Eight years ago, I was watching a long pass make its way toward me during an indoor soccer match. I was the goalkeeper on a team of fellow employees from Apple’s Fashion Valley store in San Diego.
The rest of those few moments are clear as day in my mind. A defender and attacker were running side-by-side to get the pass. I left the mouth of the goal in an attempt to stop the ball before the attacker had a chance to receive the pass and shoot.
I slid to the ground to try and catch the pass on a short hop. The attacker never saw me, and as soon as I got my hands on the ball, I felt a bony knee smack into my left cheekbone.
Everything went numb. I mumbled out a few vulgarities as a ringing sound elbowed its way into my head. I looked up at the scoreboard and saw that there were only 50 or seconds left in the game, so I stayed in goal until the game was over.
Afterward, my teammates checked on me to make sure I was okay. That night, my left eye was bloodshot, I coughed up a bit of blood and was super nauseous.
Less than 24 hours later, I was lying in a hospital bed with, as it turns out, a shattered cheekbone, cracked nasal cavity and cracked orbital bone (the one that goes around your eyeball). A surgeon would have to reconstruct my cheekbone, a procedure that ended up taking 5-and-a-half hours.
I found myself in a unique position: pretty much broke (I was making $1,200 a month working part time at Starbucks and Apple), in need of serious surgery, asked to stay in the hospital for four days and I had absolutely no medical insurance to cover the cost of the surgery.
For most of us, we never get into a situation like that. I did, and it was my first real experience with the wild world of health care.
Since the face incident, I’ve had the chance to experience healthcare: as an employee with employer coverage, a spouse to someone who bought pre-ACA healthcare, an immigrant in Spain with private insurance and a freelancer with marketplace health insurance.
I’m going to walk you through each of my experiences, then wrap everything up with my observations and tips for you as you make decisions about your 2017 healthcare.
San Diego, California: How the County Paid for a Broken Face
When I first walked into the emergency room at Grossmont Hospital in San Diego, I didn’t think much was wrong. My face wasn’t that swollen, my eye was a little bloodshot, and I had a small bruise on my cheek. The only real sign that something was amiss was the fact that I couldn’t feel the left side of my face.
I went into the emergency room and got a CAT scan of my face. Afterward, the doctor walked me through photos of my facial bones, pointing out some serious cracks. He sent me back to my bed, and a few minutes later a surgeon came in. He said my cheekbone was shattered and I needed surgery.
Over the course of the next four days, the hospital’s case workers came in and gave me a folder’s worth of paperwork to fill out. A local government organization called County Medical Services (CMS) was reviewing my case to determine whether or not they’d pay for my hospital stay and surgery.
In situations like mine, CMS has several different ways to offer financial assistance, one of which was a scholarship-style fund that I would eventually use.
If they didn’t help, I was stuck with what would have been medical bills in excess of $100,000, which, according to the bills I received, was a 50-50 split between my hospital stay and the surgery.
In the months following the surgery, I went back and forth with my case worker over the phone and sent in the necessary documents to complete my file. She assured me that my bills would be paid by the CMS fund, and, thankfully, they were – all except about $300.
My experience made me grateful that public programs like this existed. I was, after all, working pretty hard at two different jobs, paying rent for a run-down granny flat and trying to make ends meet. I was living on $60 worth of food, lost about 50 pounds and was living a very simple life.
This experience reminds me that serious financial situations can pop up out of nowhere, and when we aren’t prepared for them, they can make life very difficult.
Also, it serves as an example that certain counties will have certain benefits for uninsured patients. If you find yourself in a position where you can’t afford medical insurance and would rather pay the ACA penalty, be diligent to check out services in your area, and don’t wait until you’re hurt to find out what they are.
Knowing what’s out there before you need it will help you be prepared to handle a serious injury or big hospital bills. And be ready to fight for yourself; caseworkers can get overwhelmed by their workload. Call in to check up on your file, and make sure your caseworker has all the paperwork and information he or she needs to process your case.
Lady Lake, Florida: The Sting of Cheaping Out on Health Insurance
Four years after the face incident, I was living in Lady Lake, Fla., with my wife. At the time, I was a reporter for a local newspaper, and my wife was working as a freelance case worker for an Orlando-based social services company.
She had an individual plan through Blue Cross Blue Shield that cost her about $125 a month, which included low co-pays and a few free preventative care services.
