My experience ‘enrolling’ in Obamacare/Covered California

November 15, 2013 - By Katy Grimes

CoveredCalifornia1With all the hoopla surrounding Obamacare, I decided to call and sign up for its implementation in our state, Covered California. I dialed 1-800-300-1506. Jose answered.

He was polite but rattled when I told him I’d rather talk to him, a human, than trust my most personal information to a problematic state government computer. He attempted several times to get me to sign up online, but I held firm. I did not want to create an online account.

Jose asked for my salary information, my age, and my husband’s information. He asked me for information from our tax returns, and if I was a citizen. Rather than provide my actual income, I used $40,000 as my annual salary, to see if I would qualify for a subsidized plan.

After running a few calculations, Jose suggested I dump my husband, who gets Medicare, from the plan to lower my income, and possibly qualify for government subsidies. “Your annual income is just below the boundary — you may qualify for assistance,”

Then the awkward sales pitch began.

Silver, blue and gold

There are four levels of health plans available, from cheapest to most expensive: Bronze, Silver, Gold and Platinum.Unknown-1

While Jose was explaining the metallurgy of the health plans, the 1982 Bad Company song, “Silver, Blue and Gold,” popped into my head:

In the beginning
I believed every word that you said
Now that you’re gone
My world is in shreds

Jose skipped right over the Bronze- and Silver-level plans and tried hard to sell me on a Gold-level health plan. He said the Bronze-level health plan had the highest monthly premiums, but was reluctant to tell me what they were.

As he launched into the Gold-level health plans, I asked Jose to back up and at least explain to me what the Silver-level plan offers. Jose reluctantly explained: there is a $2,000 medical deductible under the Silver plan, and a $250 brand-name drug deductible, a primary care doctor visit costs $45, and a specialist costs $65.

Bad Company started playing again in my head:

Give me silver, blue and gold
The color of the sky, I’m told
My rainbow is overdue

Jose said Anthem Blue Cross is available in the Silver-level plan, in HMO and PPO plans. He said the PPO would be $485 per month, and the HMO is $698. I suggested perhaps the PPO is the more expensive plan, but Jose said those were the numbers he had. “Well, it might be a miscalculation,” he added. But he did not know the difference between a PPO and an HMO plan.

Oh, you loved me and left me
You took all the things that I needed so bad
I’m standin’ here wondering
Where is the love that I had

Jose said there are 10 categories all of the Covered California plans must meet, based on the Obamacare law:

  • ambulatory patient services
  • emergency services
  • hospitalization
  • maternity and newborn care
  • mental health and substance use disorder services, including behavioral health treatment
  • prescription drugs
  • rehabilitative and habilitative services and devices
  • laboratory services
  • preventive and wellness services and chronic disease management
  • pediatric services, including dental and vision care

Jose said some of these categories may add extra costs, but he would not specify which.

I told Jose I didn’t want maternity and newborn care or pediatric services. But he just laughed.

We finally got to the Gold- and Platinum-level plans. Jose explained those plans have no annual deductible and have lower costs to visit the doctor. The monthly premium for the Gold plan is $584 and the Platinum plan is $665.

The lower three of the plans have maximum out-of-pocket expense for one person of $6,350 a year, and $12,700 for a family. On the Platinum plan, those out-of-pocket expenses drop to $4,000 and $8,000.

Give me silver, blue and gold
The color of the sky, I’m told
My rainbow is overdue

He jumped back to compare these with the Bronze-level plan, which has a $5,000 medical and drug deductible and limited coverage for doctor visits.

Let me exempt you

Finally, Jose offered me a list of exemptions as a way to lower my income, in order to qualify for government subsidies:

  • alimony
  • business expenses of performing artist
  • moving expenses
  • deductible part of self-employment tax
  • self-employed health insurance deductions
  • penalty on early withdrawal of “savings”
  • IRA deductions
  • tuition and fees
  • student loan interest
  • educator expenses
  • “domestic production activities”
  • Health Savings Account interest
Jose was willing to work with me to lower my income through the exemptions, but I didn’t want to go any further. I thanked Jose for his time and said I’d need to check with my husband before I signed up — especially since I would be dumping him from my plan.

