Stacie Clary is a consultant for nonprofit groups and a career coach who lives in the small coastal city of Capitola, Calif., about an hour south of the San Francisco Bay. Her husband, Herb Walker, is a website developer. They’re both self-employed and have bought health insurance on the individual market for years.
Their current policy is a high-deductible plan from Anthem that costs $268 per month. It requires them to spend $10,000 to $12,000 out of their own pockets on health care before coverage kicks in. It also allows one annual preventive-care doctor visit apiece each year.
Ms. Clary says she and Mr. Walker have been happy with the plan, despite its limits.
“We knew that we were taking a risk that if one of us got very sick we would be paying a lot out of pocket,” she says. “But we’re both healthy and we wanted something so we wouldn’t go bankrupt” if either of them became seriously ill.
But Anthem has notified them their plan is being canceled at the end of the year, as it does not meet Affordable Care Act standards. So Clary has begun looking into the purchase of a new policy from Covered California, the state’s new ACA health insurance marketplace.
She can’t find anything comparable to what they have now, she says. Even the cheapest plans available on the exchange cost much more than their current plan. A Covered California navigator said the least-expensive “bronze” level insurance coverage in their area is priced at about $650 a month, according to Clary. A private insurance broker told her the same thing.
A search on HealthSherpa.com, an unofficial website that allows Californians to comparison shop for Obamacare insurance, indicates that “bronze plans" in Capitola for a nonsmoking couple range from $525 to $550 a month.
“Bronze plans" are more extensive than the couple's current insurance, says Clary, but she and her husband can’t afford the extra $300 or $400 per month that they cost.
“We really don’t know what we’re going to do,” she says.
Their annual income is 450 percent of poverty, so they are just over the threshold of eligibility for federal subsidies to help buy insurance.
Ironically, Clary and Walker may be exempt from the Obamacare mandate that Americans purchase health coverage. The “bronze plans" available to them would cost more than 8 percent of their annual income. That means they qualify as a hardship case and would not have to pay a tax penalty if they chose to forego coverage for the first time in decades.
Their insurance outlook might be different if they lived in one of California’s major metropolitan areas, where there is more competition between health-care providers and between insurers eager to gain new customers from large urban populations.
For instance, in the posh Nob Hill section of San Francisco, the cheapest “bronze plan" for two adults costs $450 a month, about $100 less than in Capitola. And in the famous Beverly Hills ZIP Code of 90210, comparable coverage costs between $360 and $390, according to HealthSherpa.com.
On Nov. 14, President Obama changed course and said that health insurers could temporarily continue to offer health plans that don’t meet ACA standards. If Anthem decides to keep offering the plan Clary and Walker now have, at or near its current price, they’d “certainly keep it,” she says.
If the plan’s price rises to near that of Obamacare “bronze” polices, they might opt for the latter.
“We’re just waiting to see what Anthem does,” she says.
Clary says she supports health-care reform and is not motivated by political opposition to the Obama administration.
“I’m just tired of hearing how we’re not really being hurt, when we are,” she says.
– Peter Grier, staff writer
