Let's Talk Cassidy-Graham.



Let’s Talk About Obamacare: An Introduction

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Last year, during my fourth year of medical school, I was diagnosed with a rare form of salivary gland cancer. I had surgery and then follow-up chemo and radiation. After my diagnosis, I started a blog to keep my family and friends abreast of my situation. I soon found myself using my patient experiences - good and bad - to educate my readers. I wrote about the high cost of healthcare, physician error, patient advocacy, nutrition, and medical bankruptcy. I also wrote about the Affordable Care Act (ACA), also known as Obamacare, which will be the focus of this blog.

At a recent follow-up appointment, my surgeon told me my scans were all clear. He then asked me about my career plans. I told him I'm working as a medical journalist for the foreseeable future. I had worked as a journalist prior to medical school and regained the journalistic itch while writing my blog.

After I shared my career plans with him, I expected a critical response. Something to the tune of, "You don't need to go to medical school to become a medical journalist. Why did you bother going in the first place?" I often get such responses from medical folks.

Instead, he said: “That’s a great place to be right now. So many people don’t understand how our healthcare system works and how the new healthcare law is going to affect them. Nobody spells it out clearly. … In America, we are focused on the individual. If someone gets sick, it’s because they did something wrong not because of bad luck. Thus, it’s not my (financial) responsibility if someone else gets sick.”

He had a point. My cancer type is not correlated with any vices, or for that matter, anything. In my case, plain ole bad luck left me with a hefty bill.  Luckily, I had decent insurance through my medical school. To date, Aetna has paid more than 0,000 for my care. When all is said and done, I will pay ,000 out-of-pocket: a combination of deductibles, co-pays, and denied claims. It's easy to see why more than 50 percent of American bankruptcies are due to healthcare expenses.

It could have been much worse. Had I been diagnosed with cancer in 2010, I would owe 0,000 for my care. At that time, my school's insurance plan capped annual payouts at 0,000. There are still health plans, which received grandfathered status, that are exempt from the ACA regulation that insurers can no longer place a cap on their annual payouts. In addition, these plans are exempt from the out-of-pocket maximum limits. Under ACA, the maximum amount consumers have to pay is limited to ,350 annually for individual plans and ,700 annually for family coverage.

If you are considering a grandfathered plan, likely through your work or school, check the annual limit and out-of-pocket maximum before signing up.

My goal with this blog is to ensure you understand all of your options when navigating the ACA exchanges. At this point, you may not know all your options due to hiccups with the rollout. While you wait for the government to fix the glitches and open the exchanges, learn if your current plan has grandfathered status. If so, analyze that plan in detail and don't sign up for it until you have a chance to compare it against the exchange plans.

To help you analyze your current and future health plans, I created a mnemonic -PAID COSTS:

  • Premiums
  • Annual Limits
  • Immunity to illness (Remind yourself that you aren't immune)
  • Deductibles
  • Coverage (Are my current doctors covered under the plan?)
  • Out-of-pocket costs
  • Sickness (What current and future medical problems will I need coverage for?)
  • Treatments (What medical treatments do I currently need?)
  • Symptoms (Am I experiencing any symptoms that need urgent attention?)

Every week, I’ll be answering your questions about healthcare reform -- Obamacare -- and what it means for you and your family.

You can send your questions to me via email, follow me on Twitter, or post a comment directly on this page.

I look forward to hearing from you.

Last Updated:11/5/2013
Important:The views and opinions expressed in this article are those of the author and not Everyday Health.
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Date: 05.12.2018, 13:04 / Views: 91592