Covered California will not be releasing any enrollment figures until mid-November, but San Franciscan Paul Cello says he’s already in — and reports his new insurance will have better benefits, at lower monthly cost than the plan he’s on now.
Cello originally hails from Florida and says he has friends there who are not fans of the Affordable Care Act. So he didn’t delay.
“I really wanted to be one of those people who got in line and said, ‘Look, this is a good thing,'” he said, “so I could really see what are the plans and how much do they cost.”
He enrolled in a Blue Shield PPO plan with a $1,500 deductible and maximum out-of-pocket costs of $5,000. Because he qualifies for a subsidy, he’ll pay $178 a month, shaving more than $300 a month off what he pays now.
“It’s like a whole ‘nother world,” he enthused. “The coverage is better … a lower premium, no pre-existing condition exclusions, I get mental health coverage, so there’s way more coverage than I had and I’m going to be saving.”
Cello had employer-based insurance until 2003 when he left his job, then continued insurance with COBRA. But once that ran out, he was denied coverage on the individual market due to a heart defect he was born with — what he termed a “wiring problem” in his heart. He says the issue has never troubled him (although he might one day need a pacemaker), and that his health is good.
It showed up in a routine EKG, he said. “Once it’s on your record, (insurers) can deny you.”
He finally found insurance on the state’s high risk insurance plan. But benefits were limited and the chief drawback was the annual max — $75,000. It’s easy to imagine that a car accident or cancer diagnosis would send someone over the top pretty quickly.
“It always felt like if anything big happened, I was going to be in trouble,” he said.
Cello described himself as a freelancer — he’s both a theater director and has his own consulting business. “My income really fluctuates,” he said. In the last few years, he says it’s been around $50,000 a year.
But that’s his gross income. Under the Affordable Care Act, subsidies are available for individuals with modified adjusted gross income up to $46,000, meaning people can subtract unreimbursed business expenses from their gross income. Those deductions brought Cello’s income down enough to earn him the subsidy.
[Related: Learn more about the ACA in KQED’s guide: Obamacare Explained]
As far as the sign-up process itself, Cello didn’t find it too painful, although he did give up on the first day. By Wednesday, he says, traffic had “calmed down.”
He found the process of creating an account and entering income “pretty straightforward,” but when it got to actually picking a plan, “you really have to do your homework,” he said. He says he used charts on Covered California to compare plans, something that was already familiar to him.
“It could be a little overwhelming for people who have not signed up for insurance” in the past, he said.
Cello says he’s had to make all kinds of choices because his insurance has been such a big expense — “things like, not being able to put money away for savings,” he said.
“I have been waiting very impatiently for Jan. 1, 2014.”