Where Tony’s been hiding and Thank Heaven for the Affordable Care Act
Posted by TxCowboyDancer
I’ve been out of the loop…
I heard through the grapevine that people from the dance world have been asking “Where’s Tony?” Hmmm… Is that kinda like “Where’s Waldo but in cowboy boots? Read on if you’re curious about what’s been going on and why I’ve not been around the dance scene lately
But first… let me share some good news! On Jan 1st, I’m getting health insurance and…
I’m going to be able to see the Doctor!!!!!!
No, not the cutie to the right.. LOL YummME!
First of all… some ground rules:
In this post I’m going to be voicing my opinion at great length on a “hot button topic,” the Affordable Care Act”, something which I’ve never really done on my blog before.
But this is important folks! And, to answer the question of “Where has Tony been? well, it is sorta necessary.
Setting that aside though for the moment, it is important to let folks know that the the ACA not some remote political fight. There are real people benefiting from this law. People like me. By sharing my story perhaps anyone who reads this can put a “real face” to the issue.
Having said that, I recognize that others may disagree and want to comment and/or voice a rebuttal to what I have to say, which is fine.
However… “No rude or mean comments!!!” If anyone chooses to make a comment on this post, then awesome, but if you don’t like the ACA (I refuse to call it “Obamacare”) then also fine, you are welcome to post an intelligent politely worded comment and disagree with me.
I have absolutely no problems with people holding different opinions than I, nor with people voicing those opinions, BUT there is no need to be rude or mean or demeaning while doing it. Any such posts will be deleted, not approved for posting, and I’ll remove you from my “follow” list immediately. So just don’t go there!
Say it nicely or don’t say it at all! There is too much of that kind of BS in Washington. I don’t have to put up with it on my blog.
Now… where was I? LOL I do that a lot don’t I… start out with one idea then BAM “Squirrel” I’m off on another topic! Woot! I should make a tee-shirt… Hmmmm… now there’s an idea! Woot!
I have an awesome Doctor!
Her name is Karen King; she is caring and kind and sweet, and efficient and knows her stuff and well, she’s just AWESOME! And for almost 2 years I haven’t been able to see her about stuff that I really do need to see her about.
Uh… you guys did catch that right? LET ME REPEAT:
For ALMOST TWO YEARS I have needed to go to the doctor and to the dentist for things and have not been able to do so because I can’t afford it. We live in the richest nation on the planet and a citizen of that country like myself has to go without healthcare because of money?
It is just wrong, that a person, an individual, has to ignore health issues and scrabble and scramble to make ends meet while corporations are sitting on BILLIONS of dollars protected by loopholes in the tax law written by the guys they helped elect allow them to keep piling up the wealth while people in this country go homeless and hungry and without health care?
Almost EVERY other major industrialized Western nation on the planet has UNIVERSAL HEALTHCARE for its citizens. And we don’t? There is something wrong with this picture.
ACA is getting a bad rap and it should not!
A case study of 1 — “Moi” who thinks it is AMAZING!
Rather than jump immediately into this big huge philosophical discussion of the ACA and it’s relative merits, let’s talk about this in a “real world” kind of thing.
Bringing it down to a “real person” level
Putting a face on it… My face to be precise.
And after I’m done… I DARE anyone to say that this is a bad idea! Don’t get me wrong… I believe that ANY government service should be criticized and examined closely seeking ways to improve it, however… the IDEA of giving our citizens the health care they need is NOT A BAD IDEA!
So, using myself as example, I’m going to show you that ACA is working and doing EXACTLY what it should do… get me and people like me, to a doctor.
Some Financial Background about “Moi” to put things in perspective…
On Feb 1st my financial situation is going to change dramatically and for the worse. I have been living on three sources of income:
- Withdrawals from my 401k plan…
(We will not discuss the unfairness of me having to make the withdrawals at a 30% penalty. I ask you…Why do I have to pay a 30% tax penalty to get my own money which I desperately need to make ends meet, while corporations with billions in cash are allowed to have an effective tax rate of ZERO?)
*ahem* But I digress… back to the topic at hand: I get one more check the 1st week of Jan 2014 and I get my final remaining balance from that account which will close it out the first week of Feb 2014.
