Tough ex-cop needed help collaring health insurance

Claudia Gordon, 59, retired from the Philadelphia Police Department in 2006. She wanted a plan similar to the one she had with the city, a Preferred Provider Organization.
Claudia Gordon, 59, retired from the Philadelphia Police Department in 2006. She wanted a plan similar to the one she had with the city, a Preferred Provider Organization.
Posted: June 29, 2014

Claudia Gordon spent 14 years chasing down bad boys as a Philadelphia policewoman. As a woman officer, Gordon occasionally ran into a perp who was thinking, "Whatcha gonna do?"

Bad move, bad boy.

"They think women are weak," said Gordon, 59, who retired in 2006. "But we're not as weak as they think."

On the street, there was no intimidating Gordon. But buying health insurance on the Affordable Care Act marketplace - well, that rattled her. Like so many others who tried to buy health insurance on last fall, Gordon had to make a couple of attempts to finally get her plan, and only then with the help of a navigator.

But today she couldn't be happier.

"I would tell anyone who would listen to me to check out the Affordable Care Act," she said.

Gordon's first try with the ACA marketplace was in October. With her city health insurance coverage ending on Dec. 31 and having some health issues, Gordon needed to find a plan. She knew about the ACA but wasn't sure how it worked.

So she called her daughter, Latanya Ivey, a teacher living in California, who instructed Gordon to log on to the website to see what plans were available.

Good advice, especially if you lived in California, where the state-run marketplace was humming along.

But in Pennsylvania, as in other states using the federally operated exchange, the fall had turned into a season of frozen screens and vanishing patience.

Nevertheless, Gordon followed her daughter's advice and typed in the address. Sure enough, her computer "froze up."

"I was spooked by it," she said. "I just shut my computer down."

Ivey persuaded Gordon to try again. She got through and was able to find a plan similar to the one she had with the city, a Preferred Provider Organization (PPO).

"I saw the plan, and it would cost me $800 a month," she said.

Paying that kind of monthly premium would pretty much leave Gordon with little for anything else. She decided to go uninsured.

She called her daughter to give her the news.

"She said, 'Mom, it's not like that,' " Gordon said. The monthly premium "depends on your income."

Gordon's daughter told her to contact a navigator to help with the application process. A skilled, impartial navigator can help people understand their health insurance options, including eligibility for tax-credit subsides that can greatly reduce monthly premiums.

Gordon vetoed the suggestion. She didn't want a stranger knowing her business. So Ivey went all Nike on her mother, ordering her to "just do it."

On December 6, Gordon walked into the Campaign for Working Families office at 12th and Chestnut Streets. The organization was working with navigators and certified application counselors from several groups.

The navigator was friendly, but Gordon was still nervous and certain that she would walk out the way she came in - without insurance. Gordon didn't want a Health Maintenance Organization (HMO) plan because "I didn't want to deal with referrals and all that stuff." It was a PPO policy or nothing for her.

They looked at Independence Blue Cross' silver-tier PPO plan and did some calculation. Gordon was dumbfounded when the navigator said that her monthly premium would be $135.

"I was amazed," she said. "So I signed on."

Her new plan comes with a $250 deductible - under the city plan there was no deductible - and a co-pay for doctor's visits. Gordon doesn't think her plan's $2,250 maximum annual out-of-pocket cost is worrisome based on her current situation. She also bought a standalone dental plan.

Gordon worried when January rolled around and a bill from Independence for her monthly premium didn't arrive.

The customer-service representative reassured her that she was covered and would get a bill in February. It came as promised and she has been paying monthly ever since.

In April, Gordon used her new health insurance for the first time when she visited her primary care physician. She was astonished that her share of the bill for lab work was $5.

"I got the bill and looked at it and looked at it and said, 'This can't be right,' " she said. "I said, 'I hope this isn't an oversight.' "

Now that she understands how the ACA works, when friends ask her about buying insurance on the marketplace she simply tells them, "Try it. You'll like it."

This article was done in partnership with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.


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