I had health insurance through the paper. My first year there, I chose their silver plan. Like my wife’s BCBS plan, co-pays were low, and life was pretty good. I didn’t have any major health issues, so deductibles and hospital care didn’t come into play.
In 2012, we decided to sell all of our things and move to Germany where we would work at a neighborhood arts center I’d interned at during graduate school. Knowing the toll the move and new life would take, I underwent 10 sessions of counseling to work out some issues I was dealing with.
Under the plan I had in 2011, those visits would have been free. However, when 2012 enrollment came around, premiums went up about $25 a month, so I decided to downgrade my plan. Part of my choice was pride – I had asked for a raise a few weeks before enrollment time, and I didn’t get it.
So, in my partially vindictive, partially cheapskate mind, I didn’t want to lose money by having premiums go up while my income stayed the same. I chose the cheaper plan.
Now, fast forward to my counseling sessions. As I mentioned before, they would have been free under my previous plan. They weren’t free under my new plan, but I didn’t know that until about five sessions in when the office’s secretary told me that I owed $600 for my visits instead of the $25-per-visit rate I thought they would be. It turns out I got the $25 rate after I hit my deductible.
Thankfully, my counselor was willing to meet me in the middle at $300.
The lesson here is pretty clear. First, don’t automatically drop a plan because your premiums are going up. Consider what benefits you’re getting, how much co-pays are and what your deductible is.
Then, compare those numbers to other plans. Is it worth it to pay a few bucks more a month so you can avoid unexpected costs in the future? In my experience, it’s better to pay a little more each month rather than lose valuable benefits to save a few dollars.
Second, if you’re going to get a procedure, start counseling sessions or get treatments, make sure you’re clear on how much it will cost you. It’s better to know the price up-front, rather than find out later it’s going to be more expensive than you thought because of the coverage (or lack thereof) on your health insurance plan.
Barcelona, Spain: Living a Life of Health-Insurance Luxury
Remember how I said we sold all our stuff and moved to Germany? Well, after spending seven months in a beautiful little village in the Black Forest, we decided it was time to move to Barcelona, Spain.
Local laws require that immigrants must have health insurance to get a short- or long-term residency permit, so I did a little shopping in the months before we arrived and purchased health insurance from Sanitas, a private insurance company that’s part of a bigger company called Bupa International.
In Spain, the government subsidizes private health care to keep costs down, kind of like how you can get tax credits to help pay for marketplace insurance in the U.S. However, the big difference between the two countries is that you get much more for your money in Spain than you do in the United States.
For example, our premiums were about 100 euros per month for both of us. Doctors visits were 12 euros and prescriptions were pretty cheap. The big difference came when my wife gave birth via C-section. We had to stay at the hospital for four days and had several visits from our doctor and specialists. We also had our own spacious room in the maternity ward.
The grand total? About 150 euros for the birth, various visits from our doctor and specialists, and for the tests they ran on our daughter.
To give you an idea of how that compares to marketplace rates, the current silver plans estimate birth costs at about $4,000 for normal birth (not C-section) for a family of three making around $60,000 per year. Monthly premiums are around $450.
Now, you probably know that Europe is home to free public health care, and that’s true. Spain has a free public system to anyone who has a Spanish identification number, which you can get by registering as a freelance worker or employee of a company.
However, there are some pretty big differences between private and public healthcare in Spain. In public hospitals in Barcelona, C-sections are only allowed if the child meets a certain weight standard by a certain week in the pregnancy. Private hospitals leave it up to the doctor’s discretion. Also, the chances of getting your own room after getting birth are slim in the public system.
My recommendation for expats? Go for private health insurance. There’s a good chance you can afford it, and you’ll probably fall in love with the level of care you get at the price point you pay.
Jacksonville, Florida: Venturing Into the Healthcare Marketplace
Our little family returned to the United States in October of 2016. Before we left Spain, I signed us up for healthcare through the health insurance marketplace.
At the time, our monthly income was around $3,000; not much for a family of three. As a result, we got a pretty hefty tax credit for our premiums (around $350), so our monthly premiums for a United Healthcare plan were $167.
Around open enrollment time, we received a letter from United telling us our premiums would go up to $200 a month. So, I went onto the marketplace and shopped around. Much to my delight, I found a FloridaBlue Silver plan that offered free primary care visits, no deductible and $25 specialist visits.
