Today's update #2

Application process for me, wife & daughter … 45 minutes to complete the household/personal data/ income & elgibility summary. Wife is employed, her's was simple. I am self-employed and so it was more complicated. I spent at least 25 minutes calculating the current month's income and deductions. I wasn't prepared with that data at my fingertips … finally figured out to include the self employment insurance paid, the self employment tax, and expense deductions (materials, home-office, etc.) all calculated from my 2012 return. Also deduct student loan interest paid. Double checked the summary then electronically signed and submitted.

Two things happened next. I am told that for a policy with an effective start date of Jan 1, 2014 that I must enroll into a plan by Dec. 15, 2013. I must submit documents verifying income …. for me it's IRS Account Transcript summary sheet of my 2012 tax filing I already received from student loan applications, otherwise it would be pay stubs or the full tax return. I can send them that right away unless I feel it's too damn easy and I should wait a day or something.

Then, I'm presented with the eligible plans for me to choose.
I'm going with the Silver Plan and choose between California Blue Shield PPO 70 @ $506/mo. or the Anthem Blue Cross PPO 70 @ $619/mo.

Both have no deductible, $45 copays, $6350 maximum out of pocket.

The only info to find out now is if my doctor & lab will accept the Blue Sheild plan.

Even with the more explensive Anthem Blue Cross plan I will save about $2500/yr on premiums. If I choose the Blue Sheild plan I'll save $3770./yr on premiums.

I would guess that compared to my last 2 months experience and I have similar work in the coming year, lab / xray/imaging/ pharmacy copays will save me another $2000 - $3000.

Excellent info... thanks.

Kudos to you Gary !

I think your analysis of the more successes, the more that will come will be true...

The GOTP is basking in this rollout hiccups and some think it'll save them, but once this passes (and we all know it will) they're still be the wacko, screwed up, bat-sht crazy Party ! We just gotta hang tight for a few more months until the enrollment gets there.

Enrolled. <ta da!>




Began earlier this morning making a few calls to the hospital group which my doctor belongs to confirm their acceptance of the two PPOs I was considering. Seems they are not licensed to take California Blue Shield which was the less exensive plan. They accept Anthem Blue Cross for for all doctors visits, labwork & radiology/imaging. It's my choice to pay a bit more to keep my doctor, others might chose to pay less and find a doctor that will accept their plan.

I called the CoveredCA phone line to ask a specific question. I was on hold for 15 minutes, then got the info I needed in less than 5.

In the Silver 70 PPO Plan I chose it listed Deductible (Individual/Family) as not applicable. Most all the Silver 70 plans offered had it listed this way. More expensive Gold & Platinum plans were much more expensive and had $0.0 instead. I didn't understand the difference.

So here's where reading through all the itemized information in your plan can make or break a deal. The "not applicable" listing was there because there is a separate itemized Medical deductible (individual), mine was $2000. So now I see that my plan has this deductible, and all copays and percentage of co-insurance pays apply to this amount. These costs plus premiums paid will never be more than $6350. for me, or $12,700. for my whole family.


Bottom line for me is that I'm paying less than my current plan and have better benefits. The more I've found out about policies offered in the exchange I see that my current policy may not technically be a "junk" policy, but it sucks all the same. Through the exchange I'm buying better and cheaper from the same insurance corporation.

The final decision was to compare my current plan as a point of reference with the new one for my family of three offered by the ACA.
* Premiums are around $2500/yr less
* Current policy with Anthem Blue Cross has a deductible of $7500. the new one is $2000.
* All labwork was 30% of costs, new plan is a flat $45 copay.
* Old plan had no limit to maximum out of pocket, new plan limit is $6350.

This works for me in a big way.

I know we've all read about these slogans and pitches by Obama and ACA advocates, but let me tell you in all honesty that when this reality hits you in the face see the big picture of what's going on here.

I told you guys a few days ago I had a medical emergency that sent me to the ER. If I had been admitted, needed surgery, needed a hospital stay … my current plan (which costs more than the one I'm enrolling in) would still leave me holding a bill for probably tens of thousands of dollars. I would have to cash out all my savings, borrow money, or possibly sell my house, even have my daughter's college put on hold …. with this new plan offered through the ACA none of that could ever happen. I am incredibly thankful the timing happened for me this way, it is entirely possible that without the ACA regulations in place my current policy may have never been renewed because I got sick.


Since I began on Friday, total time on the Covered CA website to enroll was less than an hour.
I spent about 2 hours over the weekend reading up about all this stuff, 10 minutes getting all our income documentation from my files.
I spent 30 minutes on the phone getting info I needed.
My wife & I spent an hour with my sister-in-law signing her up, chatting, and having a glass of wine, talking about the release of anxiety in getting this all figured out.

I've spent maybe 2 or 3 hours writing about all this here.

Edit: Re-reading last night's post I realized the entire time spent on the CoveredCA website was actually more like 1.5 hours because I did an initial look at policies on Friday afternoon. The website always worked flawlessly and on login always had all my prior input data in place. I've tried my best to be acurate with the numbers and give a true account of my experience.

Where I stand today:

The last item from the enrollment was a confirmation notice. Specifically :
"Congratulations! You've completed the checkout process from the Exchange. You information will be sent to the insurance company that carries your plan. They will contact you with billing information to complete the enrollment process, which is finalized when you provide payment."

Congratulations! Just goes to show how things actually can work when people take the effort to make them work =)

Just to confirm, since it's my understanding: the $6,300 out of pocket maximum is an annual maximum, not a lifetime maximum, correct? (Still a great thing vs. emptying your life savings ;-)

I'm still mulling-over my options. On the healthcare.gov site, those options are basically some flavor of Blue Cross or Kaiser. There's a third provider, but they're way too pricey. I currently have coverage with Kaiser and sadly they're not offering anything direct that's not already on the exchanges. It remains to be seen if my current coverage will be grandfathered under Barry's recent edict and I can keep it for a while longer, or if I really have to bite the bullet and get one of the more expensive (and better) plans off the marketplace …

Yes, the Maximum Out of Pocket are the annual amounts per your policy, just like deductibles. Maximum out of pocket applies to both individuals and families. For example, my individual out of pocket maximum is $6350. My family of 3 has a maximum out of pocket of $12,500.

I got a letter yesterday that my current policy, previously stated to be cancelled on Jan 1, 2014, would be extended through February. They added 2 months on to the cancellation date due to Obama's actions last week. Too bad suckers, I don't need two stinkin' months


The Bronze plans look like they should be avoided if possible. They all carry a deductible (about $3K-$5k) and that's why the premiums are really low. But if you read the details, copays don't become effective until after the deductible is met. Not so in the Silver and above plans, copays are applied toward your deductible.

Recieved confirmation of acceptance from Anthem Blue Cross earlier this week. Set up payment options, initial payment made and the thing is done.

That's how it rolls. Thank you California for making it simple. Thank you ACA for getting me and my family more coverage, better coverage for less cost. (And I had the choice to keep my doctor.)

You mean, there's hope after all?

Hey, I betcha Daryl Issa would love to have you testify at his ObamaScare Tour.