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Affordable Care Act: Insurance company’s termination of policy surprises couple

Scott Janet Cabot their MadisWis. home.

Scott and Janet Cabot in their Madison, Wis., home.

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Updated: December 11, 2013 6:16AM

Scott Cabot agrees with the basic premise of the Affordable Care Act: Everyone deserves health insurance.

But he doesn’t get why he, his wife and a growing number of Americans are being told they can’t keep their insurance plans and have to pay considerably more for a policy that, at least to Cabot, isn’t any better.

Cabot suspects the termination of his plan is tied to it not meeting federal requirements under the ACA. But the Oct. 28 letter from Anthem Blue Cross Blue Shield does not say, and an Anthem representative declined to comment. “This was a total surprise,” said Cabot, of Madison, Wis., formerly of Deerfield.

Cabot, 58, said he and his wife, Janet, were satisfied with their plan because it covered emergency room visits, prescription drugs, rehabilitation services and preventive care. The Cabots, who are retired, had been paying an annual premium of $6,595 with a $2,500 individual deductible and a $35 co-pay for primary and specialty visits.

About the only things missing in the plan were mental-health service and “maternity care and pediatric services, which is not at our stage of life,” Cabot said.

He was “shocked” to see the prices given by the insurer for one of the silver plans offered on the Wisconsin online marketplace. That plan, which offered their same doctors and had a similar deductible: $13,764.

It’s hard to put a number on how many people may have had their insurance terminated, effective Jan. 1 or after, because insurers decide whether to continue offering a policy.

A report released Tuesday by Kaiser Family Foundation estimates that 501,000 people in Illinois who are uninsured or buy insurance on their own will be eligible for tax credits in 2014. Nationally, 17 million will be eligible.

“It is no secret that the law provides millions with better coverage, and, at their choice, most people in the individual market today can get that coverage through their same insurers,” a U.S. Department of Health and Human Services spokesman Fabien Levy said.

But policy cancellations have angered people because President Barack Obama had promised that those who like their current coverage could keep it. He apologized Thursday to Americans losing coverage.

Nancy Metcalf, senior editor at Consumer Reports, noted that “health insurance, like all insurance, only works if all risks are pooled.” Otherwise, whatever’s not pooled would cost too much. Metcalf cited maternity care as an example, which because it wasn’t included in plans before the law passed, could cost as much as main policy itself.

The Cabots declined to reveal their income but confirmed it was over $62,040, which is 400 percent of the federal poverty level for a couple.

Under the law, people with incomes between 100 percent and 400 percent of the poverty level are supposed to be eligible for a tax credit.

Larry Levitt, with the Kaiser Family Foundation, said about 8 million people nationally are eligible to buy coverage in the exchange, but they earn more than 400 percent of poverty and won’t qualify for tax credits.

Cabot feels he must pay the higher cost because “we can’t not have insurance; we’re too old. Something could happen to us.” But “it will impact our financial decisions,” he said. “This will be our largest annual expense, higher than property tax.”

Experts noted that the Affordable Care Act has winners and losers, like other parts of the law.

That means some of the people being terminated from their plans will end up paying more – and getting more; some will pay less.


Twitter: @MonifaThomas1

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