- Payments to me from TMRS. It is a retirement fund into which I had put enough money so that from now till I die I get a monthly pension. Right now that is $810 before taxes but will go up to $817 before taxes in Jan 2014 (annual cost of living adjustment)
- And money I make from my “online enterprises” which from Zazzle, Squidoo, Amazon Referrals, iTune referrals, and taking online surveys and doing micro-tasks on sites like MTurk, I pull in between a whopping $100-200 a month.
- There used to be a fourth stream of income from line dance gigs but that came to a screeching halt in August… (more on that in just a bit)
So…. While one hopes for the best and works to make the “best” happen, you have to plan for the worst. Here is my “Worst Case Scenario” income projection for next year which assumes…
- …that I do not find a job
- …that my 401k runs out of money on Feb 1st
- …that my “online” mini-jobs continue to only bring in cash at their current levels.
- …that my arm injury and knee injury can not be fixed and I will not be able to dance again.
Assuming that all those things are true, then my annual income for next year will be [drum roll please] a huge stunning grandiose amount of $13,901.80 Daddy Warbucks, eat your heart out. 🙂
We pause for a commercial break (kinda sorta….)
Uhmmm… hey guys…. Pssssstttttt…. Got a question for you…
Do you ever shop on Amazon? Do you want to help a brother out?
Well there is a way do your Amazon shopping and help me make some money and it will not cost you a single solitary extra penny:
- Right click on this link: http://www.amazon.com/?_encoding=UTF8&camp=1789&creative=390957&linkCode=ur2&tag=5678damywatoa-20 or the right click on the image to the right:
- Choose “Bookmark this link” or “Add to Favorites” The exact language may be different depending on your browser. However you do it, just save that link. You could always come here to my blog and click on the big Amazon Box in the right hand column at the top of this page, but that’s kind of a pain.
- Once you have that link saved in your Bookmarks or Favorites then NEVER TYPE “amazon.com” again into the address box of your browser.
- INSTEAD… click on that link to get to Amazon. Why I hear the teeming masses ask? Well when you click on the saved link, it means that I, mister Tony, “referred” a potential customer to Amazon. If you actually buy something then they are very grateful, and by way of “thanking” me they throw a referral commission at me which varies from 4% to 10% depending on the phase of the moon and the position of Jupiter in the house of cards and other arcane mat-E-matical mumbo jumbo which I don’t really understand.
The POINT here guys is that it doesn’t cost you a single solitary penny more to do it this way but ANY purchase made after clicking on that link instead of getting there by typing Amazon.com, well it throws a few pennies in my direction. And did I mention that you do not pay any extra!
No cost to you, but I get to raise my annual income a bit further out of the poverty level! Woot!
We now return you to the regularly scheduled digression…
Some medical background information about “Moi”…
I’ll try very hard to make this as not-icky as possible. LOL Ok, folks… you might have noticed that I love to dance.
Well I have not danced since mid-August of this year. This would be what is called “a red flag” that SOMETHING is very wrong.
Just before losing my job in March 2012, I was diagnosed with depression. I was put on medication by a psychiatrist and and I began seeing a psychologist or a “counselor” on a monthly basis.
Then I lost my job.
When I lost my job I lost my health insurance. It was a sucky “High Deductible” plan but hey it was better than no insurance. And I lost it.
I went to my most awesome-supremely-fantastic Doctor, the FAB-u-LUS Karen King (Have I mentioned how much I love her? Which is just weird because she’s a girl and I’m a gay man and… well it is a sisterly brotherly kind of love thing) Moving on… LOL
So.. My most awesome Dr King looked at the drugs I was taking and immediately re-wrote everything as generic including the anti-depression medication that I was taking. And she switched all the prescriptions from 1 month supply to 3 month supply which is cheaper over the long haul.
And.. being prudent, I signed up for the Walgreens Rx Card. If you don’t know about this you should. In some cases it might even get you drugs cheaper than what your insurance makes you pay and if you don’t have insurance, like “Moi” then it will save you boatloads of money. For $49 per year you get this discount card that gives you cheaper prices on generic drugs.
So, the drugs were lined up for the duration, but no insurance meant no office visits. No monthly counseling sessions and no one to monitor the effectiveness of the anti-depression medications.
The “Ides of August”
And in August of this year, well something happened. The sense of despair and hoplessness and worry and stress became this huge horrible morass. A mental “Tar Pit” where I was stuck and couldn’t move.
