Jim Matthews, 48, small business owner, Hanover, N.H.
The short version: After some website fiddling my wife and I are signed up for a bronze healthcare.gov plan with a much (49 percent) lower premium than we could get in the small group market, and I've confirmed our enrollment with the insurer, but I won't be totally at ease until I see that they've actually charged my credit card for the first month's premium.
The long version: I tried signing up on Oct. 1 and ran into a variety of website errors (e.g., telling me that my password was wrong when it wasn't). I set up three accounts with three different email addresses over the course of a week before I had one that worked well enough to show me my actual plan options and premiums.
The 10 Anthem plans (Anthem is the only New Hampshire insurer on the federally run exchange) had premiums ranging from $772 (bronze, $11,500 joint deductible) to $1,269 (gold, $2,000 joint deductible). At this point in the process I paused, waiting to hear from my insurance broker about what it would cost us to renew our small group policy. In early November we got the answer: $1,579 per month for an Anthem policy with a $6,000 joint deductible.
The exchange policies were clearly much better values—I could get a silver plan with a $5,000 deductible for less than $1,000 per month. The exchange plans have a narrower network, but it includes the local medical center where my wife and I get our medical care, so that isn't a drawback for us.
By mid-November I had picked a plan—a Bronze HSA plan with a $11,000 joint deductible for $808 per month. We aren't expecting big medical expenses next year, so I gambled on a lower-premium, higher-deductible option, and I'll put pretax money into our Health Savings Account to use for out-of-pocket expenses. But when I went back to healthcare.gov to actually enroll, I couldn't login to my account. After a number of attempts and a fruitless conversation with a Live Chat support person (who suggested I apply over the phone or on paper), it occurred to me that I could start over. So I created a fourth healthcare.gov account with a fourth email address and breezed through the application and enrollment process in about half an hour on Nov. 12. The speed and stability of the site were much improved from my experiences in early October.
Then I waited, as instructed, for confirmation from Anthem that I'd enrolled and directions on paying my first month's premium. As time passed and I read about problems with 834 forms I got increasingly nervous, so I called Anthem in early December. They confirmed that I was enrolled and told me that enrollment packets were being mailed out. When nothing had arrived after a week I called back. They repeated what I'd heard previously, and this time sent me a website link and an enrollment number I could use to pay my premium. I did so Dec. 11, but so far my credit card has not actually been charged.
Joe McReynolds, 27, defense contractor, Washington, D.C.
I looked at the D.C. exchange to see if there was anything competitive with the insurance I get from my employer. The D.C. exchange was broken the first week I tried it, but it’s been working fine since then. Since I’m not eligible for subsidies, there wasn’t anything competitive for me there; for my wife and me, the cheapest bronze plan on the D.C. exchange was more than double what we pay monthly for our (quite good) HMO coverage.
So far, sticking with my current coverage, there’s been no change in my premiums—if costs are rising, someone’s eating them before they get to me. No lost coverage, doctor changes, or other problems with our current insurance. I have begun to realize just how charmed a life I lead in the health care department by having a private employer making a large contribution.
For someone like me, working his first real job after grad school and having limited experience with the economics of health care, the changes brought on by the Affordable Care Act have mainly served to help me understand just how much health care costs to provide and how hefty that employer contribution ends up being. Seeing how much of my health care is subsidized by my employer, I’m actually pretty impressed now that the D.C. exchange could offer me coverage for only double what I’m paying out of pocket.
As a young and healthy person, philosophically I’d like to be on the exchange in order to broaden their risk pool and make the ACA work (even if it costs more, that’s a small price to pay for a health-care system that covers my friends with pre-existing conditions), but if there’s some way to direct my employer’s subsidy toward purchasing on the exchange, I’m not aware of it.
Rachel Cory, rural health clinic manager, Washington state
In a word, my experience is mixed. Everything has taken longer than anticipated, from the navigator certification process to the general function of Washington state's website, wahealthplanfinder.org. The site continues to experience intermittent problems. I've only walked one person through the application from start to finish. When it worked, it worked beautifully. It made logical sense: As the client answered questions, the site took the information she'd given and led to the next step in the process. It took about 20 minutes. Unfortunately, the site is still plagued with functional glitches and has been unavailable for periods of time.
It must have been incredibly difficult to design this website. There are so many iterations of family sizes and economic statuses, and the site is tasked with processing all of those iterations against a very complex law. It then has to cross-reference this information with other federal sites, then direct the applicant to either a Medicaid application or the health insurance marketplace. I am in awe of the scope of this project. It helps to remember that when I hit a wall with a client.
I have a disclaimer that I give to prospective applicants when they call to schedule a meeting: I tell them that this is a completely new process for the entire country. People expect the navigators to have some magic knowledge that will help them get through the process. The truth is we are all learning as we go. When I present the process in this way, people are pretty understanding and a little less frustrated when we hit glitches.
I've heard mixed reviews from people, anecdotally, when they talk about how their coverage will change. For some, they had no insurance and are thrilled to be able to qualify for full coverage through the state or subsidized private insurance. These are the people who have already scheduled their appointments in January to catch up on the health care they've put off for years. Others have complained that they're being forced to do something they don't want to do. These are the individualists who don't recognize that their choices directly or indirectly affect the industry, and thus other people.