Getting Healthcare Through The A.C.A.


There are several schools of thought bandied about regarding the Affordable Care Act, a.k.a. Obamacare.  I'm not taking sides and to be perfectly honest, I don't care what your politics are regarding this law.  This article reflects our first-hand experiences securing comprehensive health insurance under this new law, nothing more, nothing less.

Our reason for repatriating to the U.S. is simple and straightforward.  In the U.S. we will receive higher quality healthcare than we are currently receiving in Costa Rica.  This is an indisputable fact, regardless of what you read in publications that like to hype Costa Rican greatness. 

For those of you who missed the full story as to why we have decided to repatriate, here is that story.

Our Initial Research...

We moved to Costa Rica in 2009 at the age of 59 due mostly to the high cost of healthcare we were paying in the U.S.  It has always been our plan to re-evaluate our expat life when we became eligible for Medicare.  However, as a result of the passing of the Affordable Care Act (aka Obamacare), it looked like it might be possible to perform this re-evaluation sooner rather than later.

I began my research by contacting representatives of the most popular insurance companies in Florida; Blue Cross, Aetna and Humana.  Initially, I conducted basic phone interviews with those companies in February 2014, however, most of what I learned seemed to be more opinion and conjecture rather than FACT.

On first blush, it appears that any American can receive high quality healthcare at affordable prices regardless of pre-existing health conditions.  On the surface, that is exactly what we were seeking because Fran and I did bring to the table a wee bit of pre-existing medical baggage. 

We tried getting private insurance in Costa Rica through INS (Costa Rica's insurance monopoly) as well as an International policy through BUPA (underwritten by Lloyds of London).  But in both cases, our pre-existing conditions were excluded; BUPA's exclusion was for 6-12 months while INS excluded them for LIFE!  And as for receiving high quality healthcare through Costa Rica's National Healthcare System (CAJA), that was not a realistic expectation.

My preliminary calls to the insurance companies were very encouraging.  Insurance premiums are based on where you live.  Although I did not have an actual house address in Florida, I gave them a Venice zip code.  They needed this to compute the amount of Federal subsidy we would receive.  Since our only source of income was through Social Security, that and our zip code was enough to determine we would receive a monthly subsidy of between $954-1025. 

This subsidy (actually a tax credit) would be applied against the actual insurance premium to determine our true monthly cost.  Taking a worst case scenario, we looked at Platinum Plans which offered the highest benefit levels.  Policies ranged in price from $1500-$1700 a month and with our ACA subsidy, we would be paying between $500-700 a month.  A far cry from the $1865 we were paying back in 2008. 

Getting Real Insurance...

In June 2014, we returned to Florida for our second Due Diligence Trip. This time, securing affordable healthcare was one of our primary objectives.  We met (face to face) with representatives of Florida Blue (Blue Cross and Blue Shield) as well as a broker for Aetna.  In both cases we asked to look at both Platinum and Silver PPO Plans.   The representatives were required to ask us a short series of questions as they entered the data into the "Marketplace;" the infamous online system that was the butt of so many jokes last year.  The good news is the site is now working as intended.

These are the questions for which we needed to provide answers:

  • Our Names?

  • City and Zip code where we would  be living?

  • Do we now or did we ever smoke cigarettes?

  • Our Social Security Numbers

  • How much did we earn in 2013?

  • Do we anticipate a change in earnings in 2014?

A Lesson To Be Learned...

In our preliminary discussions with the insurance companies, we consistently told them we earned $36,000 in 2013.  That was based on our combined monthly Social Security benefit of $3000.  It was that number on which our subsidy was going to be based... or so we thought! 

I was about to learn a very important lesson.  When the agent asked me how much we earned, they should have asked, "What was your ADJUSTED GROSS INCOME?"  For it is this number on which all subsidies are based.   We were expecting a to see a monthly subsidy of around $1000 based on our $36,000 income.  So when the agent asked us if this year's earnings (2014) would be different than last year's,  we said NO.  Bazzinga! Our application for the federal subsidy was summarily DENIED!  

The "ACA system" looked at my 2013 earnings (thanks to a direct link to the IRS database) and realized that my Adjusted Gross Income (Line 37 on the Federal 1040 form) was only $5490. 

And when I said I was going to earn the same in 2014 as I did in 2013, the ACA's computer system made the determination that I earned "too little" to qualify for the subsidy.  Therefore we were DENIED.   WTF... in what parallel universe am I living where the less you earn gets one denied benefits?  I was assuming that if I made even less than$36,000, I would be receiving even more of a subsidy.   Man... was I ever wrong.

You see, because I will be living in Florida, one of 22 States that have REJECTED the acceptance of any Federal money for healthcare, Fran and I would be ineligible to receive these benefits.  The only way we will be able to receive this assistance would be if Line 37 showed earnings of between $15,100 and something just south of $52,000.

It appears that I am screwed!

Where There's A Will, There's A Way...

In my case, my earnings showed that I was too poor to qualify for a government subsidy.  I learned that if a state expands Medicaid, most of the costs are covered by the federal government under the healthcare reform law.  At this time, Florida decided NOT to expand Medicaid.  I want to thank Florida's felonious Governor, the dishonorable Rick Scott along with the Florida State Legislature for denying healthcare benefits to more than 3.8 million people, or about 25 percent of the state’s population, who are under the age of 65.

Because my reported income is equal to 35% of the poverty level, I would not be eligible for tax credits in the ACA Marketplace.  Tax credits are only available to people who make between 100% and 400% of the poverty level.

In other words, I needed a way to show I made more money in order to quality.  Suffice it to say, working 100% within the law, I was able to secure ACA coverage through Florida Blue and receive my legal subsidy.  To prove I am not alone, take a look at Florida Congressman Marco Rubio, a staunch critic of Obamacare, defend why he took the subsidy under the Affordable Care Act.

The Higher The Subsidy; The Higher The Benefit Plan

Before the subsidy was applied, we looked at both the Platinum and Silver PPO plans.  The Platinum was a much more robust plan with only a $2000 Annual Out of Pocket per person expense.  Most doctor visits were capped at $10 and $20 depending on whether or not you saw a specialist.  And depending on your needed medicine and what category it was in, your co-pay would be between $4 and $150.  This would have cost us a staggering $1761 per month!

However, by applying the Federal subsidy, our Annual Out of Pocket dropped to a mere $500 per person while Office visits were NO COST for the first 3 visits and then $15 or $20 each for more than 3.  Prescription meds also got cheaper ranging from $4 to $75.  We checked and all the meds Fran and I take and all fall within the $4 rate.  And best of all, this was a Silver Plan and would run us only $318 per month!

In The End...

I don't care what your politics are.  I don't care  if you love Obama or hate him.  All I can tell you is (politics aside) Fran and I are now able to return to the United States, a country that we love and respect, and live a productive and dignified life and we have the Affordable Care Act to thank. 

Had it not been for that piece of legislation (that Administrations have been languishing over for decades), we would not have the opportunity to seek a more available and more qualified medical solution regarding Fran's eyesight.

Additional Resources...

  • The Marketplace Website
  • Find out if your State participates in the Federal Subsidy? HERE
  • Estimate your ACA Subsidy - HERE
  • Here is yet another heartbreaking story where the state of Tennessee has refused to implement - HERE


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