Affordable Care Act, healthcare, Obamacare — December 10, 2014 at 9:16 pm

Texas man no longer pays the price for his pre-existing condition, thanks to the ACA


After years of going without or paying steep premiums, he finally has insurance that covers the care he needs.

Tom admits he’s made some bad decisions in his life. But signing up for insurance under the Affordable Care Act is not one of them.

He contracted hepatitis C after using intravenous drugs for the first time at age 15 — something considered a rite of passage for anyone who wanted to be a Blues guitarist back in the 1960s, like Tom did. He quit using IV drugs years ago, but the damage to his liver was already done.

Tom is the father of four and works in real estate. Because he’s self-employed, he often had to do without insurance or buy coverage with a monthly premium of $1,000 that didn’t cover anything related to his hepatitis C.

One treatment he tried cost him $20,000 a month because he was paying out of his own pocket. The side effects made him so sick he had to stop the treatment, and his hepatitis C returned.

In 2013, when the Affordable Care Act (ACA) Marketplace opened, Tom jumped at the chance to finally buy coverage that wouldn’t penalize him for having a pre-existing condition. He found a plan that cost $773 a month (he doesn’t qualify for tax credits) with a $3,000 annual deductible. And the timing could not have been better, he says, especially considering the exorbitant cost of some medications.

I found out about this pill that can treat hepatitis C without the side effects. I took two pills a day for 90 days — and it cured my hepatitis C. Without insurance, those two pills would have cost me $2,000 a day. With my insurance I only paid a $15 co-pay.

Unfortunately, the hepatitis C wasn’t treated soon enough to prevent Tom from developing cirrhosis of the liver, which requires ongoing care to keep it from advancing. He was also recently diagnosed with a genetic form of lung cancer, which was found early enough to treat successfully. But he’ll still need frequent check-ups to keep an eye on both conditions, all of which will be covered by his insurance — something that wasn’t always true before the ACA was passed.

For 2015, Tom switched from a Silver plan to a Gold plan. His premium will cost $1,020 for medical and dental coverage. His deductible will go down to $1,500 a year and his annual out-of-pocket maximum will be just $3,500. His income is high enough to disqualify him from receiving any tax credits, but he’s still getting better benefits for the same premium he was paying before the ACA.

Tom understands that premiums are only one factor in the cost of insurance, so he did his homework and realized a higher premium made more sense for him.

I’d rather pay more per month than have all these out-of-pocket costs. When you get to a certain age or need a lot of check-ups, it’s better to pay the monthly premium.

He was also able to include his 16-year-old daughter on his plan, for an extra $223 a month.

“This insurance thing is the best thing that’s ever happened to me other than having my kids,” Tom says. “I want to be around for them.”

There’s still time to enroll for coverage that starts January 1, 2015. Sign up through before December 15! Open enrollment continues through February 15, 2015.