WHY I LOVE THE ACA

I live with narcolepsy, severe chronic depression, and other chronic health conditions. Without health insurance I cannot afford treatment, and without treatment I am unable to work.

My COBRA benefit ran out in July 2012. The next month I suffered several seizures and had to be transported to the E.R. and kept overnight for observation. The emergency room, diagnostic tests, hospital stay and ambulance ride cost roughly $5000. An individual plan at this time, most of which would not have covered all of my needs, was unaffordable at approximately $1200 /month or 14,400/year in premiums. A few weeks after my COBRA benefit expired NO plan covered any of my existing conditions.

A few weeks after the October 1st launch, when the Affordable Care Act market place opened, I was able to log on to the New York State marketplace. In less than an afternoon I compared plans, and made a few phone calls to ensure my prescriptions would be covered. As of January 1st I will have an excellent plan, for a cost that my family and I can afford, which includes: 

1) No deductible – full coverage begins immediately after my first premium payment. 

2) All my pharmaceuticals are covered, including specialty medications which, at approximately $5,000 for a 28 day supply, I cannot otherwise afford. 

3) An annual individual maximum (AIM) for out-of-pocket costs for physician and pharmaceutical co-pays and other co-insurance (diagnostic tests, hospital stays, surgery, etc.) This allows me to know the exact MAXIMUM I can expect to pay in year for my health care. Something I had been unable to do with my prior employer provided plans.

4) My new annual health insurance costs will be less than two months of my current out-of-pocket pharmaceutical costs, and less than my previous COBRA coverage, which lacked an AIM. Put another way, it will cost just slightly more than what I paid for the treatment required from the seizures I suffered last year. 

I can now hope to live a functional and healthy life. THAT is beyond priceless.