By Trina Ortega
Sopris Sun Correspondent
March 31 marks the final deadline
for individuals and families to enroll in
a health care plan under the new Afford-
able Care Act. While many Carbondale
residents have sifted through their op-
tions, others have yet to wade through the
state system or make a decision on their
health plan.
As planned, for some individuals and
families Obamacare is a saving grace in
terms of medical care and monthly premi-
ums. For others, it’s been a cumbersome
process without positive results, especial-
ly impacted by the higher premiums of a
resort area. The Sopris Sun interviewed
five Carbondale residents/families to see
how they’ve fared under the Affordable
Care Act.
(Editor’s Note: Names have been
changed to honor requests for anonymity).
Janice
Occupation: Self-employed small
business owner
Married: Yes; spouse is self-employed
Dependents: Four children
Question: Past insurance?
Answer: I had Cigna for me and my
three kids that was around $600 per
month. My husband had to be on a sepa-
rate policy because of pre-existing condi-
tions that were very minor. His premium
was around $275 per month. When we
went to add our fourth daughter to the
Cigna policy it was going to be $1,200
for me and the kids, NOT including my
husband — way out of our budget! For
the last five months we have had supple-
mentary insurance for all of us through
Reserve National for around $630 per
month because it is the most we could
afford. However, this does not work well
with kids who get sick and have to go to
the doctor because all doctor visits and
medication are out of pocket; it only cov-
ers major medical issues, which is not
very practical with small children.
Q: Do you qualify for a subsidy under
Obamacare?
A: After speaking with April at Martin
Insurance Group, I applied at Connect-
forhealth.com and applied for assistance.
To my surprise, all four of my children
were approved for CHP assistance. As far
as myself and my husband, we make too
much to qualify for assistance.
Q: Overall, how has this experience
been?
A: After a very confusing and time-
consuming process — making many calls,
being redirected and put on hold for over
an hour so I could try to find out what
the new coverage means — my husband
and I ended up staying on our supplemen-
tary insurance through Reserve National.
It ends up being around $320 per month,
which just covers major medical should
one of us end up in the hospital. It does not cover doctor visits and we still will
get penalized because it is not considered
full coverage through Obamacare (uggg).
However, the plans I was looking at were
going to be around $700 per month for
just the two of us with a crazy-high de-
ductible and out of pocket expenses. So I
am relieved our children are covered but
as far as the rest goes, I think it stinks.
Wouldn’t a universal health care be nice?
Name: Rosie
Occupation: Freelance writer, editor
and marketing consultant
Age: 61
Marital status: Single
Dependents: None
Q: Prior coverage?
A; First, a quick note. I almost ex-
clusively use “alternative” care, includ-
ing monthly preventive visits to the chi-
ropractor and occasional acupuncture
treatments to address minor complaints.
Those services were covered by plans I
had prior in Oregon, where I lived before
moving here. I take no prescription drugs.
In other words, I’m a major outlier at
61! The health care system is not set up
for people like me. Most recently, I had a
high-deductible plan with CIGNA, which
covered nothing until the $5,000 deduct-
ible had been met. … I considered it just
a catastrophic coverage plan. I did not
make a single claim in the year-plus that
I was covered. That plan was costing me
$392 per month in 2013; the rate went up
to $515 as of Jan. 1.
Q: Did you qualify for subsidies?
A: Yes. And I will even if my income
doubles because I’ll still be under the
threshold.
Q: How have you fared under Obam-
acare?
A: Now, under the Affordable Care
Act, I have just switched (effective Feb.
1) to a “Silver” Rocky Mountain Health
Care Plan with a premium of $262.40 per
month and much better coverage. The de-
ductible is $1,500, and I will pay a $40
co-pay when I visit a primary care physi-
cian and $60 when I see a specialist, with
RMHC picking up the rest. I do expect
my income to go up this year, so I’ll no
doubt see an increase in my monthly rate
(or a decrease in my subsidy, however you
want to slice that), but I still expect to do
much better, both on cost and coverage,
than I was doing before the ACA.
Q: Did you have assistance wading
through the system?
A: I started off getting help from Mar-
tin Insurance — they had helped me set
up my CIGNA plan and, to their credit,
they called me way back last spring to
alert me that I might qualify for a subsidy
when the ACA kicked in. Without that, I
probably would never have realized that I
should look into it. So, I met with Karen
there, and she laid out the process and
gave me some good guidance. I didn’t feel
I needed her help stepping through the
application, so I did that on my own.
Q: Advice for others?
A: Consult with a broker who under-
stands the ACA (as Karen at Martin does).
Ignore all the bad press. This is a good
thing for a lot of people, and you might
qualify for assistance without realizing it.
