Once denied insurance at any price, Amy and her husband found a plan that works for their lifestyle and budget.
One prescription for blood pressure medication. One test that showed an early-stage heart valve issue that isn’t causing any problems. That’s all it took for insurance companies to deny coverage to Amy and her husband, Mike before the Affordable Care Act (ACA).
Amy had health insurance through work before she retired from the Michigan hospital where she worked as a registered nurse, often taking care of patients with heart problems. But when she retired, she and Mike couldn’t find a private insurer to cover them at any price — despite them being two very healthy 61-year-olds with no serious health concerns.
“They saw the paper trail of my doctor writing me a prescription for blood pressure medication I never took because I was able to manage it with lifestyle changes and my husband’s trivial heart valve issue,” Amy says. “But we couldn’t get covered. So when the ACA came into effect, we dove in.”
The ACA, also known as Obamacare, has made coverage accessible and affordable for millions of Americans like Amy and Mike. They found a Bronze plan with a premium of $400 a month per person, without any tax subsidy. Their deductible is high — $12,000 a year — but their out-of-pocket maximum for the year is only $6,000.
They chose this plan because they’re both healthy and don’t take much medication. They don’t go to the doctor often, but when they do their co-pay for routine office visits is $30. Amy says that’s the same price she paid when she had insurance through work.
Because I’m a nurse, I’m always looking into preventive medicine. We follow Functional Medicine, which teaches patients to watch what they eat and be more proactive with their physician to find out what’s impacting their health and see if lifestyle changes like losing weight could help them avoid taking medication. The ACA forces people to be more accountable for their health, which is a good thing.
I follow Functional Medicine, too, and I can attest to the fact that making healthy lifestyle changes can reduce your need for medication and doctor’s appointments.
Prevention is key, like the annual checkup everyone gets at no extra cost under the ACA. Amy says her doctor is a strong supporter of the ACA because it encourages people to be proactive. She agrees.
Take advantage of the preventive care the ACA provides like free check-ups. I endorse that. If you don’t take advantage of it, then you’re setting yourself up for illnesses that could be more expensive down the road, and you’ll only have yourself to blame.
Amy rightly points out that the ACA is not government insurance. It’s private insurance made more affordable with tax subsidies for those with lower incomes. She hopes people will take the time to fully understand what the ACA does to help Americans.
Just think of all the people who are now able to get healthcare. That’s the beauty of all this. Kids can stay on their parents’ healthcare plans longer, people with pre-existing conditions can get coverage, immunizations and well-child care are all built into the plans. Patients don’t have to rely on the emergency room anymore and they’re able to get the kind of routine care and follow-up that keeps them healthy. And that will save them money in the long run.
Open enrollment runs through February 15, 2015, so now is the time to enroll in coverage, change plans or renew your current coverage for next year. Visit Healthcare.gov for details.
