Greetings everyone! I have decided I am going to blog about our experience without healthcare here in the good ol' USA.
If you're from outside the US, this may be a foreign concept to you, but we don't have universal healthcare in America. My husband and I are self-employed, but used to have employer-sponsored healthcare before the ACA (Affordable Care Act). Although many of my friends will talk about how "Obamacare is the worst," but I can tell you that our healthcare before Obamacare was bad, and the claims about increasing costs only being since the ACA are simply not true. In my old employment, my insurance costs were doubling each year.
But my blog here isn't to complain. It's to talk about what we've been doing since we lost our healthcare options about a year and a half ago. And also about my upcoming surgery on my shoulder. I will, however, give a little background on our healthcare situation prior to going without.
Our "Healthcare" Before the ACA
My then-fiancée worked as a programmer for a large electronics company from 2012 to 2014, and had employee-sponsored healthcare. He contributed about $15,000 a year into the plan, and the employer matched that. So a total of $30,000 went into our healthcare. But two things were wrong with that. Our plan had a very high deductible that we never met, and his health benefits were taxed as income because we were not married. Our benefits were taxed to the tune of about $1800 a year, and additionally his teenage son's benefits were also taxed as income because I was on the plan. Basically the same problem that same-sex couples deal with here in the US.
My husband's son has an ongoing health issue that required a maintenance medication costing about $385 a month, and because we never met the deductible, NONE of that cost was offset. We were required to pay the whole amount until the deductible was met, and it was never met, with the deductible being reset each year. We didn't pay a copay for his overpriced medications...we were required to pay the whole amount. And we didn't qualify to pay a copay at the doctor's office. We were required to pay the entire cost of the visit, which was the same amount BILLED to the insurance company—the overinflated price that is negotiated until the insurance company pays about a third. However, since we had insurance, we were required to pay the pre-negotiated price...not a copay.
We also had a healthcare savings account that we used to save pre-tax dollars to offset some of those costs.
A New Plan That Worked: Kaiser Permanente
Then we switched to Kaiser Permanente, and it was wonderful. We paid about the same amount each month, around $1100-1200, but it was healthcare we could use. We didn't see multiple bills for procedures, we could easily schedule an appointment on our iPhones, the pharmacy was colocated with the doctor's office, and my full-blown surgery on a lipoma cost a copay or $25, and I never saw another bill.
Compare and contrast that sinus surgery I had in 2010 here in Austin. I had five different bills, and even an overcharge of $850 that I spent hours fighting. I had been careful to select doctors who were "in network," but the pathologist chosen while I was knocked out was not covered on my plan. After months of fighting and hours on the phone, they finally agreed that it was covered and I owed nothing.
We also had some sort of healthcare savings account (HSA) or flexible spending account (FSA), but we learned the hard way that the money was completely LOST when my husband left his job in August of that year. All the money we had put in the account had disappeared.
Back to Texas...
We continued on with Kaiser after he quit his job to become a full-time writer. It worked well, until family issues required that we leave Denver and move back to Texas, a state that had not accepted the Medicaid expansion. In the next post I'll explain why that became a problem.