In fact, the last part of August and all of September were probably the worst six or seven weeks I’ve ever lived through. I can’t remember any other time that has ever been as bad as that period at the end of this summer. Even the break up with my last serious romantic partner was nothing compared to the gloom that hit me in August.
I’m not one to shout about bad things that happen to me.
My natural inclination is to suck it up and deal with it in private. And not moan and groan too much for too long about “Woe is me… this happens to me…” because well bad things happen to all of us at some point.
I do realize that I’m not one to pass up an opportunity to share a dramatic tale featuring the antics of well.. “Moi”…
[insert image of me putting my hand to forehead and swooning and speaking in a high pitched Southern Accent — THAT’S a picture that is going to be stuck in your head for a while isn’t it!]
“Oh, I declare, I do feel so blue today; I think I shall recline here in my boudoir and nibble on bon bons until I recover from the vapors”
But this was no cause for levity. And it wasn’t something that I’d want to parade out and put on display.
Also, when you share tales of woe, friends, for a while, will moan and groan along with you, but face it, after a while even your favorite BFF for Life friend can become annoying when your BFFFL gets stuck on the same proverbial “play list.”
And in spite of how much you may love them you really wish they’d just drop it and talk about something else. Something more cheerful. That is just human nature. Nothing wrong with it. It just “is.”
Plus talking about depression is embarrassing, especially for men. Folks I may be a gay man, but I’m still a man in oh so many stereotypical ways. 🙂
So, in spite of “depression” being listed as one of the protected classes in the ADA, and something that happens to everyone, well depression is kinda Uhmmm embarrassing…
And the period at the end of the summer wasn’t just a itty bitty ‘blue spell.” I can’t even begin describe just how hopeless and awful I felt. Let me put it this way: friends and neighbors, you ain’t been blue until you’ve been so damned down that just getting out of bed and putting on clothes feels like just too much work; a Herculean Task.
No kidding. No exaggeration. Which for me says a lot in and of itself!
THAT is where I was in August and September of this year. For me, then, a “good day” was when I managed to get up enough energy to get from my bed to my chair in front of my computer screen to watch streaming videos of TV shows off of the Internet.
Intellectually, I know that depression is a medical condition no different from getting a cold and I shouldn’t be embarrassed by it but…
After all, I’m not embarrassed about saying “Wow, this cold kicked me in the butt! I had a fever and I was down and out and couldn’t get out of bed for anything except to go tinkle in the little dancer’s room for a week!” There is no stigma there! No embarrassment.
But somehow admitting that “I feel bad” when the “feeling” bit is all about emotions well, THAT is something that somehow feels well, embarrassing.
A note of thanks to the very few friends (you know who you are) with whom I’ve already shared this bit of news. Thank you from the deepest places in my soul. Knowing that you were there and caring and that you understood means so much to me. HUG
One thing I discovered by sharing my story with those very few friends, is more widespread than you know. Over HALF of the people that I told about my depression confessed to me that they too had been treated for depression or that they were CURRENTLY in treatment for depression.
Hmmm…. that observation suddenly gives me pause… Over half the folks I’m hanging out with… Uhm… Uhhh, better that we don’t go there. LOL
To the men, the fellas, the “guys” reading this… One of the things that I found out when doing some research is that depression in men often manifests itself as anger. So if you are finding yourself “going off” or “wanting to go off” over tiny little things that didn’t used to affect you… look up “depression symptoms in Men” online and get yourself to a doctor!
Uhm… if you have insurance that is….
..which brings us to BACK to the topic at hand… Lack of UNIVERSAL HEALTHCARE IN THE RICHEST COUNTRY IN THE FRIGGIN WORLD!
sorry about that… this issue is NOT some academic argument on policy.
It is my life and I tend to get a bit passionate about the subject.
Putting the Pieces together…
Let me start to connect the dots:
- I was diagnosed with depression (looking back now at the time period then, I am damned proud of how well I handled myself given that I was, according to the counselor, clinically depressed and managing it on my own with no assistance for years!)
- Depression was a major contributing factor… in my job loss
- which leads to… no health insurance and no routine health care
- which leads to… no ongoing treatment for the condition
Fast Forward to July / August of 2014
- … I have reached a point where I can no longer to afford to compete in dancing nor can I afford any additional dance lessons.
