Ellena from New York: Struggling to Pay for Health Care
Ellena, a recent first-time mother, has spent her life struggling to overcome debilitating health problems — and struggling to pay for coverage. Both of her parents died of cancer. She was diagnosed with genetic melanoma when she was 10 and gastrointestinal cancer when she was a sophomore in college. Her health-care-fueled debt is so overwhelming that she’s not even sure how big it is anymore.
A Ph.D. candidate in Philosophy, as is her husband, Ellena has been insured a few times through school and COBRA, but "pre-existing condition" clauses have delayed and limited her care, and the policies have never covered everything she needs. Her student loans have disqualified her for most assistance, even though her fellowship pay is well below the poverty level.
Ellena gave birth to her son, Liev, in December 2009. During her high-risk pregnancy, she had to endure a multitude of medical therapies and treatments. Liev was born with several medical issues, and the insurance company claimed that Ellena’s medical conditions and life-sustaining medications caused them — and therefore that Liev’s conditions were pre-existing. The company denied most of the benefits promised in its plan.
Ellena’s husband has had to increase his course load to full time so he can take out additional student loans to pay for their COBRA plan, which costs more than $500 a month, and other medical costs not covered by their insurance. Unfortunately, the COBRA plan does not cover the special formula Liev needs, which costs roughly $550 a month.
Now requiring ongoing treatment for both herself and her sick infant, Ellena finds herself making painful choices between her own health and that of her baby.
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"Under new plans, no child under age 19 will be denied coverage for a pre-existing conditions, period. Adults who have been without insurance for six months and who have been unable to obtain insurance because of a pre-existing condition, can apply for coverage under the Pre-Existing Condition Insurance Plan (PCIP)."
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Insurers can no longer cut someone after the fact.
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New screening procedures are now in place for health care providers to eliminate fraud and waste in the health care system.
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Medicare Part D enrollees who hit the Medicare prescription drug benefit gap in 2010 will automatically receive a $250 rebate check.
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Effective immediately, qualified small employers get tax credits of up to 35% of premiums for offering coverage.
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America's new health care law makes it easier for you to find the quality, affordable health care that you and your family need.
