Finding health care: 'Maybe we'll have to get married'

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Myles Ma, CPFCSenior ReporterMyles Ma, CPFC, is a certified personal finance counselor and former senior reporter at Policygenius, where he covered insurance and personal finance. His expertise has been featured in The Washington Post, PBS, CNBC, CBS News, USA Today, HuffPost, Salon, Inc. Magazine, MarketWatch, and elsewhere.

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Lacy Ward has done the math. Buying health insurance through the federal marketplace makes financial sense for her. She has purchased plans through the exchange for four years, since aging off her parents' insurance.

"I know what I'm talking about when it comes to the ins and outs," the Houston resident said when I first talked to her in September.

Ward should be easy to insure. The 30-year-old works out daily. She doesn't smoke.

She knows to read through the details of each plan. She knows to check the deductible, the co-pays, the max out-of-pocket cost. She knows what her medical costs should be with and without insurance.

But even she got a little freaked out before open enrollment this year. In October, after the Trump administration announced it would cut cost-sharing reduction payments, I got in touch over email to ask how they would would affect her. Her confidence level seemed lower.

"I am not eligible for any subsidies and will probably see a hike in premiums," she wrote. "He's making the tax penalty seem way more favorable at this point. I may explore trying to get on my boyfriend's insurance as a domestic partner or maybe we will have to get married earlier than we planned, which is so crazy."

Ward did look into her boyfriend's coverage before open enrollment, but decided it wouldn't make sense. It would have cost an extra $450 to add her to his plan.

"I think he was going to claim me as his live-in partner or something weird," she said.

Ultimately, Ward managed to avoid that unromantic proposal. But things got hairy for a minute.

Crunching the numbers

Ward works as a geographic information systems specialist for an oil data company. The company only has four people. It offers health insurance, but Ward did the math, and a marketplace plan was less expensive.

Her main health expense is a daily dose of Adderall. She's taken it since she was 10. Every year she looks for a plan that helps pay for the medication and covers a doctor who will write a prescription.

The marketplace plan Ward purchased last year has high premiums, but covers the cost of prescriptions. The plan is slightly less expensive than going without insurance, buying the pills out of pocket and paying a tax penalty, Ward said.

"I come out just ahead with the higher premium," she said.

Ward pays $255 a month for her premium, a $30 co-pay every three months to visit a doctor for a prescription and $35 a month for a generic version of Adderall. Her plan has no deductible.

'Too high to justify'

Though Ward was confident in her grasp of the marketplace, she was unsettled following the debate over former President Barack Obama's health care law leading up to open enrollment.

"I just wonder if the premiums are going to all of a sudden be too high to justify," she said when we first spoke.

Ward tracked each proposal to repeal or curtail "Obamacare," from the "skinny repeal" of the Health Care Freedom Act to the block grants of Graham-Cassidy.

"I just wonder how people who don't have much education and knowledge are able to navigate this difficult process," she said.

Higher price, higher subsidy

Ward's premiums will end up higher for 2018. But because she was able to deduct student loan interest from her income, she qualified for a $150 premium tax credit and was able to get her same 2017 plan for $50 less a month. The plan still allows her to pay just $35 for her Adderall prescription.

She shopped around, but most of the other plans had deductibles around $7,000, which didn't appeal to her. Getting the plan cheaper was good news, but the uncertainty beforehand wasn't great. After she picked the plan, I asked her how her marketplace experience was this year overall.

"I think that it's all terrible, but it is what it is for now," she said. "It's better than not having it."

This is the third in our series profiling real people who use the Affordable Care Act. We're hoping to put a face to the controversial law and provide an up-close look at its impact, whether harmful or helpful. We'll feature someone new each week until federal open enrollment ends on Dec. 15, so check back for more stories. If you're looking for help signing up for Obamacare 2018, visit our HealthGenius section.

Image: Lacy Ward

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