The plan was amazing, and to this day I tell people it was the unicorn of health insurance plans. However, the important thing to remember is that the copays, deductible and premiums were all based on our income, which wasn’t very much at the time we signed up.
During the year of the unicorn plan, I had to get a procedure done. My doctor referred me to an imaging center where it would’ve cost me around $350. I thought this was really expensive, so I called around and found a doctor who would do it for $125.
I then called my health insurance company and found out that the same procedure can cost different prices depending on where they’re done. Huge lesson for me.
Thankfully, over the course of the year of the unicorn plan I started to earn more (living in America is expensive!) and, by the time the 2017 enrollment period came around, our income had almost doubled. When I went onto the marketplace to shop for new plans, I was pretty shocked.
Not only did our tax credit go down, but our premiums jumped around $200 and those free primary care doctor visits were now $55 a pop.
If this example teaches you anything, it’s that the marketplace gives great benefits to families who don’t make much, and those benefits decrease as you make more and more money. Deductibles, premiums, and co-pays are tied to your family size and income, so be prepared to pay more as your income rises.
With our unicorn plan now out of the question because of rising costs, I shopped around and did some price comparisons. I found a Gold plan with Molina Healthcare for around $600 a month. The family deductible is $2,500; as far as Gold plans go in Florida, that’s a steal.
But here’s the catch: Molina is a California company who is making their first appearance in the Florida marketplace. For Jacksonville residents, that means limited doctors in our area. Yes, the premiums are cheap for a Gold plan, but access is really thin. For example, there is only one obstetrician in the entire city that currently accepts Molina patients.
When I called Molina to ask about their Jacksonville doctors, they told me that they’re just coming to the area and more and more doctors will sign on with them in the upcoming year. While that sounds great, I’m a bit hesitant to believe it.
Will we choose the Molina Gold plan for the low deductible and cheap doctor’s visits, or will we stick with a Silver plan that has lower premiums but higher deductibles?
These are the kinds of choices consumers are facing.
Do the Research on the Healthcare Marketplace to Get the Best Fit
As far as advice goes, give yourself at least two hours to comparison shop on the healthcare marketplace. Filter your results by the max amount you’re willing to pay in monthly premiums, then review the results. Take note of deductibles and co-pays.
In my opinion, these are the two most important numbers. It’s hard to justify buying the cheapest Bronze plan if it’s going to cost you $100 per visit to go to your primary care doctor.
Also, be clear on how many doctors the insurance company has in your area. For example, the 2016 open enrollment introduced a new provider to the Jacksonville area: Ambetter.
I’d never heard of it, so I went to their website and searched local doctors. There are barely any family practices and even fewer specialists. While the price was attractive, their system of doctors and hospitals was a huge red flag.
Final Thoughts on My Healthcare Journey
Healthcare is one of those things that, from a consumer’s perspective, is different in nearly every place you live. For me, that meant relying on public assistance when I was in California, employer insurance in Florida, private insurance in Spain and marketplace insurance in Florida.
While each of those situations differed greatly from one another, I have found some basic principles to be true no matter when, where and how you get your health insurance:
- Weigh the cost of deductibles, premiums, and co-pays. Find a balance that works best for your budget and health needs.
- Be clear on how much certain procedures will cost you. Ask your doctor for the procedure code, then use that to call around to different offices and get estimates. It also comes in handy when you talk with your health insurance company.
- Know how much a pregnancy and birth will cost. There’s about a $2,000 difference between Silver and Gold plans in Florida, which could be the make-or-break factor in your decision.
- Check out private health care plans when you move abroad. You’ll find that they offer some pretty good benefits at competitive prices.
- Expect to see increases in marketplace deductibles, premiums, and co-pays when you start earning more money.
My final suggestion would be to do your research when it comes to marketplace plans. For example, in the fall of 2016, the Department of Health and Human Services published their expected premium increases, which were predicted to be between 22 and 25%. News outlets took that information and plastered it across headlines.
Average consumers were stuck with this imminent sense of health-insurance doom. However, what those reports failed to mention is that the HHS also reported that an increase in tax credits would, in many cases, cover the increase in premiums.
To learn more about premium increases, check out our article on the 2016 early enrollment period. We review the numbers for each state, and we talk with experts about why ACA premiums increase. While the 2016 increases spurred the article, the principles we talk about are applicable for many years.