Service Employee in Saratoga Springs

Meghan was employed in the service industry in Saratoga Springs. The city, which has 30,000 residents and lots of horses, was packed on a gorgeous summer weekend. Meghan shared her health insurance story.

What were her medical needs? Meghan, who was in her 30s, had suffered asthma since childhood and had developed chronic issues recently. She saw her primary care doctor annually and specialists as needed.

How was she covered? Meghan was one of more than one million New Yorkers who were covered through the state’s marketplace, New York State of Health. She had enrolled in the same plan for several years.

Why didn’t she have employer coverage? While half of 19 million New Yorkers had employer health insurance, Meghan did not. She worked for a spa and, her job—like many in the service industry—didn’t provide it.

How much did she spend? Meghan’s premium was $20 per month thanks to the American Rescue Plan (ARP). Previously, she paid $200 per month, and the savings “have made a difference.”

What about plan design? Meghan’s health plan had a $7,000 annual deductible with a 40% coinsurance. The out-of-pocket maximum was nearly $15,000. “I’ve met only $2,000 of my deductible for the year, which is scary.”

Who helped her? Meghan worked with a navigator during enrollment to understand her plan options and make an informed choice. The navigator also helped her benefit from the ARP.

What else? Meghan paid for a nutritionist and acupuncturist as they were excluded from her health plan. “I spend about half my rent every month, but they understand my needs sometimes better than my doctors.”

Meghan was an informed consumer who educated herself about her health and searched for her own solutions. It had not been easy. But while she juggled her job and health, she also was Mastering Health Insurance.

Sources: KFF (2019 data)

Photo: Saratoga Springs, where even the horses wear masks. BTW, the city’s official slogan is “Health, History, and Horses.”