Update on the nightmare

We got a year's reprieve, but we're back where we were a year ago:  at the mercy of Obamacare.  This week it occurred to me that a catastrophic plan might be the way out.  It turns out to be devilishly difficult to find any information about catastrophic coverage, because they're so bad for you, so you shouldn't find out about them, even though they had to stick them in the law to quiet some nervous senators down or something, but they weren't serious about them, I mean, come on.

Here's scoop as far as I can make out:  Originally, the ACA provided that you couldn't get catastrophic coverage unless you were under 30.  By "you can't get it," I don't just mean you'll be fined (or taxed, or whatever) for not having eligible coverage, I mean an insurance company can't or won't (hard to tell) offer it to you.  Late last year, however, when the Obama administration was feeling heat from the millions of Americans who had their coverage terminated because it was too affordable, they announced a special exception:  you can be under 30, or you can prove you had your insurance terminated and you "believe" the available replacement insurance is too expensive.  They couldn't bring themselves to say it actually was more expensive, just that you had some kind of irrational right-wing belief that it was.  Whatever:  my irrational right-wing belief apparently qualifies, so that's all good.

But now comes the tricky part.  Who offers such insurance, what are its terms (especially its network), and what does it cost?  Ah, that's not information anyone is prepared to share with us just yet.  Wouldn't you like a nice metallic plan instead?  No?  Well, we don't offer catastrophic plans, anyway.  Who does?  No one does.  Nope, not anywhere in the country.  OK, that's not quite true, because occasionally a broker does find one; Humana offers a rather cheap one right here in my county.  Unfortunately, it's an HMO, a spectacularly useless form of catastrophic insurance, because if we hit that sky-high deductible we're going to want a real doctor, thank you.  But it's a start:  if there's one, there may be others.  They're not entirely mythical.

Now comes the really hard part.  Most agents and insurers insist that the only way to find out about catastrophic coverage options is to go to healthcare.gov and fill out an official application.  Not only is that a monumental pain, but we've heard horror stories all year about people who started the application process, hated the options, and tried to withdraw, only to find the spider web wasn't prepared to let them fly away.  Some even found they'd been signed up for a plan, or for Medicaid, despite never having clicked on any "options."  Too bad:  if you even want to find out who offers a catastrophic plan, or what it might cost, this is your only route.  Eventually, it's unavoidable, because you won't be able to finalize any purchase of catastrophic coverage without a note from Healthcare.gov giving you a special hardship exemption code, anyway.  As best I can tell, the website won't even generate the options until you have the approval code.  The website's information page does explain helpfully that, if you qualify, you'll still have to go to the insurers to get the real scoop on the plans.  The insurers, on the other hand, refer you back to the website.

While I was making up my mind whether to break down and file a formal application with the government, I discovered a little squib on a Cigna site.  Cigna doesn't offer any catastrophic coverage (big surprise), but they were kind enough to provide a better explanation than "you really wouldn't like this; go log onto Healthcare.gov and leave us alone."  They explained the special December 2014 expansion of the hardship exemption that I mentioned above, and they added one more piece of information that kills the whole deal for us:  pre-existing conditions are excluded from catastrophic coverage by a special exemption from both HIPPA and ACA requirements.  We have semi-affordable catastrophic coverage now with no pre-existing condition exclusion, because we bought it a long time ago when we were healthy, the way you're supposed to.  But now that it's being taken away because it's not good for us, the only way to replace it with catastrophic coverage is to lose coverage for the pre-existing conditions we've thoughtlessly developed in the meantime.  Because, you know, the whole point of the ACA was that pre-existing condition exclusions are a crime against humanity.

What's more, even if we didn't have pre-existing conditions, there's an admirable Catch-22:  despite the President's December 2014 announcement, the bureaucrats insist that you have to establish a "hardship."  If your income is too low, you may have a hardship, but it doesn't count because you can get a subsidy.  If your income is too high, you can't get a subsidy, but they'll insist you don't have a hardship, and you can't get permission to buy a catastrophic plan.

I have to tip my hat to these people.  When they write a Kafkaesque law, they put serious effort into making it nightmarish.


Ymar Sakar said...

The amount of money they are filtering through the bureaucratic laundering layer is amazing. If they put their minds to it constructing water filters and de salinization nuke plants at California, world's water source would become extra viable.

Grim said...

I'm beginning to think we're going to end up with that British/Canadian style system after all -- everyone may ultimately agree it's just better than this.

Anonymous said...

My condolences, Texan.

I'm sure just about everyone has a pre-existing condition thoughtlessly developed over the last few years too...

raven said...

I found some catastrophic type insurance, but it covers no pre existing conditions- it is very strict on what they will cover- basically it is a last ditch protection against the necessity of immediate critical care, like a M/C accident or the like. If I need any routine surgery ie knee replacement , hernia, etc I will go overseas or to the Oklahoma Surgery Center.
So far those bastards cost me my insurance and my doctor- I will not forget this.

Elise said...

Horizon BC/BS of NJ offers a "catastrophic" plan - they call it "Horizon Advantage EPO Essentials". You can log into their website and tell them you're under 30 if you want to play with numbers. Just for fun, of course, since neither you nor I can actually buy such a plan.

I'm where you are with my "grandfathered" health insurance expiring on December 15. If I stick with BC/BS, I can get a plan with a decent network but no out of network benefits. If I go with Amerihealth, I can get out of network benefits but a narrower network. We're leaving NJ and, at least for 2014, the options were better in Alabama. We'll see if the same holds true in 2015.

And, speaking of narrow networks, I thought the graph here was interesting:


And by "interesting" I mean "enraging".

Texan99 said...

Just read it. Yep.

Elise, if you're not aiming for subsidies, have you tried looking at companies that don't offer plans through the exchanges at all? Last year Assurant looked good to me. The prices were nearly the same, but their network was better. They have the usual metallic plans, all ACA-compliant, but they were determined to stay out of the exchanges. I don't know if they've kept to that intention.

Elise said...

In 2014 (and my renewal would still be considered 2014) the only three companies offering individual health insurance in NJ were also in the exchanges (BC/BS, AmeriHealth, and one of the ObamaCare co-op things). I appreciate the suggestion, though, and will check it out in Alabama.

Ymar Sakar said...

everyone may ultimately agree it's just better than this.

And you still think that's an accident? Of weaklings like Ayers, accidentally bringing us to this.

raven said...

I went to my Dem Rep's meeting and tried to explain to some folks that I was brought up to believe a man takes care of his family, works hard to provide for them, takes pride in being responsible and a good provider, and that to my ancestors being on the dole was shameful and only a last ditch measure to be considered if your kids were starving.
They looked at me like I had snakes in my hair.