- … My effort to raise money to attend the DanceSport Games in Taiwan fail. — I didn’t raise enough money so I couldn’t go.
- …which means… there are no more “dance deadlines.” In other words, since I’m not “getting ready” for a competition there is less of a motivation to go to the studio and practice.
- Uhmmm… hey guys… do you see this? Just in case you missed the significance: one of the MOST IMPORTANT THINGS in Tony’s life is suddenly gone: getting ready for and competing in the dance world. One of the very few things that continued when he lost his job is *zap* gone. POOF
- Now… look into the future. See the financial guillotine hanging there? Hmmm… right now, I can pay all my monthly bills and have food and clothes and gas for the truck… but come Feb 1st well, DA-DA-DA-DUM…. That ain’t gonna be the case.
- can we say “stress?” NO WONDER I got hit by the depression fairy Hmmmm????
An important observational note: I have discovered during my time being “retired” slash “unemployed” slash “self-employed” that I like being my own boss! I like managing my own time. I like not having to commute for over an hour a day on crowded freeways.
If my fairy godmother appeared right now and said “Poof you have three wishes” I would wish for:
- a perfectly fit and healthy body
- a confirmed gig as a dance instructor pulling in enough money to pay bills and to be able to compete on the Pro level AND
- world peace
So… here we are in August…. The Doom of Damocles is now visible on the horizon of the not so distant future and I’m have this awesome opportunity to interview and to try to get a gig as a dance instructor in Austin and BAM….
I somehow injured my arm. I mean come on! I. CAN. NOT. CATCH. a friggin break! Sheeesh!
I have no idea what I did or how I did it.
But I woke up one morning about a week after The Lone Star Invitational, where I was a staff Line Dance Instructor, and I couldn’t use the arm.
At all. I couldn’t even pick a cup of coffee in my left hand. (I use my left hand almost as much as I use my right most days)
I couldn’t lift my arm past the level of my elbow without it hurting. Raising the arm it to shoulder level caused excruciating eye watering literally gasping aloud PAIN!!!!! About 9 on that pain scale that doctors use to gauge pain.
So I slap some ice on it and pray that it will get better and I cancel all of my dance obligations. Hey Donna! did you read that… See I do listen when you tell me stuff. LOL Ice… not heat…. I can be taught up! Woot!
Arm update: it is better now, but I can not put a jacket on without assistance. I can’t bend the arm enough to get it in the arm hole; it just hurts too much to bend it that far. I can lift it to shoulder height without pain but no higher. The most weight I can lift with the arm is about a tenth of what I used to be able to do.
Still with me? Connecting the dots…
- … Dancer who can’t dance (try spinning without your arm… maybe Gary Mcyintre can do it but I can’t) and
- … Dancer who can’t lead… (try leading a lady in an under arm turn or an outside turn with no left arm) Ain’t gonna happen.
- then BAM — Mr. Depression SMACKS me upside the head. I don’t know what happened. I really don’t. I don’t know why it got so bad so fast. If I had HEALTH INSURANCE I would have scheduled a doctor’s appointment and let a professional figure it out. My best guess is that my meds need adjusting; but I can’t find out for sure until I can go to the friggin doctor and I don’t have the money to do that right now.
So… there I was, in late August. I was so depressed that literally I went ten days at one point without showering. Icky right? Try living it. I slept so much that I felt like I was hibernating. EVERYTHING felt like it was an impossible task, yes, even taking a shower.
… depressed to the point of immobility. Check!
… physical injury which needs treatment and limits mobility. Check!
… only comfort or bright spot seems to be when I eat. Check!
Helllllllooooooo Weight Gain!!!!!!!
Why do I suddenly feel like breaking into song and why am I looking for a line of chorus boys to carry me down a flight of golden stairs… [get it? … “hello dolly/hello weight gain” ] ROFL!!!! I crack myself up sometimes.
