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Medicaid a Life Saver

8th April 2015 by Admin Comments Off

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Jessica Palys, a CBHC Navigator, first met Chris in October 2013. They initially had several phone conversations in which he explained that he strongly preferred not to enroll in the Medicaid program. Chris changed his opinion following a health crisis and he now claims to be a “poster boy” for Illinois’ expanded Medicaid program. To respect Chris’ privacy, we’ve agreed not to use his last name.

Chris lost his well-paying job due to downsizing in early 2013. Despite holding multiple college degrees, he still hasn’t been able to find work. “I had offers for $20 an hour and passed those by,” says Chris, who is over fifty years old, “Had I known what I was getting into, I would have taken those jobs.”

His former employer paid COBRA premiums for the first 6 months as severance. Chris then took over the payments himself. On his fourth month, he was one day late with his payment and his policy was immediately cancelled. “Consider that we paid them around $9,000 without a single claim, and they cancelled me for being one day late. What kind of business does that?”  This was in late 2013.

Chris had already tried unsuccessfully to purchase insurance independently as COBRA is very expensive. He was denied coverage due to “trumped up” pre-existing conditions, which was a common practice at that time. When his COBRA policy was cancelled, Chris was told by a health insurance broker his only option was to wait for ‘Obamacare’ to take effect and pray nothing happens in the meantime.  Imagine how that felt, for the first time his life Chris had no health insurance whatsoever!

In early October 2013, Chris attended an event to learn how he could get coverage through the new Health Insurance Marketplace. Afterwards, he completed an application on healthcare.gov. He was dismayed, however, when the system found him eligible for Medicaid. He was very resistant to the idea of being on Medicaid, and tried to figure out ways to conjure up enough income to qualify for Marketplace coverage, a difficult thing to do since he was still unemployed. He eventually relented and applied for coverage through Illinois’ expanded Medicaid program. After several months of waiting, he received his medical card in May of 2014.

6 months later, Chris had reason to be thankful for his Medicaid coverage. The weekend before Thanksgiving, he noticed severe stiffness in his calves, which was soon accompanied by pain in his rib cage. Soon the pain became so intense that he decided he needed to go to the emergency room. There he was given an x-ray and CAT scan in an effort to determine the cause of his overwhelming pain. After hearing about the stiff calves, the doctor immediately suspected the pain in Chris’ rib was actually a blood clot in his lung (Pulmonary Embolism). Chris was also developing pneumonia and coughing up blood, and he thought about the possibility that he may die that day.

The doctor did more tests and found 2 clots in Chris’ lungs and 2 more in his legs.  Chris was admitted to a hospital on a Tuesday night and discharged the following Friday. “It was the worst Thanksgiving meal I ever had,” he says.  Yet he survived thanks in no small part to his Medicaid coverage.

Chris’ long-term treatment is coordinated by a Primary Care Physician who is working with a hematologist to get Chris off blood thinners, and a pulmonologist to ascertain the damage in his lungs.  Shortly after Chris’ hospital stay, his pulmonologist ordered another sonogram, a CAT Scan, and a PET scan to rule out cancer.  After 6 expensive tests and 3 nights in the hospital, Chris is certain he would have been in debt somewhere between $50,000 and $100,000 if he had been uninsured.  “If I still had my COBRA insurance, I might be on the hook for ten or twenty thousand dollars while being unemployed,” he says. “Before Obamacare, I couldn’t get insurance.”

As he continues to work through these serious medical issues, Chris is incredibly thankful for his Medicaid.  “I don’t know what I would do if I was in Texas, or North Carolina. I’m fortunate to live in a state with strong Democratic influences that embraced Obamacare. In fact I have become a “poster boy” for Illinois’ expanded Medicaid program and I am grateful!”

Good ACA Experience Leads to Renewal for Another Year

13th January 2015 by Admin Comments Off

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When we first talked with Keith Moens, he and his family were emerging from a long period without health insurance. Having signed up for health coverage through the newly-opened Health Insurance Marketplace, they were pleased to finally have coverage again. Now, a year later, they are happy with their Marketplace plan and have recently renewed it.

