Residents with different needs set to explore new health plan marketplace

URBANA — Adrienne Bauer can't remember a time in her life when she didn't worry about how much health care was going to cost.

Even back in high school, when she was hit by a car, she was anxious riding in the ambulance.

"I remember being so stressed that it was going to be so expensive," she said.

Now a 28-year-old, self-employed house painter living in Urbana, Bauer said she plans to check out her options for health coverage in Illinois' new insurance marketplace after open enrollment starts Tuesday.

A cornerstone of the Affordable Care Act, the marketplace — called Get Covered Illinois — is the state's online shopping center for health coverage.

Nearly everyone will be required to have coverage starting next year or pay a penalty, and the marketplace has been set up as a one-stop shop to compare and apply for health plans and subsidies to offset the cost of premiums and for the neediest uninsured to apply for coverage in the state's newly expanded Medicaid program.

For the first year, Gov. Pat Quinn's administration expects about 300,000 people to enroll in marketplace health plans, for which final rates and details have yet to be disclosed.

Bauer said she's either lacked insurance or hasn't had much of it most of her life. She now pays $157 a month for some "pretty basic" coverage but hopes to find something more thorough — and affordable — in the state marketplace.

"I would like to be able to go to the doctor's office and ask real questions about my own health, and be able to be supported, instead of feel fear," she said.

Here are some others who will be checking out the health marketplace:

No more job, no more insurance

Jerry Pica, 60, of Champaign worked in health care for 37 years as a physical therapist, and his wife, Jane, is a retired nurse.

So, he said, he was surprised to find himself and his wife uninsured for the past three months after he lost his job with Presence Covenant Medical Center.

Buying COBRA continued coverage would have been too expensive and private health coverage was going to run about $500 a month, he said. So he and his wife have been taking their chances and exercising, eating right — and hoping and praying they don't get sick.

"We've been lucky so far," Pica said.

Pica said seeing a sample of the lowest premium rates in the state marketplace — information released by Quinn's office this past week — wasn't encouraging, and he's concerned about what rates are going to run for older adults.

But he doesn't plan to wait long to find out more. Pica said he plans to check out the marketplace plans when the website launches Tuesday.

Part-time, no insurance

Rick Royse of Monticello is a 59-year-old father of two grown daughters. He's been uninsured for about five years, he said.

What medical care he's needed in that time has come courtesy of Carle's community care program, he says.

Royse said he once had good insurance when he worked for General Cable Co. for 24 years, and again when he worked as a groundskeeper for an apartment complex for a couple of years.

Now, he's living on a part-time job (with no health coverage) and early pension payments that will end when he's 63. He's not sure just how affordable health insurance will be for him through the state marketplace, he said.

He plans to seek guidance signing up for coverage through Champaign County Health Care Consumers, an organization that helped him get health care in the past, Royse said.

"I'm not sure how the whole thing works," he said. "I'll be paying something (for insurance) come Jan. 1. It'll be tighter, but you got to do what you got to do."

Pre-existing nightmare

Laura Huth, the 43-year-old owner of Do Good Consulting, said she was diagnosed with Crohn's disease when she was 12 years old.

And that diagnosis tagged her with a pre-existing condition that has followed her in the health insurance world, even though she's never had any symptoms, she said.

"Since I was about 23, when I got kicked off my parents' (health) plan, I got hit smack in the fact that I was going to be discriminated against because that was going to be my life, or until this problem got fixed," Huth said.

Under the Affordable Care Act, children under age 19 can't be denied coverage for a pre-existing condition, and starting next year, nobody can be denied coverage for a pre-existing condition.

Huth said she plans to sign up for coverage in the new state marketplace as soon as she finds out how to make the transition from her current coverage in what is now a federally run pre-existing condition health plan set to expire at the end of the year.

"I will have to move to this Affordable Care Act, or I will be left holding absolutely nothing," she said. "That or I will have to find a husband really quick."

The cost of having to get your health coverage through a government high-risk pool isn't cheap, Huth said, "and I cringe every time I have to write the check for it."

It's about $5,000 a year, she said, but she's not going to take the risk of going without health insurance at 43.

A former Urbana alderwoman, Huth describes herself as being a motivated person who has been able to accomplish about anything she puts her mind to. But she hasn't been able to overcome her struggle with private insurers.

"I cannot get (private) health insurance, unless I get married or went to work for a company," she said.

Uninsured musician

Jim Bean, 53, of Champaign, has been uninsured since he got out of the Navy in 1979.

"I do what so many people do," he said. "My health care plan was to not get sick."

A professional musician and former union rigger who worked off and on for the University of Illinois, he said he was typically categorized as part-time temporary help, without health benefits. He remains part-time as head rigger at Foellinger Auditorium.

And his plan to stay well hasn't worked entirely.

He once broke his hand. He's had herniated discs that came with killer back pain. He's had major surgeries that about finished him financially, though Carle wound up pardoning his bills, Bean said.

"I appreciate the fact that because I live in America that I was able to be treated at all, but my treatment was always whatever primary care was available in the emergency room," he said.

He is "absolutely" checking into the marketplace when it opens.

"I've already been doing some research," he said.

Affordable Care Act in Illinois

Illinois has a new health marketplace called Get Covered Illinois to compare dozens of health insurance plans and apply for coverage and tax credits because a major requirement of the Affordable Care Act calls for nearly everyone to have health insurance starting next year.

The marketplace launches Tuesday at http://www.GetCoveredIllinois.gov — or you can call a federal help line at 800-318-2596. A state call center number is expected to be available soon.

Trained in-person marketplace enrollment help will be available at public health departments.

Also see this website to find help: http://www.healthcare.gov/contact-us/.

Enrolling soon?

The News-Gazette would like to hear about your experience.

Please contact reporter Debra Pressey at 217-351-5229 or dpressey@news-gazette.com.

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