My Personal Experience with Using the Health Insurance Marketplace

Taken in my cousin Chet's yard.....
Taken in my cousin Chet's yard..... | Source

What to Do

For the first time in decades I found myself needing to apply for affordable health insurance. Most of my life I had coverage at my job sight. Even when I lost that job and was forced to take work where they did not offer insurance coverage I still had other affordable options (my husband’s group plan at his workplace) and without worry about a lapse in coverage either. The year he was laid off we were able to keep the insurance under the Cobra plan, but we had to pay a much higher price. Lucky for us the government that year deferred some of the cost.

Now Bill (my husband) has become disabled with COPD, Congestive Heart Failure and other ongoing health problems. He has not been able to work since December of 2013. With no chance of him likely to ever return to work we started the wheels turning to get Medicare the beginning of June. Only this is a time consuming venture and time is something we lack when it comes to waiting on health care coverage. We first applied for Medicaid in hopes of help until Medicare is available. We had a month to prepare ourselves to find other sources of insurance. It would have been much longer, but Bill refused to believe that he was not returning to his part time semi retired work any time soon. We couldn’t even get an appointment to discuss Medicare until July 14, 2014. Shocked by the news we make too much money for Medicaid (applying for him only because of health issues) with my little job of odd hours and his Social Security checks I am beside myself with the race to get coverage. Prior to this, Bill had been drawing sick-pay with our insurance paid by his employer. It was due to cease June 23, 2014. Lucky for us Cobra is offered to us once again, only this time minus a discount. Worried about a lapse in coverage I keep Bill on the plan. We cannot afford the price for both of us. So I find myself searching for health insurance for myself.

My son's picture.....
My son's picture..... | Source

My next stop is the Marketplace.

I get online and begin searching for affordable health insurance. This should be easy and most questionnaires are fairly simple until I get to where you enter your phone number and it lets you know that they will share your contact information. I freeze. I hate those none stop telemarketers calling all hours of the day and night. I back out and try another sight. I do this several times and finally locate a sight only dealing with the Marketplace where someone will call and guide you through the process letting you know how much help the government will be reducing your cost. I even notice it promises not to share my information with other companies. I agree and am satisfied I have reached the right place. My coverage had ran out the day before and if you just lose coverage you don’t have to let a whole month go by, you can begin coverage right away beginning with the first day of the month following your enrollment. You also need not fear a penalty for not having health insurance until after sixty days has passed.

Source

Talking to a Representative

I receive a phone call from a very friendly lady that guides me through the application to affordable health insurance. I am so pleased I got someone so friendly and that talks plain English. She tells me of the plan and says she will send me an email about how this all works. I’m thinking this is great and cheaper than what my husband had been paying each month to have me added to his plan at work. I wait for the email.

Several minutes go by and I don’t get an email. The phone rings and it is the same lady letting me know how sorry she is but she somehow entered the wrong zip code and I can’t use that plan. She has to set me up with a different one which is seventy dollars more each month. The plan does have a much lower co-pay so I’m still thinking it to be a fair deal and the price is only a little more than what Bill had been paying for me on his policy. I’m not real pleased that the deductible is higher on hospital stays, but I agree to the plan. She sends an email and tells me I can keep in touch with her through email if I have any questions come up along with an attachment of the Marketplace’s agreement and instructions.

After reading all the literature sent me. I send her an email and ask about how I pay the first premium. I need to know if I should wait for an invoice or am I given the time to mail it. She tells me I should send it to them so it will reach them by the first of July. So I copy my personal documents they ask for and enclose a check for the first month hoping to get it there by the first. This gives me only one week.

I Wait

On the first I receive an invoice from an insurance company for the exact amount of the first quote given me the day I applied for coverage. I’m confused. I know I was told I could not use this cheaper plan. I wonder if the check had crossed paths. I get online to the company’s website and I register to see if they got my payment. As the same amount due is still pending that is on the invoice I assume the answer is no that they hadn’t got it yet. Something told me this was not the right plan and with the check I sent a higher amount I hesitate to take any action just yet. This was a Friday night I’d give it until Monday and call someone about it or send the lady who signed me up another email.

