So How's That Insurance Marketplace Working for You? Four Mainers Weigh In

Jan 27, 2015

It's been more than a year that Mainers have been able to buy insurance on the Affordable Care Act's online marketplace. The goal of the marketplace, say advocates, is to provide affordable insurance and increase access to healthcare. But what is it really like to use these plans?

Patty Wight spoke to four Mainers who enrolled last year, and each had a different experience.

Stephanie LaPlante is a list-maker. And that makes her very good at her job. "I am the foreman of a horse stable with 21 horses."

Her job is to make sure essential daily tasks get done at Meadow View Equestrian Center in Readfield. Today, stuffing snack hay into individual bags for each horse is on that list. 

Last year, LaPlante's list of personal to-dos was buy health insurance. She turned 26 and was taken off her parents' plan - and that terrified her.

"Large animals - horses - they can be kind of unpredictable," she says. "Usually they're really great, but you can never be 100 percent sure 100 percent of the time, and I just wanted to make sure I had a back up in case something happened."

LaPlante also needs prescription allergy medication. So she checked out the online insurance marketplace and bought a silver level plan, where her allergy meds cost only five bucks.

Stephanie LaPlante with a horse at Meadow View Equestrian Center in Readfield.
Credit Patty Wight / MPBN

  Even while juggling college and car loan bills, LaPlante says her insurance plan is affordable. "Incredibly affordable!  I wouldn't have health insurance now if I didn't have this."

While LaPlante wanted insurance as a safety net, others who've signed up need coverage to manage chronic conditions. Heidi Perkins is a freelance documentary film editor who also has Type 2 diabetes.  After being laid off in 2013, she was without insurance for six months, before the marketplace opened.  

"It's a lifesaver," she says, "because I'm not the best monitor of myself when it comes to the diabetes."  

Perkins says regular appointments with her doctor keep her diligent about her diet. Her marketplace insurance also allows her to continue her career in film as a freelancer.  Perkins was even able to get her premiums reduced mid-year when a work project fell through, which reduced her income.  

"For a freelancer who can't join a group plan, who now can join a group plan through the Affordable Care Act, it's a game changer." she says.

The marketplace was a potential game changer for Christine Lutz-Gerrity, a realtor in Ellsworth.  For years, she got insurance coverage  through her husband's employer.  But when that employer stopped offering insurance in 2014, she and her husband bought plans on the marketplace.

After subsidies, their premiums cost a little more than $400 a month. Lutz-Gerrity was happy - until she started using her new plan.  Some claims were processed at different rates toward her deductible - even for the same provider.

"And then another issue we experienced is that some of our claims were rejected, and when I called to find out why that was, it was indicated that the provider was out of network," she says - even though Lutz-Gerrity checked before she bought the plans to make sure her doctors were in-network.  

After more than six months of phone calls, Lutz-Gerrity expects the issue will be resolved soon. But, currently, she's facing another headache. She and her husband earned more income than expected last year, so they'll likely have to pay back all their subsidies - about $4,700, "which will be a significant chunk of money that we have to come up with at tax time."

So when her husband's employer offered insurance again this year, Lutz-Gerrity decided to ditch the marketplace, at least for now -  even though the employer insurance is slightly more expensive and restrictive.  

"In the end, it felt like a safer choice," she says, "because we didn't have to worry so much about our incomes as far as whether we would go over the threshold or not."  
 

Retired Augusta resident Juliette Lounsbury.
Credit Patty Wight / MPBN

Juliette Lounsbury of Augusta was always mindful of her income and budget.  She and her husband Mike went years without seeing a doctor.

"First of all, we are retired," she says. "I'm 64 years old, and my husband and I, 41 years married.  Never had insurance really, never really have been sick."

Spending a good chunk of their careers in the restaurant business, Lounsbury says health insurance was always just too expensive.  Even when her husband started complaining that he didn't feel quite right a little more than a year ago, they couldn't afford to go to the doctor.

"He said, 'I'll wait - I've got six months 'til I get my Medicare, and then I'll go and be checked,'" she says. "And six months before, he dropped."

Her husband had a heart attack and needed eight-way bypass heart surgery.  It was a wake-up call for Lounsbury, who decided that she'd better get insured.  

"Dr. Cheng is our doctor here in Augusta, and he said if only Mike had come in just for preventative, we could have detected it long before it ever got to this point," she says.

Lounsbury pays $26, with a $500 deductible.  She now goes to the doctor for regular check ups.  Per doctor's advice, she and Mike exercise regularly and eat a strict diet.  They've both lost weight.  

Her insurance, says Lounsbury, is better than she ever expected. "I'm praying to God they don't take it away."

After years of not having insurance, Lounsbury says now she can't imagine not being covered. The deadline for those seeking insurance for the first time, or for finding an alternative option on the marketplace, if Feb. 15.