Her story demonstrates how critical health insurance is for many people — and disproves the myth that small companies aren’t going to provide employee insurance under the ACA.
For Emily Todebush, going without health insurance simply isn’t an option. In early 2013, the 29-year-old was diagnosed with multiple sclerosis (MS), an unpredictable, often disabling disease of the central nervous system that requires expensive, consistent care to slow the progression of its debilitating effects. Emily shared her story at Eclectablog last year, and it’s well worth reading.
Since writing that post, Emily found herself downsized out of the job that provided excellent health insurance. She was given three months of COBRA coverage fully paid, but she was anxious about making sure she stayed insured. “There was an element of fear that I was going to have to figure something else out if I didn’t find a job in three months,” she says.
She knew she’d have the option of applying for coverage on the health insurance Marketplace because she had a qualifying life event that meant she didn’t have to wait for open enrollment.
Fortunately, Emily found another job quickly. The company has less than 50 employees so they’re not required to provide health insurance under the Affordable Care Act (ACA) — but they provide it anyway.
There was still a concern, though, because Emily’s new employer needed to find an insurance plan to replace the one that was being phased out because it didn’t meet the coverage requirements of the ACA. “They kept telling me ‘We’re going to have a health insurance meeting soon,’ and I thought they must be preparing me for the worst,” Emily says.
It was the exact opposite. Emily’s employer found ACA-compliant plans to offer their employees — and Emily will pay less than she did with her previous employer-provided coverage. Her employer is paying a portion of the premium and employees pay a contribution plus the annual deductible. Here’s how Emily’s plan breaks down.
My contribution toward the premium is $80 per month. My deductible with the new plan is $500 compared to $1,000 last year, and my out-of-pocket maximum is $1,000 instead of $5,000. I’ll blow through the $1,000 in the first month with the tests and doctor’s appointments I need at the beginning of each year.
Once I hit that $1,000 I won’t have any co-pays, even for prescriptions. With my old plan, I was paying about $150 a month for my prescriptions. It’s not like I can skip my medications. They all affect me on a daily basis. If I went just one month without my medications, I’d probably have another MS attack, a return of symptoms — something that hasn’t happened since early 2014 because I’m on the right treatment regimen.
Emily could have opted for a Gold-level plan, but says the Platinum plan she chose — with a slightly higher premium cost but a lower deductible — made the most sense for her. She’s paying $120 more a year in premiums to save $1,000 on her deductible.
She kept all of her doctors, including her neurologist, so her treatment was never disrupted. The only change is that Emily must now get a referral to see her specialists, but she only has to do it once a year and considers it an easy part of managing her disease.
Living well with MS includes getting plenty of rest and managing stress — something Emily says the ACA has helped her do.
Whenever you can take the super-stressful things away, like finding health insurance, it’s good. Fatigue can set me back. When I was working on President Obama’s re-election campaign in 2012, before I was diagnosed, I knew the ACA was going to make things better — and I was right.
Although her employer hasn’t said how much the Gold and Platinum plans they’re letting their employees choose from cost the company, Emily says the fact that they continue to offer coverage disproves the talking point that smaller businesses are going to cut hours or lay people off because of the ACA.
No one here got their hours cut. No one got laid off. Our CFO said he’d find the best option and he did — even though they didn’t even have to provide insurance at all because the company has less than 50 employees. And I’m saving money because of it.
Open enrollment begins November 15th. For details, visit Healthcare.gov.
[Photo courtesy of Emily Todebush.]