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Comments(52)
  1. The Ted Steele Conceptual Abstraction Unit says:

    Zzzzzzzzzzzzzzzzzzz Katy, this was fun to read–honestly, but, —-newsflash—–the roll out is going poorly—- thanks for the update– VERY useful—- How about more info on what the ultra right can do legislativly about fixing the problem to make this all work— that’s if you all have any ideas?

    • John Seiler says:

      Why should “the ultra right” fix a broken program that: a) they hate; and b) is unfixable?

      • Rex the Wonderdog! says:

        Why should “the ultra right” fix a broken program that: a) they hate; and b) is unfixable?
        ==
        Don’t ask Teddy a question that needs common sense to answer ;)

      • Ted Steele, CEO says:

        Ah, John, er ah, I guess… uh, I don’t know….to help America?

        • John Seiler says:

          Ted: If it’s unfixable, something you didn’t dispute in your previous post, why waste time and money trying to fix it?

          The best way to “help” America is to move away from the current U.S. medical system, which is about 60% socialist, toward the free system we had before it was wrecked beginning in 1965 by LBJ with Medicare and Medicaid and by Nixon in the early 1970s with HMOs. Under that older system, the poor were cared for by doctor and hospital charity. Everybody got real freedom of choice.

          • Rex the Wonderdog! says:

            The roll out has not been good, but I am still of the position we should try it, for 1-2 years, if it is a dude then we can drop it.

            My only fear is that once a large government program gets started you can never put the brakes on it, and that is a legit fear.

          • S Moderation Douglas says:

            The poor were NOT paid for by doctor and hospital charity. They were subsidized by the paying customers.

          • LetitCollapse says:

            “The poor were NOT paid for by doctor and hospital charity. They were subsidized by the paying customers.”

            That’s not entirely true, S Moderation.

            Mom was born to a poor family and had 10 siblings (not so unusual back in those days), 8 of whom survived past the age of 2. 3 of her siblings suffered from Rickets, a vitamin D deficiency, that resulted in some pretty horrendous orthopedic deformaties. The Shriners organization arranged for the surgeries and the follow-up required to treat those children and allow them to lead normal lives. All free of charge to the family. The money came from private donations and contributions and profits from other Shriner events. No taxdollars.

            The Shriners was just one of many charity organization that did this sort of thing.

            Plus, back then, the U.S. had mostly a free-market in health care. They paid the doctor out of pocket. They paid for their drugs out of pocket. Treatment costs were small (relative to average incomes) compared to what they are today. Insurance was only used to help out in the event of hospitalizations or medical catastrophies of some sort.

            Healthcare today has been turned into a financial scam.

          • S Moderation Douglas says:

            Not untrue, either, private donations are one thing, St Jude’s and Shriners are wonderful, but if the doctor or hospital donates its “own” money, as John said, that can only come from one source, paying customers. 

            Not to mention, a lot of lifesaving and life extending medical procedures were MUCH less expensive back then. 

            Like 
            heart-lung machine
            tetracycline 
            pacemaker
            hip replacement
            ultrasound
            MRI
            CTscan
            liver transplant
            heart transplant
            lung transplant

            Because none of these was available before 1950. 

            Kidney dialysis alone costs tens of thousands of dollars a year per person, but can prolong life long enough for an organ to become available, another very expensive operation. 

            Ah, back then, “Treatment costs were small (relative to average incomes) compared to what they are today.”

            Because there WAS no treatment. Heart disease, renal disease, cancer, et al. = death sentence. Might that be one reason for the greatly increased costs?

            There are a lot of older, and some younger people, walking around on artificial knees and hips who would never have had them under a real “free market”. 

            I think most of us, if we really knew, would not want to go back to the “good old days”

          • John Seiler says:

            Actually, what happened was that doctors took a big wage cut to aid the poor, so the other patients (consumers) didn’t pay for that. And hospitals, as now, got a lot of charity donations to pay for the poor. So again, the regular patient (consumer) didn’t pay.

            Also, before 1965 and the coming of Medicare, Medicaid, widespread insurance and HMOs (third parties), there was a lot of competition among doctors and hospitals because patients shopped around, just as patients shop around now for cheaper operations in Mexico, Belgium and Singapore.

