Chelsea Byers of Flagstaff is insured for the first time in her life through Healthcare.gov and couldn’t be more pleased.
She might even go skiing for the first time, now that any injuries from an accident would be covered.
Nitza Glick and Ashley Staie, both of Flagstaff, also signed up late last year for insurance at Healthcare.gov. But both received a shock this month when they went to use their insurance for health services and found their plans didn’t apply to Coconino County.
“They told me the plan was only good in Maricopa County,” Glick said. “I should never have been offered this plan.”
Ed Gussio of Benefit Logic Inc., an independent insurance company in Flagstaff, said those kind of mixups are possible because of the complexity of the Healthcare.gov site.
“There are a lot of plans listed for Coconino County but with no doctors in Flagstaff or FMC,” he said.
Of the 129 plans listed under the county, Gussio estimated that half either have no health care providers in the Flagstaff region or they are out-of-network and thus would cost far more.
“The plans are all (Affordable Care Act) compliant,” Gussio said. “But half don’t have providers here.”
Gussio has six so-called “navigators” certified to walk people at no cost through the maze of signing up for health insurance under the ACA. So far, his firm has enrolled about 130 people. Statewide, about 28,000 people have enrolled.
“Some are quite happy, especially those who have never had health insurance before,” Gussio said. “Others are upset because the costs are higher than they expected.”
He cited one couple who own a small business and had been uninsurable because of pre-existing medical conditions. He was able to find a policy for them for $695 a month — still too pricey, they said, even though they would be insured for the first time.
LIVING WITH PAIN
Chelsea Byers’ parents also owned a small business, and they could never afford insurance.
“I knew that I simply could not get sick and I could not break anything, ever, because life as I knew it would dramatically change,” she said in an email.
“This was proven time and time again. The time my kidneys almost failed on me, my mom spent months working to get just partial coverage for the 200K plus in hospital bills we dealt with.”
Not having insurance meant she lived for years with shoulder pain from an auto accident because she could not afford to pay for medical care out-of-pocket.
It also limited what she felt she could do for recreation.
“Living in Flagstaff, I’ve held off enjoying the beauty and accessibility of SnowBowl for fear that my first time on skis would land me in a hospital bed and in debt for a lifetime.”
Byers said she had heard the horror stories of long waits and crashes on the Healthcare.gov website, but it was an opportunity she felt she couldn’t pass up.
“I was prepared to deal with whatever problems I encountered because for the first time in my life, I had an opportunity to be insured.”
But instead of hassle, Byers said she was signed up just 20 minutes after logging on to the site on the day after Thanksgiving.
Ashley Staie also had a relatively easy time navigating Healthcare.gov with the help of a call to a representative. She is 26 and lost coverage under her parents’ health insurance in 2009 when she got married. She is self-employed and was not able to afford individual coverage until the ACA.
But last week she called to make her first doctor’s appointment and was told she had a plan for Maricopa County.
“I was totally bummed because all the people I talked to reassured me about the plan and how it was covered in Coconino County,” she said in an email. “I was very discouraged and it changed everything for me. I called to cancel my plan and it was all a runaround.”
Nitza Glick joins Staie with almost an identical story.
Glick said it took her seven tries before she was able to sign up for health insurance on the Healthcare.gov website.
“I really thought I had all my ducks in a row,” she said. “I haven’t had health insurance for 2 1/2 years. I was really proud of myself.”
She had signed up before the deadline, got her insurance card and made her doctor’s appointment.
When she showed the doctor’s office her Aetna Advantage insurance card on Jan. 9, they told her the policy was only valid in Maricopa County.
Glick said there was nothing on the Healthcare.gov website that told her the plan was only good in Maricopa County.
“I know I picked the right county, because they ask you what county you live in,” Glick said.
She ended up paying the entire cost of her doctor’s visit, tests and medication out of her own pocket.
“And it doesn’t even go toward the deductible on the plan,” she said.
As soon as she got home from the doctor’s office, she called the Healthcare.gov help line. A customer service representative told her that she was stuck with the policy until a health care navigator called her to get her details to cancel it.
But as of Friday, there had still been no call back.
“I’m totally stuck,” Glick said. “I can’t get out of this plan until the navigator contacts me to cancel the plan and gets my money back.”
Glick’s main worry, other than not having health coverage and not being able to apply for a new plan until the old one is canceled, is that someone else in the Flagstaff area may have purchased the same plan.
“I can’t be the only person that picked this plan,” she said. “They won’t know until they try to use it that’s its only good in Maricopa County.”
VERY FEW YOUNG PEOPLE
Gussio of Benefit Logic said that because the sign-up window has been extended to March 31 for coverage in 2014, those who signed up for the wrong plans by mistake might have a chance to replace them.
“On the other hand, they may have to live with them for a year,” he said.
He is also concerned that very few young people age 30 and under have enrolled for insurance so far.
“Nationwide, it’s under 30 percent, but we’ve seen just 10 percent,” he said.
Gussio said that Flagstaff has a very “outdoorsy” set of young people who might feel invincible and figure that the penalty of $95 or 1 percent of annual income is more affordable in the first year than insurance.
He concedes that a policy for a healthy 30-year-old with a $5,000 deductible will cost $150 a month vs. $70 before, assuming no tax credits.
“But if it turns out they need it, they’ll have to wait a whole year until they can sign up again.”