Hey! Stop rolling your eyes! It’s my fantasy world… I can play whatever musical I like on my mental screens and have as many chorus boys as I want running around…! But I digress…
I ballooned up to 327 lbs. Yes. Three HUNDRED and twenty-seven pounds! sigh I felt awful about the gain in weight and the drop in physical fitness…
Which of course fed back into the depression and…. then
BAM… I re-injured my knee. Sigh. The LEFT knee, same side as the injured arm. SIGH
Last year just before Worlds I strained my knee working on some of the advanced moves in the line dances. I managed it properly and it healed up and then at Worlds, during a warm up practice, I aggravated the injury and had to scratch my line dance competitions. sigh
Well over the course of this year the injury has been just fine until September…
… where the additional pounds I guess overloaded my knee and it flared back up again.
Climbing the stairs to my apartment carrying groceries or laundry became a literally endurance test. A nightmare of one step at a time using my right leg to carry most of the weight and move me from one step to the next.
By the end of September I was a mess. And I needed to go to the doctor, more than one of them for different reasons.
The tale of how I managed to pull myself out of the Tar Pit and get moving forward again will be shared later.
For now, I’m going to return to the main topic: the ACA and how it is going to help me.
Climbing out of the Pit…
A new beginning.
- Since then I’ve managed to climb out of that pit of despair and I’m moving forward both physically (I’m down to 318 lbs, a lost of 9 lbs)
- I’m no longer sleeping my life away. Yay!
- I’m working like a madman on my online enterprises (more on that in a later post) and hoping that it will start pulling in enough money to replace the 401k money which will disappear in Feb.
BUT… I still needed to go to the doctor
Aha! I hear the teeming masses cry out!
Dear readers, those who are still with me. I promise that I didn’t mean for this all to go on so long, but all that background information was important to share if you were to be able to understand just HOW FRIGGIN IMPORTANT AND AWESOME HAVING ACCESS TO GOOD MEDICAL CARE IS GOING TO BE for me!!!!
So, finally we’ve caught up to the present in my tale of adventure (for lack of a better word) That would be called sarcasm folks. Don’t cut yourself on my razor wit…. ahem
About a week ago, I decide “What have I got to loose” and I sign onto healthcare.gov. I fill out the application and…
The sun comes out. The birds start singing in harmony. A rainbow lands in my friggin lap and a leprechaun starts waggling his eyebrows at me saying “How ya doin’ big fella?”
Tiny Tim is shouting “God Bless us every one” on the corner and Little Orphan Annie is singing and dancing with Daddy Warbucks outside my window.
Folks this is BIG!
For the first time in so long, I feel like I’ve caught a break. SOMETHING good has happened! And not to put too fine a point on it, this “break” is one that will lead to a whole string of things which will allow me to improve the quality of my life and get myself in shape to get back into the workforce. OMG! I’ve won the lottery! Woot!
Then this week, I broke my record for single day sales on Zazzle! Things are looking up!
Uhmmm… But I digress.. back on to the topic at hand….
Here, arranged in order of importance are the things that I’m going to be able to do something about starting Jan 1st:
- I can get a MRI scan of my arm and shoulder and see what the heck is going on in there. Then get it treated whether that means surgery or just physical therapy (which is my best guess as to what is going to happen. My arm is much better now but nowhere near 100%) For the record, without the new health care law, pre-existing conditions like this would have disqualified me from an individual policy like the one that I am going to be getting.
- I can get a scan of knee and get PT for it.
- I can make an appointment with the head guys and see if my meds need adjusting and resume counseling.
- I can ask my doctor, the most awesome Dr. King, to monitor me and my progress while I work toward getting healthy and loosing weight. The plan that I’m getting doesn’t cover “weight loss programs” like what you’d get if you enrolled in Baylor’s weight management program but it does cover routine office visits so I can see her regularly and she can monitor my progress and make sure I’m on track by checking Cholesterol etc etc.
- My doc can check and make sure that my Hypertension (high blood pressure) meds are still working and make adjustments if needed THEN hopefully if everything goes as planned, this time next year I’ll be fit and healthy and I won’t need any high-blood pressure meds any longer! Woot!
- And then there is a whole host of tiny things that all fall under the category of “I’m getting older and while not life threatening, it sure would be nice to have a doctor take care of it…” kind of stuff. We won’t discuss–icky-ness and all that… LOL You know, getting Older (notice that I did not say “old”) is not easy and not for the faint of heart LOL
The ACA also has dental insurance included in the marketplace and which I enrolled. So I can:
- Get my teeth cleaned! Woot!
