Sunday, September 29, 2013

Virtual Camping Out in Line for the Health Insurance Exchange (Post No. 3 of Adventures in Health Insurance)

Being both a writer and a lawyer, I have hard time turning off my brain (or maybe that's why I became a writer and a lawyer). As I wrote in my two previous posts, I'm self-employed, so I have no group insurance option, and I was turned down for individual health insurance. So I did some preliminary research on the exchanges. Below is what I learned.

Differences in types of plans:  The main difference I found between the Bronze, Silver, Gold, and Platinum plans that will be offered is the estimated percentage of healthcare costs you will pay versus the insurer -- 60%, 70%, 80% or 90% respectively. I'm a little confused about whether the percentage of payment refers to a co-pay, deductible level, or out of pocket. Or all three.

Deductibles: I found one article that estimated the Silver deductible as averaging $2,550 based on data for 6 different states. There may be more info out there on this, but as Tuesday is only two days away, I'll wait to see what the actual exchange says. (It's too nice a day outside to spend it all in front of the laptop. After all, this is Chicago, tomorrow it could be snowing.)

Premiums and costs: Kaiser has a calculator which gives some estimates, with a lot of caveats about how no one really knows. Here's what the calculator calculated for one adult living alone (errors in typing in data, if any, are mine):

47 year old non-smoker living in Chicago, IL (no subsidies):

Silver: $259/month (out of pocket limit of $6,350)

Bronze: $186/month (out of pocket limit not listed)

31 year old non-smoker living in Chicago, IL, earning $35,000/year (no subsidies):

Silver: $191/month (out of pocket limit of $6,350)

Bronze: $138/month (out of pocket limit not listed)

31 year old non-smoker living in Chicago, IL, earning $20,000 (qualifies for subsidies):

Silver: $85/month (subsidized) (out of pocket limit of $2,250)

Bronze: $31/month (subsidized) (out of pocket limit not listed)

Questions I still have:  The premium estimate for me is about $50 less per month than I pay now, but there's no way to compare apples to apples. Now, both my deductible and out of pocket limit are $5,000. So if I am under the deductible, as I am this year and was the first year I had the plan, the Silver plan would be far more affordable for me. If I'm over the deductible, my current plan might be a better. I'm also unclear on differences in the quality and breadth of the networks offered, the deductibles, and the co-pays.

Whether I have good coverage now depends on your perspective. I'm in the Blue Cross PPO. Nothing, even prescriptions, is paid for until I hit the $5,000, which I obviously aspire each year not to reach. The plan thrills me, having faced no coverage at all. A friend who has never been self-employed, though (and who is against any type of universal health insurance) said to me, "That's terrible. Can't your firm get you better coverage?" Me: "I am the firm. And according to the health insurance companies, I'm not insurable." Friend: "But you're healthy. Can't your doctor write them a letter?" But that's not how it works - see my last post: Once I Became Self-Employed

Happily, it looks like I misunderstood a previous communication from ICHIP. While my particular plan may go away, I can be migrated to a similar one that might cost me slightly more. Still, I will likely purchase through the exchange, as it seems to me that my plan won't continue in the long run if the exchanges work well.

Links that may be helpful:

Lisa M. Lilly is the author of Amazon occult bestseller The Awakening.  A short film of the title story of her collection The Tower Formerly Known as Sears and Two Other Tales of Urban Horror was recently produced under the title Willis Tower.  Her poems and short fiction have appeared in numerous print and on-line magazines, including Parade of PhantomsStrong Coffee, and Hair Trigger.  She is currently working on The Awakening, Book II: The Unbelievers.
The Awakening for Kindle:


  1. I feel for you, and I hope you'll find a good plan. Two years ago I was faced with paying roughly $1400 a month for a family through COBRA. Once that would run out, we'd be uninsured. Not a happy prospect. Needless to say, I was ecstatic I got a job offer the same month my premiums went up. I hope the state you live in is not one of those who block the navigators from helping people get coverage.

    1. Thanks for your comment. $1,400 for a family -- that's such a large premium. I have a friend who faced the same thing and had lupus, so she had to COBRA. Glad to hear you got a job offer. I, too, hope there will be no blocks to the exchanges.