Signing up for the Affordable Care Act

Step one:

Access your Health Benefit Echange on the Web.  Register, if you want to (or can) Write down your user ID and password.   It may not matter since your user id and password may not be saved in the system.  Rather than using  your SS number or case number they want  you to make up a user id and/or password you will likely forget.

Expect to receive  a message the site is down, we want to help you try again later. blah, blah, blah.
Once you are able to access the site the page loads will be irregular, very slow  to load and may disconnect.   Your best time to reach a site is between mindinte and 5  AM,  however  you also may receive "the site is down for maintenance'... try during our regular business hours.

When you resort to calling.  Set your telephone auto dialer and begin calling at five minutes before the exchanges open.  I receive a message that my wait time would be 5 minutes....I waited 45 minutes.  This was after ten attempts during regular business hours. If  you do not call before ten minutes after the phones are on....forget it.


Step two:

Once I accessed a human being, things went very well. The agent was more than helpful and spent 30 minutes going over enrollment.  In fact because my first attempt went so badly even with help I had to re-enroll in a different insurance company.  Some of the least expensive plansl have very limited provider and hospital access.

Because I am a retired MD I know many of the physicians that were listed as providers. The providers were often foreign medical graduates, spoke multiple languages, such as Vietnamese, Tagalag, Hindi, and Spanish. The FMGs were multicultural.    Also most of the providers in Covered California were predominantly former Med-Cal providers and familiar with Medicaid patients and reimbursement.

The printed subsidies were complicated and many times the subsidy rates made no sense for some policies. The best approach is to wait an receive your invoice, then call if you have a question.  Be certain it is correct because once you pay your premium you are locked in for one year, except for life-changing events such as additon to famly, loss of employment and/or changes in income. The next entrollment period is October 2014.

My advice is to not rush. Delaying enrollment will only mean your activation date is delayed a month. Spend a lot of time going over all your options for your income level. Search from   high to low premiums to assess the differences,  which can be subtle with deductibles, co pays for drugs and providers. Some have high co pays for medications. Plan on spending several hours to study it and assess your needs.  The web site is very good for comparing   how much  medical care you use annually, and the number of prescription drugs you use.

Now that my wife is enrolled I am relieved....15 years with her being uninsurable, with a very high copayment for her disability Medi-caid coverage was terrible, and inhumane.

Regardless of the Affordable Care Act. having an insurance cared will NOT cure our problems. The ACA does not address accessibilty, uniformity of coverage, or qualty of care.  Most of the law addresses insurance companies, and does nothing to relieve providers from a terrible and overriding responsibility for their patients with little help or cooperation from the bureaucrats.

Media reports indicate there will be a serious and committed effort to make major amendment, additions to, or repeal the Act.  Most responsible leaders who are not political idealogues are in favor of this course.

Freedom of Information Act Request filed by Health Train Express

Doctors Complain They Will Be Paid Less by Exchange Plans.  Many will opt out of private plans. News reports indicate that 70% of California MDs will not participate in the Health Exchange and the Private plans Some have complained to medical associations, including those in New York, California, Connecticut, Texas and Georgia, saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, potentially making it harder for consumers to get the care they need.

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

If you’re a physician and you’ve negotiated a rate from insurance, shouldn’t it be the same on or off the exchange?” said Matthew Katz, executive vice president of the Connecticut State Medical Society. “You’re providing the same service.”

The benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.

Health Train Express has filed a FOIA request from CMS (Freedom of Information Act which will require full disclosure to the providers and public  (ie, transparency that Obama claims to encourage)  Watch for the published link in about one month