The next day I get another invoice from yet another insurance company. This time for the amount I was told I would be paying. I also get a letter from the Marketplace with my check returned to me. They say they cannot process it. I need to send payment to the insurance company. The only address or contact information I have at the time is for the Health Insurance Marketplace. The lady who enrolled me never even told me the name of the second plan was a different company than the first one was. I send her an email to let her know what chaos I am going through. I then am able to pay my premium by phone come Monday. Finally I am on the right track. Only now I am signed up with two companies and continue to get billed by the one that I was told I lived in the wrong zip code to be able to get. Can’t be they know this. I sent them an email through their website. And recently I got another invoice billing me for two months. I quickly returned it with cancel written all over it and I let them know there has been a mistake.

Conclusion

Due process will always prevail. Some things take more time than others do. For this health insurance plan to work the way the government wants it to, much improvement is needed. This should have been a simple transaction. I hope the people doing enrollment are more careful with other folks in the future and at least give them the contact to the insurance company they sign them up for.

Now I have to wait and see if my husband will be able to get Medicare or if we need to keep him on the Cobra until we can get him coverage through the marketplace. Not only is the price of Cobra more than we can afford, but it is only allowed for eighteen months. He is only sixty three and not old enough for Medicare without being disabled. I have seen disabled people turned down before. I hate to change coverage with him because the plan he has is somewhat better than the one I am signed up for and it’s likely he won’t have a better one. I’m hoping if he gets Medicare I can get him signed up for a Medicare supplement plan to go with it and save more than we are now.

It just doesn’t seem right to spend half your income on health insurance and still have doctor bills to pay that the plan doesn’t cover. But right now with paying the high Cobra premium and with it not covering everything that is what we are dealing with. I know it could be worse if his next insurance plan covers less than what he already has.

Another dilemma that really is upsetting is that even though the online application claims to not share information with other companies that doesn’t stop the calls. The representative signing you up over the phone does share your number while finding you a suitable plan. I still get plenty of calls trying to sell me insurance. They have subsided some as I ask each of them to remove me from their call list.

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Comments 6 comments

Sunshine625 profile image

Sunshine625 2 years ago from Orlando, FL

Oh my, what a journey for you! My husband and I are also on Cobra until his Medicare kicks in some time in Oct or Nov. He's been disabled with Stage4 Prostate Cancer since Oct 2012. At the time he was given 4-6 months to live and we were still told he had to wait 2 years from start of disability to be eligible for medicare. Wow. Shocking how the system works. I began to look into the Marketplace for myself...I gave up after a day or two of research. One day I'll research it again. Good luck to both you and your husband.


Diana Lee profile image

Diana Lee 2 years ago from Potter County, Pa. Author

Thank you, Sunshine625. It helps to share stories to help us make any logic of how things work. Looks like I may as well get use to spending this much money for quite sometime.


Faith Reaper profile image

Faith Reaper 2 years ago from southern USA

This is an eye-opener of a hub here. Thank you for sharing and it is shocking how it all works.

Blessings to you and your husband.


Diana Lee profile image

Diana Lee 2 years ago from Potter County, Pa. Author

Yes, it is a real eye-opener, Faith Reaper. I never would have thought it so hard to get Medicare for someone in need of it. It's not like you ask for charity. I thought this was a benefit the working class had earned through all those years of paying into the system. I guess we best not expect anything to be there when we get old and disabled.


ThelmaC profile image

ThelmaC 2 years ago from Blue Ridge Mountains, USA

I am in much the same situation as you and I understand your frustration. Thanks for including the link...I will check it out.


Diana Lee profile image

Diana Lee 2 years ago from Potter County, Pa. Author

I wish you luck, ThelmaC. Thanks for reading my rant.

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