Lacey Donle: When Following Doctor's Orders Means Paying Out of Pocket

Lacey Donle lives in Lisbon, Maine and works in early childhood education as a preschool teacher. When she first shared her story in 2025, she had recently left a job with employer coverage for less stress and a better childcare situation for her children, and she had been enrolled in Marketplace coverage for a year. “I know that taking care of myself is important,” she said.

In the summer of 2024, Lacey’s younger brother had “a massive and unexpected heart attack.” Medical professionals were able to resuscitate him long enough for his family to gather around his bedside and say goodbye. “While we were in the cardiac ICU watching my brother exist on life support, the doctors let us know that this tragic event may have been the result of a genetic condition and that I should get checked out,” she said. He had another heart attack at the hospital and died a few hours later. He was 39.

“I took the doctor’s advice seriously and had a full cardio workup as a precaution,” Lacey said. Her echocardiogram would have cost $3,000, but a prior authorization error meant she was “off the hook.” She then saw a cardiologist and followed her recommendations for a cardiac stress test, blood tests and genetic testing. Lacey spent around $1,000 on the appointment and follow-up tests.

As a result of those tests, her cardiologist also recommended a cardiac CT with contrast. Her insurance company denied coverage. While her provider appealed the decision, Lacey researched the cost and was eventually quoted $1,600 for the cash price. She could not get a quote for the negotiated rate from the hospital or her insurer. “The insurance company told me that was proprietary info and I was not able to have access to it,” she said. “It was a lot of money, but I felt I needed the test since it was recommended by my cardiologist.”

The insurance company changed its decision and approved the procedure, but because Lacey had a high deductible plan, the insurer covered $0, and the bill came to around $3,000. “Despite my best attempts to get an accurate price up front from the hospital, additional charges, like $900 for a required nitroglycerine spray were added,” she said. She set up an 18-month payment plan with the hospital, the maximum time allowed, and was making payments of $104 a month.

“The health coverage I have now is already expensive,” