Trump has been ranting about the failing ObamaCare market since before he was elected, and has been working tirelessly since to make his predictions come through. After spending months threatening to withhold the subsidies for low-income patients, he finally carried through on his threat last month, but it didn’t matter much. Months of threats and deadlines for the insurance companies to set their 2018 rates meant that without certainty in the rules, a withdrawal of subsidies would get priced into our 2018 rates. Behind the scenes, they worked to change the rules in ways that at best could be described as malicious. These changes have been disguised as much as possible, since they serve little purpose other than to reverse Obama’s policies on principle, with little to no upside for anyone who’s covered. On Nov 1st, 2017, open enrollment was started, and for many of us, it was our first opportunity to even see the rates and changes that we’d be signing up for in the year 2018. I’m a nerd and geek, although one blessed with good health, but nonetheless, I’ve been concerned about my coverage, and have been anxiously awaiting the details of the changes. I received those details yesterday, and the best way to describe them is that…. we’re all fucked.
The first changes that impact us are the changes in the open enrollment period. I didn’t realize the perniciousness of it until after seeing my new policy. The open enrollment period in the year 2016, which is when you were able to sign up for coverage for the year 2017, was available from Nov 15th 2015 to Feb 15th 2016. This was the period of time in which you could sign up for a new policy that would give you coverage in the year 2016. I’m not going to go into details as to why we have an open enrollment period, but essentially it’s there to prevent you from signing up for coverage only right before you get sick. In the year 2017, the open enrollment was changed to Nov. 1st, 2017 to Dec. 15th, 2017, for coverage in the year 2018.
They also reduced the advertising budget for the program advertising this open enrollment period. When I initially heard about these changes, it was obvious that the changes served no purpose other than try and discourage people from signing up, but I missed the sneakiest part of the whole deal. If there are changes in your existing health care policy, those can only be changed at the start of the new year, and I can only change plans to a new one during the open enrollment period. Those 2 events no longer overlap, meaning that I have to be aware that my plan might change, understand the consequences of those changes, and find a new plan before the new plans go into effect. This means I won’t see the first bill, or face the consequences of my new coverage until after the open enrollment period has closed. This incentivizes the companies to try and be as opaque as possible about these changes, so that I’m locked into my new, worse coverage.
The way I was notified about my coverage changes comes straight out of a Douglas Adams book. I’ve signed up electronic e-mail and text notifications, and fittingly, in early October, I received written notice by mail that my existing policy wouldn’t exist in the year 2018, and that I would be automatically moved to a new policy that does exist in that year. It also notified me that I would receive another written letter containing the policy changes in the near future. I logged onto the web page for my health care provider to see if I could read about the changes, and it said that details of my new policy wouldn’t be available until November 1st.
On November 1st, I logged into my health care provider’s web page, and sure enough, I was moved to a new health care policy. This new health care policy has the same name as the old policy, but a different ID number. The old health care plan I was on was called “Blue Choice Preferred PPO”, and my new policy shows the same name, but shows as a different policy that’s pending for the year 2018. Clicking around in the portal, it didn’t seem like there were any changes. The portal shows me a copy of my health insurance card with helpful (full sarcasm implied with that word) information, which I’ve included here.
|COPAY – SPECIALIST OFFICE VISIT||$60.00 Day|
|COPAY – URGENT CARE FACILITY||$40.00 Service|
|EMERGENCY ROOM COPAY||$600.00 Service|
|LIFETIME MAXIMUM||No Limit|
|DEDUCTIBLE PER FAMILY||$9000.00 CalendarYear|
My new policy? It shows exactly the same limits. I clicked around to try and find what has changed on my new policy, but I was unable to find any detailed coverage details for the new policy. Any links showing my full coverage just displayed my existing coverage.
In my continued quest to find out how I’d be fucked, I clicked on the convenient online support link on their web page, which is only available from 8am to 5pm, CST, Monday through Friday. After several minutes of trying to figure out why the button wasn’t doing anything, I remembered that browsers now kill popup boxes, and managed to disable the popup killer, and started chatting with a customer service representative. I told him I wanted a list of all the changes to my health care policy that I’d been notified about, and he told me that they had sent me a letter detailing those changes on October 17th. They may have, but I had not yet received anything on November 1st, so I asked if he could list the changes. I’m going to give him the benefit of the doubt and assume that he didn’t entirely understand my question, but after several minutes of back and forth, he finally explained that he could have the system automatically re-send the letter listing the changes, or he could manually post them into the chat window. I told him I wanted both, and he obliged, up to a point. After several pages of changes, he followed up with “and there’s a bunch more like that, and you’ll be able to see them all on the brochure we send out”. None of the changes he showed me looked particularly promising.
So what changed in my plan, and why am I so angry about it? Here’s what I saw when I finally saw my new plan. They have auto-migrated me to a new plan that is “closest” to my existing plan, and there will be no break in coverage. The old plan used to cost me about $900 a month, had a deductible of about $3000, and most services would charge me either a fixed-cost fee or a 20% co-pay amount. The new plan costs $1200 a month, has a lower deductible of $1500, but charges me 50% co-pay on most everything. Looking at their web-page, I can “downgrade” my plan from a silver plan to a bronze one, and instead of paying $1200 a month, I’m back to paying $900 a month. My deductible goes up to $3000, as opposed to the new silver plan’s $1500, but $3000 is the deductible I had in the original silver plan, so no problem there. The interesting part is that my co-pay on everything is 40% instead of 50%. So I called my insurer, and told them that instead of being auto-migrated to the new, more expensive plan, I wanted to downgrade to the cheaper plan on Jan 1st, 2018. No problem, I can switch plans any time up to December 15th, without a problem, so I told them to switch me. They asked for a credit card, which I dutifully gave them, glad that I had found their switcheroo scam before December 15th.
My next shock came in a couple days later, when I noticed my bank balance was lower than I had expected. I checked the charges, and sure enough, right after December 1st, they charged me $900 for my old plan and the December coverage. If I had remained on the auto-switch plan, then I would have been charged again on Jan 1st. Since I called them a couple days after the 1st of December to switch to a plan that was cheaper and provided a lower co-pay than their original plan, they decided they needed to charge me ahead of time for that plan so that it could start on the 1st of January. Now I do reasonably well, and so I was able to afford the extra $900 it cost me early to switch my plan, but the whole thing just reeks of scaminess and profiteering.
The whole business plan is to give the least amount of coverage at the highest price possible, and you can see it at work here. The ACA requires them to provide (at least) a minimum set of benefits. Since Trump refused to make the CHIP payments, and his lack of commitment to even that principle, meant that insurance companies weren’t able to move forward on disclosures for their 2018 plans. However, insurance companies, never ones to leave profit on the table, also took this moment of confusion to create a new plan, significantly worse than my old plan, and more expensive as well. They then helpfully offered me a transparent switch-over to the new plan, while waiting as long as possible to disclose any of the terms of the new plan to me, and requiring a preemptive effort on my behalf to get them to tell me what the changes were. Finally, as a nail in the coffin, they structure the whole thing in a way where I have to absorb higher costs before Christmas, instead of waiting for the new year, to charge me for the switch over, even though they don’t charge me the same way if I stay on the worse, more expensive plan. The final product is then packaged up so that its not obvious to me what the changes and/or charges will be until 2 weeks after the deadline for me changing the plan. This is our wonderful free market at work, where as consumers, we can spend infinite amounts of time and energy to try and prevent companies from taking additional advantage of us, while the laws work in their favor to help obfuscate what they’re trying to do to me. It’s one thing when it’s a non-essential consumer product, like a new TV, or a gym membership, but its another thing when it’s literally our health that is at stake.