            And just as people shop around now for laser eye surgery and plastic surgery, where prices have been dropping for a long time because they mostly are outside the government-insurance-HMO medical-industrial complex.

          • S Moderation Douglas says:

            Actually, I understand, dialysis may be tens of thousands per MONTH. And there are over 300,000 using it.

          • S Moderation Douglas says:

            “Actually, what happened was that doctors took a big wage cut to aid the poor, so the other patients (consumers) didn’t pay for that.”

            ?????? “wage cut” from what?

            Seems like, if you only “need” $2,000 a month to live on, and you have 200 paying patients, you charge an average of $10 a visit. (we’re talking 1950 here)

            And, you treat 10 indigent patients for “free”.

            BUT, if you charged ALL patients, the same, each could get their office visit for $9.50. Your paying patients are paying 50 cents to subsidize the indigent.

            Same thing goes for the hospitals. Charity aside, the only thing the hospital has to “give” comes from paying customers.

            ……………………
            on a related matter:

            http://www.bloomberg.com/news/2013-11-18/a-conservative-cure-for-obamacare.html

          • John Seiler says:

            Charity is charity. If I give $10 to a hospital, other “consumers” don’t pay for it.

            If a doctor takes half pay for treating poor patients, other “consumers” don’t pay for it.

            Charity is just common decency that any society needs to thrive. It doesn’t reduce; it multiplies.

        • fletch92131 says:

          “Ah, John, er ah, I guess… uh, I don’t know….to help America?”
          Could it be that you’d only be helping Obummer fundamentally restructure America!

  2. Ulysses Uhaul says:

    Red blooded patriotic Americans want good health care and reasonable health insurance alternatives.

    The Messiah looks to be a suspicious Prophet hawking a magic elixir from a constesoga wagon that nobody wants!

  3. Larry Naritelli says:

    Perhaps instead of bronze, silver, gold, and platinum they should be named parsley, sage, rosemary, and thyme. IRS care is here. Did he offer to do your taxes too?

  4. Katy Grimes says:

    The “ultra right” Ted? How about talking about most of America — the 85 percent who liked their health care plans who are now SOL? The health exchanges will collapse due to partisan politics, and not at the hands of the “ultra-right.”

    Katy

  5. LetitCollapse says:

    The purpose here is to morph ObamaCare into a one health care plan that fits all. IOW’s, full-blown socialized healthcare. No private choices unless you happen to be incredibly weathly. This was obvious to those paying attention back in 2010 when this disaster was approved by Congress. It was a designed failure. Even the one’s who passed it proclaimed “We have to pass it to find out what’s in it”. Come on. How irresponsible was that on a piece of legislation that controlled 1 dollar of every 5 dollars spent in the US economy? If you were purchasing a large property and the lender told you that you would have to buy the property before you could find out what’s in the mortgage contract – what would you tell that lender?

    America has been conned once again. The masses were sold a bill of goods. And only now is it becoming obvious to everyone. Remember when the mainstream media applauded the signing of the ACA law back in 2010? I do. The gatekeepers once again failed to do their job – just like with all the events that lead up to the 2008 economic meltdown. All of them acted surprised as the DOW plummeted to 6000. Deliberately ignorant. It’s the 4th quarter and tryanny is ahead by 4 touchdowns and are back in the red zone.

  6. Ted Steele, CEO says:

    85% will lose there plans Katy?

    LOL

    Fox “News” talking points yet again?

    sad

    • LetitCollapse says:

      No. 85% is not unrealistic at all. In fact, it’s a low estimate. More like 95%.

      Don’t you know the terms of the ACA law?

      Read closely: Under the law, if there are ANY sort of changes to your private HI policy post March-2010 it is immediately disqualified from the ObamaCare HC system.

      HI corporations routinely alter the terms of their HI coverages. It just goes hand in hand with that business. In fact, I have never seen a HI policy that remained unchanged for more than 3 years. The logical conclusion is that everyone holding a private policy would eventually (in short order) get switched over to ACA.

      So, no. It’s not just ‘talking points’. It’s reality.

      • The Ted Steele Conceptual Abstraction Unit says:

        LOL Collapse you live in a FOX NEWS alternate reality!!! 85% –LMAO !!~! Are you Ted Cruz?