Before losing their jobs, Keith and his wife never had to worry much about health insurance. It was provided by their employers. Suddenly, they were faced with several untenable options: paying exorbitant premiums for COBRA, finding a private plan despite Keith’s wife’s preexisting condition, or living without health coverage and paying healthcare costs themselves on a limited budget.

The opening of the Health Insurance Marketplace marked a dramatic improvement for Keith’s family. In late 2013, Jillian Phillips from the Campaign for Better Health Care helped them find an affordable plan covering the care they needed. Because of new regulations under the ACA, no questions about previous medical history prevented them from buying their chosen plan.

Keith says that using the new insurance has also been a learning opportunity. Initially, the relatively high deductible on the plan was a cause for concern. But they’ve come to understand that many of the health services they use are considered “Essential Health Benefits”, which are covered under the ACA. They can also get most of their prescriptions filled with a small co-payment. Keith is pleased to report that they don’t spend anything close to their deductible and that their premium payment will actually be a little lower in the second year.

“It’s an immeasurable load off the shoulders to have health insurance again”, Keith says. “People who want to repeal the ACA have never lived without insurance,” and should “try going without insurance” to understand how difficult it is. Thankfully, his family no longer has to face the uncertainty of living without health care coverage.

Coverage at an Affordable Cost

26th November 2014 by Anya Krenicki Comments Off

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Bill Koclanis 

Oak Forest, IL

The Affordable Care Act has finally made health insurance accessible to Bill Koclanis and his wife.

“It brought insurance down to a price that a person could actually pay,” says Koclanis.

Prior to obtaining a Marketplace insurance plan, Koclanis and his wife had been covered under a health savings account (HSA) for about a year and a half.

“The price had gone up considerably from the time we had taken the health savings account,” says Koclanis. “[The monthly cost] probably jumped $400 or $500. We’d get letters saying ‘You’re 60 years old now,’ or ‘You weigh this much and you’re only this tall.’”

With each notification came an increase in price, says Koclanis. He and his wife didn’t know when to expect a price increase; he says that it seems the bill would climb every few months.

In January 2013, Koclanis attended a seminar on the ACA led by a former Campaign for Better Health Care Navigator, Jose Espinoza.

“He did an excellent job of explaining it,” says Koclanis. “It was very manageable for me.”

Koclanis and his wife later met with Espinoza again, this time to get enrolled. Koclanis said they walked away a half hour later with new coverage.

“Our savings is astronomical,” says Koclanis, who opted for both a medical and dental plan for he and his wife. “Our actual billed amount for both of our medical and dental plans is $1,046 a month. Our tax subsidy is $623 a month, so we only pay $423 a month.”

Koclanis says that, without this tax subsidy, he would not be able to afford his new coverage.

“It is awesome. It’s kind of like a dream come true,” he says of his new coverage plan.

Koclanis says that he sees other benefits of the ACA beyond his own vital savings.

“I can see for younger people, if they would take advantage of this, that to be able to cover your medical would allow you to leave your job, basically, and a person could go chase their entrepreneurial dream,” says Koclanis. “I worked in the trades. I knew guys who wanted real badly to strike out on their own, but the medical was always the large issue. It was always the killer; it was always the deal breaker that kept you where you were. I don’t know if the country seems to understand this [benefit of the ACA] yet. I think the Navigators made all the difference in the world. Still, the Navigators can speak to you, but you still have to listen.”

Koclanis says that his son has recently left his job to pursue an entrepreneurial endeavor of his own; he is in the process of signing up for a Marketplace plan as well.

“I think that the Navigators are very good,” says Koclanis. “It made all the difference in the world. If people would just search out for the help…I contacted [Navigator Jose Espinoza] and he was more than generous with his time. It worked out beautifully.”

No More Costly Care: A Family Saves With the Marketplace

23rd October 2014 by Anya Krenicki Comments Off

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Alan C. & Family 

Des Plaines, IL 

When Alan C. lost his job, he and his wife were concerned about switching to a new health care coverage plan; their son suffers from asthma, and Alan says that they wanted to be sure his son’s care would not be negatively affected by an insurance change.

