Patrick’s Story

December 28, 2013

Unaffordable Care

By Senator Kevin Kelly (R-21), Ranking Member of the General Assembly’s Insurance and Real Estate Committee. This is the first in a series of stories highlighting real people’s experiences with Access Health CT.

Over the past few weeks I have spoken out on the need to open dialogue between Access Health CT, lawmakers and the people of Connecticut. The roll out of the Affordable Care Act has been bumpy and I am concerned that we are not doing enough to help the people of Connecticut.

People like Patrick from Monroe.

Patrick has been a business owner since 1989. Providing health insurance for his family was always a priority for him. He gave up vacations and other luxuries to ensure that he would always be able to afford quality insurance for his family of four.

Over the years, Patrick tried different plans to get the best value and quality of care for his family. He became very familiar with the pricing and average rate increases of plans. He learned how to navigate the healthcare system, work with a broker, research plans and understand what was included or excluded in different plans. In short, he became extremely literate in the health insurance industry.

The plan he ended up with a few years ago was an Anthem Blue Cross Blue Shield $10,000 HSA – which cost him $520 per month. He stayed with this plan for over two years, and watched his premium increase an expected amount, bringing him to a cost of $683 per month. He really liked this plan. He had wellness visits, access to great physicians and it fit the needs of his family perfectly.

In September, Patrick received a letter from Anthem telling him his current insurance plan was not compliant with the Affordable Care Act. It wouldn’t be offered and it wouldn’t be renewed. Anthem indicated in their letter that they would help make the process easy by assigning him a new plan. So Patrick waited.

On October 23, Patrick received a second letter from Anthem, this one with information about the new plan he could be assigned to.

The letter offered an $11,000 HSA for $1,200 per month.

Patrick was stunned. His premium increased over 70 percent for the same level of coverage. That meant he would be paying over $6,000 more per year than he had budgeted.

That’s a big problem when you’re getting ready to send your daughter to college.

Patrick panicked.

He turned to the Access Health CT website to try to find something he could afford.

As he navigated through the pages of the site, inputting every personal detail of his family’s life, he was taken aback by the lack of human contact in the process. Eventually, he ran into the need to make a phone call to Access Health CT, which turned into a frustratingly long wait and a lack of answers in the end.

When Patrick was finally able to see the choice of plans available to him, he was not impressed. He did not see that many options. He found a plan similar to the unaffordable replacement plan Anthem offered him, but the cost was almost identical. He also remembered that in a letter from Anthem, the insurance company alerted him to the fact that Anthem plans purchased through Access Health CT had a smaller number of doctors and hospitals in their networks. Patrick was confused and upset. All his life he had worked hard to provide his family with the best insurance he could afford. Now, all the plans offered to him were out of his budget. Where was the level of care he had before?

Patrick went back to his broker. After a great deal of research, Patrick eventually found an Aetna plan for a $5500 HSA that would cost him $775 per month. The price was expensive, but manageable. The plan was not ACA compliant, but would go into effect December 15, 2013 and would cover Patrick’s family for a year.

So what happens to Patrick when his new Aetna plan is phased out in future years for not being ACA compliant? Where does he go then? Patrick lost his insurance because of the Affordable Care Act, and Connecticut lawmakers have to make sure people like Patrick get their care and coverage back.