- Get a filling on one of my teeth that at the moment thankfully is not causing me any pain but that could change at a moment’s notice. Right now a filling will do. If it goes untreated then the tooth will need a crown. Ugh.
- Get the two crowns which fell off earlier this year replaced. It is too late to just re-affix them. If I had had health insurance….
- and so on and so on and so on… I’ll spare you the details about the rest of the dental stuff that I need done. Let’s just say that there’s work to be done.
Can we have a “Hip-Hip-Hooray!?!”
Even if you hate the Affordable Care Act at least be happy for me! And if you do hate the act, then maybe seeing how much GOOD this is doing for someone will change your mind about it.
The gritty details about how I got my new insurance, how the application process worked, and how much it will cost:
The reason I went to Healthcare.gov and did some investigating was that I was desperate. I knew that next year my income was about to drastically drop and I thought “What the hell? What have I got to loose? All they can do is say “no”.
I don’t watch TV but I usually keep up with the news from online sources like the NY Times or Washington Post websites.
However, over the past few months, not only have I NOT been watching TV, I haven’t been following any news at all. Not since mid-August. Literally. I’ve been purposefully avoiding the news. Right now, avoiding the news, is one less stressor in my life.
Nonetheless… a tiny bit of froth from the InterWebz has spilled into my awareness.
I had a very vague sense that applying at healthcare.gov would be difficult, based on the teeny tiny bits of information which had hit my radar. I was braced for the worst. I was expecting a difficult, time consuming agonizing Modern Tale of Horror! Eeeeeeeeekkkkkkkkkkkkkkk!!!!!!!!!
I was wrong. WRONG! Did you get that? Hmmmm???? Let me make this absolutely clear: The process was smooth, easy, efficient, and painless:
- The information on HealthCare.gov is clear and easy to understand. It does an amazing job of taking a very complex topic and making it understandable.
- The application process is SIMPLE and easy to use.
- The interface (remember I have a background in computer systems) is EXTREMELY well designed. It walked me step by step through the process, asking me easy to understand and easy to answer questions.
In complete candor, there was one time where I had to wipe the slate and start over from scratch. But that was mostly my fault and only partly the system’s fault. After I was about 3/4 of the way through the process I realized that I had added wrong and entered the wrong amount on my expected annual income for next year. The system had no way to allow me to back up and change that information from where I was. So the easiest thing to do was to just delete my application and start over. I was able to do that with no problems and because I’d already answered all the questions once, I was able to enter the correct information and be back to where I was when I discovered my error in about 15 minutes. Like I said, that was my fault, not really the systems. Only once did the website lock up but I use AT&T so it could have been them…even Google locks up on my internet connection sometime. *sigh* I hate AT&T but I digress…
- I was told immediately by the software on the website, that I qualified for a tax credit to enable me to purchase the insurance. I qualified based on my income. I am above the official “Poverty Line” just barely: As a ‘household” of “one” the poverty line is $11,490 <<< You got to be kidding me! But that my friends is the topic for another post.
So… I was able to go to healthcare.gov, create my userID and login with no problems.
I was able to easily read and understand the information about my options and read the information which allowed me to make the choices which work best for me.
I know that some other people have had problems but I did not. It was a smooth and easy process.
And hey folks…. Rome was NOT built in a day. I defy anyone to build a major new program or project or building or road or software program from ZERO, from “scratch” to fully functional operational system with no GLITCHES!
Come on… you do not expect perfection right out of the gate. You expect “workability” Don’t believe me? Then ask Microsoft. That has been their standard operational procedure for years.
Here is what I’m getting starting Jan 1st:
HMO Plan with Blue Cross / Blue Shield
- Monthly Premium that I pay: $21.38
- Monthly Premium paid by US Govt: $376 (in the form of a tax credit which technically is my “tax credit” which I qualify for based on my income but is being sent directly to the Insurance company instead being given to me on my tax return for 2014 — my choice to do it this way. I could pay for the insruance on my own — yeah, right like THAT is possible, and get the “credit” or refund for that expense when I file my 2014 tax return. Uhmmm let me think about this… DUH! So I chose to have the funds directed to the Insurance company now.)
- My annual deductible: $0
- Prescription drug deductable: $0
- My Out-of-pocket maximum: $500 annual
- My copayments:
- $35 Primary doctor
- $55 Specialist doctor
- 80/20 split after deductible met until maximum Out of Pocket reached.
