The need for healthcare reform, be it Obamacare or some other plan, has become more apparent. This i...

1. Looking Past The Glitches, Obamacare Provides Health Care
for More People
The need for healthcare reform, be it Obamacare or some other plan, has become more apparent.
This is especially true if you have tried to buy insurance for an individual. It is easy to do, as long as
you have never been sick, injured or take one or more medications to control a condition that at one
was possibly fatal.
Let me explain.
After 22 years with the same company and a gold-plated group insurance plan, the day came when
that job was eliminated. A generous severance package was part of the going-away gift as well as
the company paying one-year of COBRA insurance coverage. COBRA is the federal act that allows
you to take your benefits with you when you leave a job for up to 18 months.
The company agreed to pay the premium for 12 months of COBRA coverage, as part of the
severance package. The cost each month after that was going to be $1,700 for yours truly and
spouse. That is a little steep when you are unemployed. However, being one to plan ahead, I began
an immediate search for alternate insurance via the Internet. A word of warning does not try to
purchase insurance over the Internet. My goal was to find out what was out there, get an idea of
what kind of coverage was available and some idea about the price.
Most businesses would not talk to me until I was one-month away from losing my COBRA coverage,
because prices could change. So I stepped back. As efforts to secure a new job continued to be
unsuccessful, it looked like it was a good time to start an insurance hunt again.
Using the Internet
So you start your favorite web browser, type in the words "health insurance," and all sorts of offers
pop up, most of them showing many lines of insurance, including the big-name companies' common
to your area. The phone calls started immediately, even before the online form was completed. It
seems that many of those sites started selling my name lead to various brokers that represented
many companies. You fill out the form, age, height, smoker or non-smoker, followed by spouse, age,
height and weight, a smoker or non-smoker. They ask for the phone number, zip code, city, state and
address. However, before the form is finished someone is calling offering you the deal y. They have
few questions. The first being does you, or your spouse had any prior health conditions. The reply
was, "Of course we do. We are 60 years old. We take medication to control all the conditions."
They want to know the conditions. Starting with myself, the first condition I mentioned was that I
was technically a Type 2 diabetic patient. Without delay, you learn, "I'm sorry sir. You are not
eligible." I explained that I took no medication or insulin. My blood sugar is about 85 most mornings
(Max you are allowed is 129). My A1C, a test to measure blood sugar over time, ranges from 5.7 to
6.1. The maximum for a non-diabetic person is 7.0. The maximum level for a diabetic is 6.5.

2. Therefore, regular insurance was not available. You need to be part of a group; then the preexisting
conditions cannot keep you from being covered. There are all kinds of groups out there offering
insurance, but the insurance is not "major medical" insurance. It will provide limited coverage for
some of your medications, some doctors visits and a daily rate for a hospital stay, with is nowhere
near what most hospitals charge. The policy has maximum limits on everything. The prescription
coverage is so poor that I decided to get my medications from Canada. I once had a perforated
colon. The retail cost was about $120,000. These new limited group plans would not come close to
covering it. Some are better than others, so you have to shop around. However, you are not going to
find the coverage you are expecting.
Conflicts Within Federal Program
I have canceled two and am on my third plan. However, there is hope, the government has a
program in place call the Preexisting Condition Insurance Plan (PCIP). Some states operate their
own plan and in others, the federal government administers the plan. Basically, it provides
affordable coverage for people with preexisting health conditions. So problem solved, right. Wrong.
To qualify for this coverage you have to go six months without any insurance coverage or without
credible coverage.
You have to have been turned down for health insurance by a private carrier and have a letter from
the insurance company. You also need a letter from your doctor attesting to the fact that you have
these conditions. Few people want to go without insurance. That is where the Internet group plans

3. come into play. They are not actual insurance plans. They are indemnity plans. They do not offer
major medical coverage. In fact, you could be using one company for prescription coverage, another
for lab coverage and so on, thus the plan does not meet the definition as listed in the PCIP rules.
However, this health care agency has a different definition.
The PCIP appeal's person remarked in one conversation that any policy that pays for any event is
considered credible. The amount the policy pays is not an issue. Thus if you are unwilling to go
without any coverage for six months, you cannot get into the plan. Remember, this is the plan that
was designed to aid people with pre-existing conditions.
It is an old story, instead of trying to get Medicaid or some other government assistance, a person
take responsibility to get whatever coverage he can, will make himself ineligible for the government
program he needs. Furthermore, this is not a free program. The premium for a couple, age 60 or
higher is between $800 and $900 per month. The PCIP plan is an 80/20 plan where you are
responsible for 20 percent of the cost. However, there is an out-of-pocket maximum.
Changes Will Come With Obamacare in 2014
I offer these comments only as an observer. I am not insurance agent or broker. I do not work for the
federal government. I am not a lawyer. I am a 62-year-old, unemployed man, anxiously awaiting
Medicare. It is my hope to find a job, but after filling out about 100 applications for a combination of
state civil service and private industry jobs, I am beginning to have doubts about the possibility of
ever being employed again. Some people qualify for Medicaid, which provides some help.
Actually, the real name of the plan is the "Patient Protection and Affordable Care Act."
I do not think you can fund this program by cutting Medicare to the doctors. My family doctor is in
the office from 7 to after 5 p.m. He has called me with test results from his home later in the
evening. My private insurance, with my co-pay was paying about 60 percent of what he charged. I do
not begrudge doctors making money. They spent four years in college, four years in medical school
and at least a year, maybe two, working as an intern, before they could start making a decent living.
The overhead is high, and they are smart people. I could never be a doctor. So cutting their
Medicare reimbursements is not the answer. Now, checking for bad apples in the barrel that
overcharge for nonexistence patients should be found and handled in the proper manner.
However, that is only one part of the problem. The issue is complicated and so is the answer. I think
we are going to have some rough years ahead as health reform is sorted out, retooled and re-invented
on an as-needed basis.