    Kathy813 Well-Known Member Staff Member

    Nancy, I am just going by the website that I linked to but I am not sure how it will all work either. I don't know about Ohio but Florida's governor refused to participate in the ACA so difficult child is using what the federal government is providing. I think it is different depending on the state where you live and whether they are participating in Obamacare or not.

    I read that people that live in states where the state is not participating will have to pay more than those in participating states. $19 is awesome for a premium and your difficult child will still get preventative care for free and doctor's visits with copays that will apply towards the deductible. That deductible is really high, though. The out of pocket max is reasonable. Even my wonderful school health insurance has high out of pocket maximums.

    Most people aren't expected to have those kinds of health needs where they will reach the out of pocket maximums.
  12. Nancy

    Nancy Well-Known Member Staff Member

    I have no problem with the out of pocket max because right now we have $25,000 out of pocket so the $6350 is great. I understand the point, so that one is not bankrupted by an illness or accident. I'm most worried for my difficult child about dr visits for normal illnesses. If she has to exhaust her deductible first she's in trouble.

    Ohio is like Florida, our governor also refused to create our own exchange so we are under the Fed Gvt exchange.

    While I am a big proponent of the ACA I am not sure how many of the low income people will be able to pay anything for premiums. Many of those people have no money left at the end of the month and do not have checking accounts or credit cards, they pay cash for everything. How will they pay the premium even if they had the money?

    I'm anxious to see how it all works out. Right now I'm thrilled that we will be saving $400 a month.