Central Jerseyans share their experiences

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Here’s what’s happening this weekend.
Joe Martino | Staff Video

Editor’s note: Earlier this summer, as the debate raged in Congress over the future of the Affordable Care Act, we asked Central Jerseyans to talk about their own experiences with the health insurance market. We received dozens of responses. Here are two of their stories, with suggestions on how to improve the health plans offered to individuals in New Jersey.

Donna Krebs is seemingly in no hurry to retire.

After working for three decades as a wholesale buyer of small appliances, Krebs, 58, of Avenel, decided it was time for a career switch and became a certified nursing assistant specializing in home health care. 

As an independent contractor, that meant having to buy health insurance on her own — leading Krebs to New Jersey’s version of the Affordable Care Act (ACA) marketplace.

But as a Baby Boomer too young for Medicare — a group socked with higher premiums keyed to their age — she said it was impossible during this year’s enrollment period to find an affordable Obamacare plan that offered the quality health coverage she wants.     

“I’m at a point where I need good healthcare,” Krebs said.  “I can honestly say that I now have the worst insurance coverage I have ever had in my lifetime.” 

Even something as simple as seeing a primary care doctor can be difficult, she said.

“For a physical, I called to make an appointment the first of week of July, and my appointment was the last week of August. Most of the time I could not get into the primary care doctor, so I had to go to the walk-in.”

While Krebs helps others with their health needs, performing tasks such as lifting patients that have strained her knees, she has had to put off treatment because of her plan’s high deductibles and out-of-pocket costs.

“I’m waiting for it to get better,” she said.

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It wasn’t always this way

Things weren’t so bad the first two years that Krebs had to buy individual coverage.  

In fact, she found the “silver” plan she purchased from the now-defunct Health Republic Insurance of New Jersey to be acceptable.  

“The Health Republic plan had all of my doctors on it,” said Krebs, who paid less than $600 in monthly premiums.

By 2017, the state marketplace roster had dwindled to only two companies: AmeriHealth New Jersey and Horizon Blue Cross Blue Shield of New Jersey.

Higher premiums followed, along with policy terms that made it difficult for Krebs to continue using her own doctors or preferred hospital, which, she says, would now require paying 50 percent of the bill.    

“New Jersey has very few options for Obamacare users who have to pay the entire premium themselves,” she explained. “A plan that would be comparable to the one I had in 2016 at $550 would now cost me $1000 a month. So the plans keep getting more expensive, and people like me keep taking less insurance that costs more and hope we don’t get sick.”

Krebs believes the lack of competition has led to “sketchy” behavior by the insurers, whom she feels are maximizing prices charged to individuals with nowhere else to turn. 

Her prescription for a fix: New Jersey consumers must be given more and better health plan choices. 

“I think we should have nationwide access to insurance, and insurance providers should be able to sell across state lines,” Krebs said, suggesting Amazon as a potential competitor. 

“I’m sure Amazon would jump on a nationwide insurance program.  Imagine the amount of people they could insure.”

She questions why a pack of insurance companies compete for business from New Jerseyans on Medicare, while shutting out those on Obamacare. 

“Maybe an insurer should only get to sell to a Medicare person if they offer private plans for people under 65, as well,” Krebs said. 

She would like to see the federal government sell a prescription drug plan akin to the program the Veterans Administration makes available to her husband and others who’ve served in the military.     

The plan’s massive buying power would keep medication costs in check, she reasons, allowing for a dramatic reduction in Obamacare premiums.   

With Congress back in session and still grappling over how to tweak — or replace —Affordable Care, Krebs worries about where her next health insurance plan will come from.      

“I can’t wait till I get to Medicare so I can have good coverage again,” she says. “Isn’t that sad?”

Moving to Medicare

About a half-hour down the road in Old Bridge, disc jockey Frank Glaz, aka Frank Todd, hosts a retro radio and Internet music countdown show called “Todd’s Top 20.”   

Glaz adds satire with celebrity impersonations, including the likeness of President Donald Trump promising listeners that he will “build a wall around the Earth to keep out the songs sung by aliens.” 

 

He has also been heard for the past eight years as a summer replacement host on Princeton University’s WPRB 103.3 FM. 

Although Glaz believes the ACA was well-intentioned, he says he’s thankful that Medicare took the place of his Obamacare plan this year when he turned 65.  

Off the air, Glaz is an IT consultant who found himself without full-time work or health insurance in his early 60’s as Obamacare was just getting off the ground.  

“Given the age discrimination that was rampant in my business, I got booted out,” he said.

The married father of three grown children turned to Uber driving and working as a supermarket cashier to supplement his income, and, when first applying for ACA coverage in 2014, met New Jersey’s income requirement for Medicaid.

While grateful to have insurance, Glaz characterized the coverage as “pretty poor.”  

“The scrambling to get providers who accepted Medicaid was really tough,” he said.  “I couldn’t use my GP (general practitioner) anymore.  I had seen her for like 25 years.”

Nor could Glaz continue using his cardiologist or chiropractor, unless he paid for the care out of pocket.

Even doctors listed as New Jersey Medicaid providers might refuse to take Medicaid patients, a humiliating lesson he learned while inside a primary care facility seeking treatment for a clogged ear.   

“They said we’re no longer going to accept Medicaid,” said Glaz, who had used the practice before.  An exception to take him as a patient that day was made because he was never informed they had dropped their Medicaid affiliation.

Over the next two years, Glaz bought individual marketplace insurance for $700 a month with a 50 percent subsidy — leaving monthly premiums of $350.

But the coverage proved difficult to actually use.  

Just as with Medicaid, Glaz’s own doctors were not in the provider network.  With recurring back issues, he felt it was important to stay with the chiropractor he liked, which meant total responsibility for the bills.    

The plan’s copays — $75 for specialist visits, he said — on top of high deductibles for tests and procedures, caused him to limit his visits to the cardiologist, and even forego an echocardiogram. 

“I tried to keep my doctor visits infrequent because of the cost,” he said.   

When tax-filing time rolled around, Glaz was in for a surprise.  

He learned from his accountant that the monthly subsidy he was getting to reduce the high cost of premiums was, in reality, taxable income.

“The government never told me — and still doesn’t tell people — that all the subsidy money they give you is added to your income.  They’re giving you a wage, and you have to report it to the IRS,” he said.

As a result, he had an outstanding tax debt of $800 this year.  

The misperception that ACA insurance is a “government hand-out” must be changed, Glaz said. 

In offering suggestions for improving Obamacare, Glaz cites the need for an increased network of doctors and other providers. He’d like to see the high copays eliminated. 

However, Glaz feels that large-scale reform is the best solution.     

“We need to have soclialzied medicine like they do in other countries,” he said. “Nobody should be denied medical coverage based on their ability to pay.”

 

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