Healthcare in America: Don't Take No for an Answer

By mid-May, roughly two months into quarantine, I had increased mental bandwidth to do more than simply survive. My mindset shifted toward ways to thrive during these unforeseen times. The priority became laying a more solid foundation for safety as the previously built infrastructure crumbled worldwide. My first step to secure a stronger base was to pursue health insurance. 

For the last year, since my last full-time employment role, I have freelanced a bit while pursuing full-time employment. In this search, I have communicated my preference for my next assignment to include health benefits. Fast forward to 2020, and it has become clear that health insurance tied to employment in Texas or America is the opposite of a stable or secure. 

Between COBRA and an attempt to apply for health insurance through the Affordable Care Act, my option last year was to pay $450-600/month. That was not a realistic option without a consistent source of income. 

Sharing is Caring

After a call with a dear friend who has been quite the cheerleader for not leaving any money on the table during the pandemic, I applied for Medicaid. I was immediately denied. I soon learned that women must be pregnant and single to be approved in Texas. Next, I was directed to apply for coverage through “the marketplace.” Again, I was immediately denied since enrollment was closed. 

Resolved to navigate the global pandemic without insurance, I put the idea out of my mind until I had a physical distanced tea date with a gym girlfriend. We talked about how we were taking care of ourselves and paying bills without consistent employment. We were both fortunate to have secured pandemic unemployment assistance. When I mentioned I was declined in all ways for health insurance, she was confused. She was approved.

When I asked about her application process, I learned she spoke with a person to get enrolled, while my entire process was completed online. I requested the contact information for her person. She shared a guy’s name, phone number and email address. Albeit a bit skeptical of the whole thing, I decided to call her guy. I left a message. He called me later that day, and in less than a 15 minute call, I was approved for free healthcare, based on my employment status. 

It’s Legit

Two weeks later, my insurance card arrived. Within days of its arrival, I scheduled my annual physical. My appointment was free. My nurse practitioner scheduled labs totaling $2152, of which I am responsible for $130. I filled a name brand prescription and paid only $9 for it. Off brand prescriptions range between $0-3. I can’t fully describe how grateful I felt in that first week of July. I was signed up for insurance with Oscar Health. My girlfriend’s insurance is with Ambetter. 

One week after experiencing free health insurance, I reached out to the guy who signed me up and requested an upgrade that moved me from a “zero premium / pay full-price until an $8,150 deductible is met” model for non-preventative and specialist visits to a copay model. I now pay $40/month and my copay for primary care physician (PCP) and specialist visits is $5. Telemedicine visits are free. I have honestly paid more for a meal with wine, while dining out BC (before COVID-19).

Marketplace Contact

So, who is this guy who signed me up? Who pays him? Why didn’t I know about this offering? The guy has been paid by the government since 2011 to qualify and sign people up for health insurance following the passing of the Affordable Care Act. One year into the current occupant’s appointment as the leader of the “free world,” he cut the program’s advertising budget by 90% and the in-person outreach program by $23 million. 

As he shared with me, he relies on word of mouth to enroll Americans for healthcare not tied to employment. He further explained, when I asked about the appropriate contacts for other states and regions including New York and California. He replied “They're all very different actually. New York and California both have their own enrollment platforms developed by their respective states so they don't use the Federal one like I use for say Florida, Georgia, Texas and most other states in the south.” 

Please know there are affordable options and regardless of the state you are in, his team can point you in the right direction. Feel free to reach out to him directly. His name is Jeffrey Mercado. He’s what’s referred to as a Navigator. He’s based out of Florida and can be reached by phone at 727-417-5534 or email at jeff@getcoveredusa.org. His facebook page is @getcoveredusa.

What’s a Navigator?

“Navigators are trained to assist consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing eligibility and enrollment forms. They are funded through federal grant funds, and their services are free to consumers.” If Jeffrey is unavailable, it may benefit you to search the In-Person Assistance (IPA)/Navigator directory for your state or region. Once you identify the appropriate agency for where you live, inquire about the dates and times when enrollment assistance is available.

Plan Options

Types of plans available in the healthcare marketplace vary by state. Between 2015 and 2016, many—if not all—preferred provider organizations (PPOs) in Texas were canceled, leaving exclusive provider organizations (EPOs) and health maintenance organizations (HMOs). In my personal opinion, HMOs are the worst. They require you have a PCP that you are required to see and request referrals for any specialists. HMO coverage also tends to be limited to specific service areas in the state. This can be an issue when traveling. EPOs (and PPOs) allow you to see who you want, in-network, when you want.

Act Fast

A special enrollment period is now open until August 29, 2020.