        • LetitCollapse says:

          Can you read and comprehend? Or is that an erroneous assumption?

          I gave you the reason why more than 85% would eventually lose their HC insurance plan and get flushed into ACA. A perfectly factual and legitimate reason that a very average intellect should be able to handle.

          Your flippant and unfocused response gives me the impression I’m making way too many assumptions. If so, I apologize.

          • S Moderation Douglas says:

            85% is the new 47%.

            You know what that did for Mitt Romney.

            “the 85 percent who liked their health care plans who are now SOL.”

            Is bogus.

          • Ted Steele, CEO says:

            LOL– short isn’t per se flippant little buddy! The 85% stat is false. It might work at a tea party rally. Maybe you and Dysphoric can go dust off your Ben Franklin costumes and head downtown to the park with some signs?

            oh my

          • LetitCollapse says:

            Long on rant. Short on facts. And no counterargument to the premise of my original position of why greater than 85% of consumers will eventually lose their own personal health care insurance and get transferred over into a ACA exchange. I’ll give you one more chance before I move on.

    • Dyspeptic says:

      Ted, are you sure your real name isn’t Debbie Wasserman Schultz? Please keep worshiping His Supreme Imperial Majesty Barack. Your hopelessly sycophantic behavior provides endless comic relief.

  7. RT says:

    Here are but a few of the problems with California’s Version of Obamacare “Covered California”:
    1. Many of the largest Health Insurance Companies in California are leery of California’s ever changing Health Insurance regulations and the interpretation/misinterpretation of those regulations by enforcement bureaus at the state level.
    2. Just as has happened with “Medi-Cal,” Covered California will soon begin to lose health care providers such as doctors and hospitals due to low payment rates.
    3. In most counties, Covered California customers are being encouraged to contact their local Department of Health and Human Services (The Welfare Dept.) for help. Not only are County Department of Health and Human Services known for their poor customer service, many have gone to “call center” formats which means a customer may get conflicting answers depending on what staff they contact.
    4. As, Covered California customers begin to see the monthly cost and the extremely high deductibles, there will be sticker shock.
    5. Once the federal subsidies tied to Obamacare end, the entire Covered California system will crash causing yet another budget crisis for California.

    • pickynicki says:

      Amen. As a supporter of the ideal that Americans should have access to reasonably priced health care coverage, I couldn’t understand why everyone was so down on the ACA. In learning more, I’ve had to face the fact that, between the ACA and the insurance companies and the employers, there is very little room for the people to receive any sort of comprehensive health care coverage. Sure, sweeping reform, and massive change. Those things are happening. But those things don’t seem to help folks.

      RT, what are your thoughts on single-payer health care? What do you see as the perfect (or best) system of providing access to health care to Americans?

      I am someone who has had to avail herself of care through the Dept. of Health and Human Services, because of a terrible ankle break occurring immediately after I finished my second education in my 40′s. My intent was to upgrade my skills and become a paralegal, thereby becoming more employable than when my prior employer retired from construction in 2010. I spent my savings for education, only to have a stupid accident causing devastating injury. It has delayed my job search for more than a year and required 2 surgeries to date. The DHHS coverage I received costs me up to $1,000.00 per month, and I am 100% responsible for all medical costs until they exceed my monthly share of cost. This is great during the months I had surgery. Not so great for each and every month that orthopedists, x-rays, physical therapy, etc., are needed, but don’t add up to more than my monthly share of cost. AND THIS IS WHAT A VERY POOR PERSON MUST PAY. Thankfully, the county is happy to set me up with a repayment plan so that my medical bills are consolidated under one account. Oh, wait – the x-ray department at the county hospital and the orthopedist who sees me at the county hospital bill me directly. The county will only consolidate the bills from the hospital that are associated with the facility, whatever that means. So, in addition to my monthly payment to the county toward expenses that are deemed facility related, I am billed for additional expenses that must also be paid…now, please.

      Whew! So sorry to have gone on a rant. Believe me, I’m nowhere near done, but I realize no one wants or needs to hear all of my drama. It just seems that there must be a better way to address very real issues and problems. U.S. citizens deserve a standard of care. We deserve to be able to afford medical care, AND our mortgages, AND to feed our families (not for free, but because we work hard).

