Without Obamacare Our Son Would Not Have Coverage – Story

Our experience is that while Obamacare may be far from perfect, it does provide coverage for our 29 year old son who otherwise would be excluded from health insurance because of a preexisting condition.

My son graduated from college in 2009. He was 24 at the time and was dropped from my husband’s healthcare plan which at that time only covered children until they were 21, out of school or 24. Fortunately my husband had great coverage through his employer, earns a good salary and we were able to keep coverage on my son, who did not have a job, through COBRA but it cost over $600 per month just to cover him (as much or more than we paid for the other 3 family members).

He had always been relatively healthy so when he began to complain of hip pain, he blamed it on his old mattress. It wasn’t until he was rushed to the emergency room by friends the middle of the night because he was in such agony he couldn’t walk, that any of us realized something more serious was going on. The doctors thought it must be from either rheumatoid arthritis or an infection but the tests showed neither to be the case. Over the next several months, his symptoms began to multiply.

Many, many doctors visits and tests later he was eventually diagnosed with a very rare, autoimmune disease. A so-called orphan disease because there are so few people with it and consequently little money or interest in researching it. It is a disease that generally doesn’t show up until people reach their mid to late 20’s. It’s causes are unknown and it is treatable but not curable. It is also associated with a high degree of morbidity. Blindness, and in the worst cases, death can result.

Because COBRA only lasts 2 or 2 1/2 years, we were overjoyed when the ACA passed. Under it, our son was able to go back on my husband’s plan until he was 26. By then he had moved to CA and obtained a job with a small company which did not provide health insurance. At the end of his 26th year, he went back on COBRA. Then when the CoveredCA exchange opened, he got coverage through that although he didn’t qualify for a subsidy.

Now he is on a privately purchased plan but it is subject to all the provisions of Obamacare. He pays about $450/month for a Gold level plan.

The plan is not perfect. He couldn’t find any that covers all the doctors he sees and doesn’t cover his main specialists. But the $200/month savings helps make up for the difference between what the plan would cover were his rheumatologist “in-network” and what it actually covers (80% vs. 50% of covered costs). His disease has been managed for over a year now without a relapse and he just needs to go in for periodic check ups.

The paperwork and just figuring out what his options were challenged me, a well-educated woman with a Master’s degree. But at least he has options and we have the peace of mind of knowing that as long as Obamacare is in place we won’t have to worry about him either going without needed care or bankrupting us if he does have a relapse.