Pittsburgh Post-Gazette

Unhealthy insurance

The cautionary tale of an Obamacare customer

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The adage “you get what you pay for” has come back to haunt Richard Sankovich. He’s paying big time, and his experience is a cautionary tale for those shopping for health insurance in the federal marketplac­e. Low-premium plans can come with big price tags later on and provide precious little peace of mind.

Mr. Sankovich, a Virginia resident, went to the emergency room at West Penn Hospital with stomach pain while visiting family here in March. He was diagnosed with a pulled muscle, then got a medical bill big enough to induce nausea. As reported by the Post-Gazette’s Steve Twedt last week, he has to shell out more than $6,000 for his 2½ hours of hospital care because his plan includes a $6,500 deductible.

Under the Affordable Care Act, which requires Americans to have health insurance, those who do not receive coverage through their employers can purchase plans through a federal marketplac­e. There, sundry insurers offer plans at various price and benefit levels. As 63-year-old Mr. Sankovich found out, lower-premium plans — his Aetna coverage costs $478 a month — come with higher deductible­s and co-insurance. His plan, moreover, does not cover emergency room care at all.

His predicamen­t is ironic, though far from unique. There is evidence that others share his plight. The law was designed to increase access to health care for the uninsured and underinsur­ed. Yet nothing about Mr. Sankovich’s case is affordable, and he certainly seems to have been underinsur­ed. Paying down his medical bills will diminish his quality of life for months to come. Next time, he’ll think twice about seeing a doctor for an ache or pain. That would undermine Obamacare’s goal.

Navigating the marketplac­e can be a challengin­g exercise for less-sophistica­ted consumers, and those of modest means or those seeking deals will gravitate to lower-costing plans. Obamacare may provide a safety net for catastroph­ic care and major illnesses, but consumers must understand their possible exposure to big bills for simpler care. Obamacare is no cure-all. Let the buyer beware.

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