Tammy Boudreaux now has until December 23 to enroll in a plan, and until New Year’s Eve to pay the premium.
Boudreaux is 43 and works as a freelance psychiatric social worker.
She can’t get insurance from her partner Laura, because Laura’s employer doesn’t offer same-sex benefits.
“Yeah, it’s worrisome. It’s like gambling. Gambling with my health, and it is very frustrating.”
Boudreaux has been skipping mammograms and other check-ups for a few years.
She does take a few prescription medications and occasionally sees a psychiatrist and a nutritionist.
This year Boudreaux estimates she spent about $1,500 on medical care, including a trip to the ER for a cut finger.
At home in Missouri City, she logs onto HealthCare.gov to see if she can get a better deal.
Boudreaux likes the premiums that are offered, but balks at the high deductibles.
“Let’s say if I paid the $178 a month my deductible would be $5,000. Which means I would have to pay up to $5,000 before I received any kind of payment from my insurance company.”
That reaction is typical, says Caroline Pearson of the consulting firm Avalere Health.
“A lot of people aren’t ever going to get out of that deductible. Only if you have a catastrophic health event or you’re really chronically ill will you ever hit your out-of-pocket cap. People are left, I think, feeling like ‘I spent a lot of money this year on premium and I didn’t get any meaningful coverage from my insurance.’”
But Pearson says people forget two things if they just focus on the high deductible. One is that the new plans must offer some free preventive services, like a mammogram. And the other is that having a plan protects you from medical bankruptcy if you get hit by a bus or get a cancer diagnosis.
The Affordable Care Act requires that the new plans have a yearly cap on expenses.
If something did happen to Boudreaux, she wouldn’t pay more than $6,350 out of pocket. Boudreaux says she has considered the possibility that something catastrophic can happen at any time.
“Yeah, that is a huge fear. Um, that is a huge fear. What if…”
But if nothing happens, she thinks she’d pay less just continuing to go along on her own.
She could put the $200 that would go to the monthly premium into a savings account.
“I’m going to sleep on it, I’m going to talk to Laura, I’m going to do more calculations.”
If Boudreaux does not enroll in a plan, her tax penalty, because of the individual mandate, would probably be a few hundred dollars — for the first year.