The family qualified for COBRA continuation coverage, enabling them to stay on the group insurance plan provided by Alan’s employer prior to his job loss, but they knew this was not a permanent solution.

In February of this year, during a trip to his local library, Alan noticed signs advertising seminars and one-on-one information sessions on the health insurance Marketplace.

“I made an appointment to learn more about it, because before that it could be very intimidating,” says Alan.

Alan and Campaign for Better Health Care Navigator Cheryl Gay met to discuss his health care options.

“Cheryl showed me how to navigate the [Marketplace] system,” says Alan. “I was able to go on there to seek out the comparable insurance to the one that we had… we found comparable [coverage plans] for less money. It was good coverage, so we went that way, and we were able to get some savings.”

Alan says that he has been “very happy” while utilizing his new coverage plan.

“You don’t feel a difference from the [plan] that we had before,” he says.

There is one difference, though , Alan says: a huge savings of over $400 monthly, compared to what the family was paying for COBRA coverage.

“The Navigator system made this process less intimidating and more manageable,” says Alan. “[It] is so valuable to help us understand it. This is something that works for our family. [The Marketplace] is controversial, you know, some people are very against it, but for our family it worked very well. I was in the middle of a job transition situation, and my son has some sickness. We worried what if [a new insurance provider] doesn’t take that condition, but after managing to navigate the Marketplace system and seeking out a plan that fit our family’s needs, it worked out really well. We have savings over $400; that worked out real well.”

Embracing Change Under the ACA

17th October 2014 by Anya Krenicki Comments Off

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 Tanine Murdock 

Chicago, IL

When Tanine Murdock became eligible for Medicare, she was hesitant to sign up.

“I got penalized for the few years that I didn’t take [Medicare] once I reached 65,” says Murdock. “That was my choice. I wasn’t getting a lot of money from Social Security, and it didn’t make sense. I was well, I didn’t have any severe medical problems, and I wasn’t on a lot of medication. So it didn’t make sense for me to put out money, you know, and I wasn’t using [the Medicare plan].”

Instead, Murdock sought out alternative sources of medical care.

“I was getting my medical care at the Board of Health and then I was also on a committee there,” says Murdock. “I was invited to be on the advisory council there, so I had knowledge of the community clinic starting in the same building right there.”

“Around the first of the year about four years ago, when the downsizing started at the Board of Health, I went to the community clinic,” says Murdock. “So I was over there for a couple of years until Obamacare came on board. That clinic, if you didn’t have any insurance or Medicare or Medicaid, you qualified to be in the clinic, and they took extremely good care of me and the rest of the patients. It wasn’t a crowded place, the atmosphere was good. And then Obamacare came and I was forced to get my Medicare.”

Murdock met with a Navigator who enrolled Murdock, but left her unsure of how to use her new coverage plan. Murdock admits that she was wary of the change and did not actively pursue utilizing her Medicare coverage for some time.  During a trip to her local food pantry, Murdock met Campaign for Better Health Care Navigator Cheryl Gay.

“I went to [Gay] and it didn’t make any difference to her where I was in life or what I needed or didn’t need or who I was,” says Murdock. “She was determined to put me on the right track and that’s what she did. Whatever box I was in, whatever mental box I was in, she helped me get out of that and move forward and it was so simple.”

Gay informed Murdock of how the Medicare program had improved under the Affordable Care Act, expanding to provide increased benefits, including savings on preventative care and prescriptions. She helped Murdock to apply for additional financial assistance through Medicaid.

In the interim, Murdock made an appointment at a facility she had never visited before, the Miles Square Health Center in Chicago. She says that she had a minor medical issue that she needed addressed, as well as information on her prescriptions, a flu shot, and a mammogram.

“On Medicare, things are just rolling right along,” says Murdock. “They didn’t ask for a co-pay; I didn’t have to be concerned about that.”

Murdock is still waiting on her Medicaid determination but says that she has been receiving her necessary prescriptions at very little cost in the interim.

“I am grateful, ecstatic,” says Murdock. “Nothing but good professional people around with getting into the Obamacare thing. I am really, really grateful to you guys.”