- No Charge Generic drugs
- Preferred brand drugs: $50
- Non-preferred brand drugs: $100
- Specialty drugs: $150
Blue Cross Blue Shield Dental Plan (2A)
- Monthly Premium that I pay: $34.70
- Monthly Premium paid by US Govt: $0
- My annual deductible: $75
- My annual Out of Pocket Maximum: $700 (applies only to the things at the 80/20 level then everything is covered at 100% once the maximum is reached)
- The benefits are pretty typical for dental insurance: Things like cleanings are free (2 per year). Things like fillings are an 80/20 split.
- Major work like crowns or implants are covered at 50/50.
My total monthly premimum for both Medical and Dental: $56.08
Here is what had at my last job:
I was a Librarian working full time for the City of Bedford.
Cigna PPO High Deductible Plan
- Monthly Premium that I paid: $0
- Monthly Premium paid by the City to the Insurance company: $358.24 (PLEASE NOTE that this is only $18 less than what the Fed is paying Blue Cross Blue Shield on my behalf AND I get a much better health insurance plan under the new law!!!!!!!!!!!!)
- My annual deductible: $2,500 (yes you’re reading that right. I had a TWO THOUSAND FIVE HUNDRED dollar deductible which basically meant that unless I was in a major accident or was hospitalized, I’d never make the deductible which meant that I was basically responsible for 100% of my annual healthcare costs. So.. Cigna was getting $358.24 per month to provide healthcare and I still had to pay a 100% of my expenses up to $2,500 — Uhmmm can we say “rip off”?)
- Prescription drug deductable: $0
- My Out-of-pocket maximum: $5,000 annual (yes — FIVE THOUSAND dollars)
- My copayments:
- $50 Primary doctor <<< more than my new plan under the new law
- $65 Specialist doctor <<< more than my new plan under the new law
- 70/30 split after deductible met until maximum Out of Pocket reached. <<< lower benefit than my new plan under the new law
- No Charge “maintenance” Generic drugs
- All other generics: $25
- Preferred brand drugs: contracted rate (varied depending on the drug)
- Non-preferred brand drugs: contracted rate (varied depending on the drug)
- Specialty drugs: contracted rate (varied depending on the drug)
Cigna Dental Plan
- Monthly Premium that I paid: $0
- Monthly Premium paid by the City: $28.55
- My annual deductible: $250
- My annual Out of Pocket Maximum: $2,000 (applies only to the things at the 80/20 level then everything is covered at 100% once the maximum is reached)
- The benefits were pretty typical for dental insurance: Things like cleanings are free (2 per year). Things like fillings are an 80/20 split.
- Major work like crowns or implants are covered at 50/50.
Bottom line: I’m going to have a better medical plan AND a better dental plan starting Jan 1st, than I had as a full time employee of a city government at my last job. Wow!
We now pause for a political exposition…
Now, I’m intelligent enough to know that my case may not be typical. But I also know it is not the exception either.
I don’t know exactly how typical my case is without doing further research.
But my suspicion is that it is a mixed bag for now; different people = different situations. But no matter what, the bottom line is, come Jan 1st a hell of a lot of people are going to have health care who did not have it on Dec 31st!!!!
Because of the Affordable Care Act I am going to have access to,
well, uhmmm… “Affordable Health Care” for the first time in almost two years!
And this is a problem how? What about this is a BAD IDEA?
I defy the critics of the Affordable Healthcare Act to look me in the eye and say
“Tony, I believe that your arm and knee should go untreated. I believe that you should just let your teeth be exposed and your crowns should not be replaced. I believe that you should continue to suffer from severe bouts of depression because I don’t believe that government should provide basic services to its citizens.”
Go ahead. I dare ya! It is Christmas time isn’t it. Go ahead. Channel old Mr. Scrooge.
If you believe that government should not be involved in providing services that benefit the greater good, then let’s get rid of things like Fire Departments, Police Departments, Traffic Lights, Municipal Water supplies, Municipal Sewage treatment and trash pick up.
Let’s toss out Libraries and parks and community swimming pools. Let’s toss out parades on Veterans day. Let’s toss out the Army and Navy and all the defenses that keep us safe and our country free.
Let’s toss out Medicare, Medicaid and Social Security.