Sue and Charlie
Marital status: married
Ages: 43, 45
Occupations: She’s self-employed as
an editor; he’s in a management position
with a local non-profit
Dependents: Two school-age children
Q: Current plan?
A: My non-profit offers a group plan
with a $10,000 family deductible. The
organization pays my premium. The cost
to cover the additional three family mem-
bers is $860 per month.
Q: Do you qualify for a subsidy?
A: Yes. However, because the addi-
tional family members are offered cover-
age — whether we accept it or decline it
— we are automatically ineligible for any
subsidies. Until the deductible is met, all
costs up to the $10,000 are out of pocket.
Q: How have you fared under Obam-
acare?
A: We are considering going with no
coverage because we cannot afford to
pay monthly premiums of $860 as well
as “everyday” medical, vision and dental
visits. We have not decided if that is the
best option with two young children, so
we cashed out on one of our IRAs to help
us through this first year. That should give
you an idea of how we are faring under
the Affordable Care Act. Not sure what
the smartest plan is: draining our IRAs,
savings and college funds to pay for of-
fice visits plus monthly premiums or risk
having to pay exorbitant hospital bills
should one of us get sick or have an ac-
cident. Either option is going to crush us
financially.
Betty and Norman
Marital status: married
Occupations: self-employed (one as a
freelance writer/instructor one as a small
business owner)
Prior Coverage: They have been here
two years from the East Coast. “We both
were working full time, and we were
on my husband’s insurance because he
worked for a major corporation, and I
worked for a small business.”
Q: Did you qualify for a subsidy?
A: Because we have money in savings,
we can’t qualify for any subsidies.
Q: Current coverage?
A: We have decided to not have insur-
ance. We’ve been without for two years
since we moved here to the land of self-
employment and working part-time jobs
that don’t provide insurance. Even $300
a month is too expensive for us. We were
looking with interest when this would
shift over to Obama; we said, “Great,
maybe this will be an option for us.” Then
my husband got a quote for $897 per
month for him only. On some other site,
he got a quote for $825 for the two of us.
When you’re faced with so many choices,
and it’s so confusing to find information,
it’s often easier to stick with what you
know which is nothing.
Q: What if you need health care?
A: That is our choice to make sure
we’re exercising and eating as much fresh food as we possibly can. This is a con-
scious choice on our part. Stress is one of
the number 1 causes for disease and we’re
really aware of that. We make sure that
we build in time to have fun and to do
social things that elevate joy and combat
stress.. … My husband’s line of work re-
quires worker’s comp, so at least he has
that.
Q: Thoughts on the Affordable Care Act?
A; This conversation is definitely a na-
tionwide conversation. I have a freelance
single female friend in Austin, Texas,
who’s better off with Obamacare because
the rates are better there. It’s so clear that
being categorized as a resort area is im-
pacting our ability to have coverage [be-
cause the premiums are higher]. Yes, we
are anchored by a resort activity but the
people who live in this valley service the
resort activity. I think there is an impor-
tant distinction from the state aspect —
it’s a resort but if you punish the people
who are making the resort run, you’re
shooting yourself in the foot. I understand
the spirit of Obamacare, but it missed the
mark considerably.
Chuck and Tanya
Occupation: Small business owners
Age: 63, 65
Dependents: None
Q: Prior coverage?
A: For years, my wife and I had group
insurance through our small business. It
was just the two of us as a “group.” Be-
cause of pre-existing conditions, it was
very expensive. The last time premium
had been increased to $2,300 per month.
To pay more than $2,000 for premium —
that’s nuts; that’s more than a mortgage.
So we kept moving around, changing car-
riers, getting a little better deal. Then we
qualified for Cover Colorado, [the now-
defunct state-assistance plan for individu-
als with pre-existing conditions]. Then
our premium was $1,600 but with much
better coverage. That came out to be $823
per month for my wife, who needed a
unique plan.
Q: Current coverage?
A: Under the Affordable Care Act, she’s
paying $250 for a plan that is at least as
good. And I would be paying the same if I
needed a plan, but I’m now on Medicare.
So we moved around, changed carriers,
got a little better deal. Now our premium
is $1,600 but with much better coverage.
Q: Did you qualify for subsidies?
A: Yes.
Q: Did you seek help in wading through
the system?
A: We didn’t use a broker. The first thing
you have to do is qualify for a subsidy or
get rejected by Medicaid. That’s a little
bit of a pain. Once you get rejected, you
get an authorization number and look
through the plans. Shopping for a plan on
the state website is easy.
Q: How have you fared under the Afford-
able Care Act
A: It’s definitely saving a bunch of money,
so that’s a good thing .
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