  8. NTHEOC says:

    I wish I had the opportunity to save some some money and see if the covered California had any plans for me! I pay around $650 a month for the best PPO plan,but because I am a unionized public employee I am not eligible for the covered California plans….

  9. Ulysses Uhaul says:

    Collapse….such an alarmist.

    Do not believe all those cryptic articles on Obamacare. ….dear leader just told us all will be ok. He would never dare to misspeak again. You know that-

    -forgive and forget

  10. Linda Bruzzone says:

    Sadly enough, that $40,000 income, after self employment taxes and other taxes is more than likely $30,000 a year or $2500 a month. Take from that (and this is very, very low and most likely unrealistic) $1000 for rent and the amount is now $1500 a month; $200 for food and we are down to $1300 a month, subtract $250 for utilities, phone and water, that amount is $1050 a month. Subtract mortgage taxes and insurance of $350 a month, the amount is down to $700 a month, Subtract car insurance at $100 a month, it is down to $600. Subtract gas and oil to operate the car at $120 per month, the amount is down to $480 a month. Add costs for luxuries such as toilet paper, cleaning supplies, laundry soap and clothing from Goodwill or other thrift store, at $60 a month, the amount is down to $420 a month…not enough to buy the health insurance… Whatever are the government employees thinking when they run the numbers? Don’t they know how much it costs for the bare boned basics in California, today?

  11. NovAKs47 says:

    Wow, $40k a year, and they want $450+ for that,plus high co-pays?! That’s insane. I make around that amount, and there’s no way I could afford that. What a joke. Guess when I lose my insurance, then that’s it, no more insurance for me! And you can guess what I’ll be telling the IRS when they come a knockin’….

  12. LetitCollapse says:

    ObamaCare is really nothing more than a fraud, packaged and sold as an improved service but actually nothing more than a big tax.

    Senator Gillibrand (D-NY) fully admitted on Face The Nation yesterday that the Democrats were fully aware that Americans would lose their healthcare insurance plans as a result of the ObamaCare implementation when they voted to pass the law. Go watch the replay, if you question me.

    IOW’s, they made claims that were false to get your votes so that they could enact the law. In my dictionary that’s called ‘fraud’.

    As long as you continue to provide your consent to being victims of ‘fraud’ they will continue to lie to you. It’s really that simple.

    Yes, you are willfully being lied to – through bait and switch – and then taken to the cleaners financially by those you elected to office.

    Are you growning weary yet? Or do you like being the victim? Some people do, you know.

  13. doug says:

    whats more disturbing is the customer service guy jose, trying to sell you on getting more govt assistance.

    everything is free and nobody has to pay for anything. the new 99%.

  14. BobA says:

    I haven’t been to this site in months but here goes:

    Get use to ObeyMe-care folks. It’s just the beginning -of the end. The government needs money and next on the menu is pension funds, IRA & 401K accounts.

    What’s best for you and your family is not your choice to make. The government will decide your choices for you and there are many here in this forum who like it that way.

  15. Ulysses Uhaul says:

    Welcome back Bobo.

    We missed you. Teddy will be joyous!

    The current chroniclers are an unsophisticated lot. We need masters of misinformation to bring out the best of the Fair and Balanced posters on CWD.

  16. The Ted Steele Conceptual Abstraction Unit says:

    Well said U Haul—- I missed tjhe doomer Bobo and his simple, unsophisticated home spun psuedo-adequate misinformation!

  17. BobA says:

    Ulysses Uhaul:

    Don’t get use to it. I’m having a house built in another state and my house here in California is now a vacation home for the time being. I thought I’d drop in to see what’s changed. Same clowns and same lowbrow conversations from two mutts who I happen to like and loathe at the same time. Thanks for the laughs though.

  18. Diane Kudisch says:

    I called, it took 20 minutes and I was covered! No problems, just a short wait.

  19. David Sundy says:

    I was lied to about the plan I signed up for. I was told my deductible would be $250. After I paid, then I received documents that state that my deductible is $2000!!! I’m going to cancel my plan and tell them to shove it. –David

  20. Andrea says:

    I just tried signing up now and ironically the HMO is much higher than the PPO. So I don’t think Jose was wrong in his calcs or necessarily was ignorant on the differences of HMO and PPO.

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