Let’s toss out any and every service where the whole citizenry shares the cost to the benefit of all. That would include things like public schools too!
NEWS FLASH!!!!!! Public education is a socialist institution. GASP! Oh my god, tell me it ain’t so!
Well folks it is! Don’t like socialism? Lets see how you manage to pay for your own kids education — for all twelve years of it. On your own with no help from anyone else. Do you have those kinds of resources? Oh my? Maybe sharing the cost for the benefit of all is a good idea you say?
Still don’t like socialism? Lets do away with mandatory auto inspections. Let’s get rid of such socialist things like meat inspectors from the Department of Agriculture. Let’s get rid of the Food and Drug Administration too while we’re chopping off those evil socialistic institutions from our GUV-ment.
Let’s go back to the days of the Traveling Pill salesman when god knows what was actually inside those medicines and drug companies, indeed even soda companies like our beloved iconic Coca Cola Company, could put whatever they wanted into their products and make whatever ridiculous claims they wanted about it and NOW ONE HAD THE POWER TO STOP THEM!
The list goes on and on and on and on where we, as a society have decided that for the greater good, we are going to fund certain activities and services and enforce certain laws and jointly hire the people to make sure the laws are enforced and provide those services.
If you believe that government should not get involved in these things, then let’s go back to the days at the dawn of the industrial revolution where Industrialists were King.
Let’s go back to a time where if you were unlucky to be born in the lower economic classes then that was where you’d be for the rest of your life. You were stuck. You had no way out.
You would be uneducated, could not read, nor write, had a life expectancy of under 50 and could be expected to die of any number of causes that we, now would be horrified if anyone died from that.
You’d drink from a common well, contaminated from the runoff of the city that surrounded you. A time when sewage ran in the streets and the pollution from the factories was so thick that people literally suffocated from the fumes.
Yes, my tirade above may be sarcastic and dramatic but it also is laden with truth and the essential point is valid:
We live in a society where we agree that some things are so basic that EVERY SINGLE CITIZEN SHOULD HAVE THEM.
Health care is one of those basic things.
This has been a very rough year. It hit the lowest spot on Sept 30th. Since then I’ve made quite a bit of progress at “making a come back” and just last week I found out that…
On Jan 1st, I will get health care insurance. For the first time in almost two years, I’ll be able to afford medical care.
With that care, in a few months time I am going to be healthier and fitter and happier because I can will be able to afford to go to the doctor and get the medical care I need.
It isn’t going to be easy.
At my projected 2014 income levels a $35 doctor visit and a $55 specialist visit each month, and the 50% of the dental work for which I will have to pay, will be tough to budget but it will be POSSIBLE.
Not easy, but possible.
Right now, at this moment, it is IM-possible.
The only bad thing about the Affordable Care Act is that it does not go far enough. No one in this country should do without basic health care.
No one should be where I am now. No one should be where I was in August and September of this year.
If you want to help me out you can…
- Make a donation via PayPal
- or you can do the “no extra cost” thing by bookmarking then shopping on Amazon
- or you can buy one of my designs, or any design, on Zazzle.
See ya on the dance floor!
P.S. If you’ve followed a link from Twitter or Facebook, especially Facebook to here, well I’m not on Facebook much these days because I’m working VERY hard on my Zazzle store and two new “dance” related websites which I’ll talk more about once they are ready for prime time
So please don’t take it personally if I don’t reply to a post or answer an email you send via FB. If you really need or want to get in touch use my contact form here on my website or call me on the phone.
About TxCowboyDancerEight time Country Dance World Champion. I love to dance. In the middle of a journey, transforming myself from "unemployed and out-of-shape" to "in-shape and full time dance instructor, writer and graphic artist."
Posted on Thu, Dec 12, 2013, in Misc and tagged ACA, Affordable Care Act, amazon, Amazon.com, arm injury, basic human rights, blue cross blue shield, cigna, city of bedford, dentist, depression, depression in men, doctors, Health, health care, Health care reform, Health insurance, healthcare, healthcare.gov, humor, iTunes, knee injury, librarian, new health care law, Patient Protection and Affordable Care Act, politics, socialism, socialist institutions in the united states, Squidoo, teeth, unemployed, United States, universal health care, USA, Washington, weight gain, zazzle. Bookmark the permalink. 7 Comments.