Obamacare’s Doctored Coverage



The Anthem Blue Cross representative could not have been more helpful earlier this year in pointing me to a new health insurance plan, one which lowered the monthly premium for my family of five yet maintained an adequate level of coverage for us. Most importantly, the new higher-deductible plan saved us a couple of hundred dollars a month in premium costs. Among other things, it covers three sick-person visits to the doctor for each of us per year with a reasonable co-payment when visiting in-network doctors. Fortunately, we are in good health and do not require frequent health care, so the limit of three covered office visits is not a burden.

Surprisingly, the representative also guaranteed that the $666 monthly premium would not increase for the rest of this year. The plan, and every other Anthem policy available to individuals in California for that matter, did not meet federal requirements under the Affordable Care Act, he explained. As a result, it would not exist beyond Dec. 31. So, as a bone to its individual market captives, Anthem would not increase the premium for the remaining 11 months. We could then buy new insurance through the state’s Obamacare exchange for coverage in 2014.

I have visited the state exchange, CoveredCA.com, and what I found is not encouraging. In fact, it’s frightening, with few policy choices, higher monthly premiums and higher out-of-pocket costs.

After inputting financial information, the number of people to be covered and their ages, and our ZIP code, the website produced options for coverage in each of four color-coded tiers (bronze, silver, gold and platinum) as required by federal law.

The bronze plan options, which feature the lowest premiums and highest deductibles, for example, were disappointing and hardly affordable. For starters, the bronze offerings included just three carriers, including two HMO providers and our current carrier, Anthem.

Relieved to see Anthem, which has provided my family’s health insurance policies for nearly 10 years, I was stunned by the $900 monthly premium, not to mention higher out-of pocket costs. Like our current plan, Anthem’s Obamacare policy would cover three doctor visits per person per year, but with a 35 percent increase in the monthly premium.

The sticker shock did not end at the premium. Our doctor office co-payment would double from $30 under our current policy to $60 under the Obamacare policy, and in the event of a trip to an emergency room, our co-pay would triple from $100 to $300. Our current policy includes no co-pay for an urgent care visit; Obamacare would hit us for a co-pay of $120.

Midlevel silver plans and upper-tier gold and platinum plans offered lower out-of-pocket costs, but considerably higher monthly premiums, putting them out of reach.


As one who is self-employed, I don’t have the luxury of employer-provided insurance. Since 2004, I have purchased health insurance on the individual market and every year or so, I managed premium increases (of no more than 20 percent) by moving to higher-deductible plans with less robust benefits.

I am not complaining, nor am I looking for sympathy. The plans my family has had over the years have protected us against catastrophic illness and injury, and little else. And that’s been fine.

Under Obamacare, however, there appears to be no alternative to significantly higher premiums and out-of-pocket costs. If we want insurance, we will have no choice but to shop through the exchange.

The new normal at our house could mean living without health insurance, which would result in penalties at tax time. In the meantime, we’ll take our chances that we won’t get sick or hurt.

We’ll stash a few bucks in a health savings account and pay as we go to the doctor. If, heaven forbid, my wife or I receive a cancer diagnosis, we’ll go straight to the exchange since carriers will be prohibited from denying coverage because of pre-existing conditions. How’s that for a perverse incentive created by a flawed law?

Back in January, the Anthem representative could not predict Obamacare prices, but now we know. And the more we learn about the Affordable Care Act, the less affordable it becomes. It’s open season on individual health insurance consumers.

Steve Duchesne is a public relations consultant. He lives in Redondo Beach.

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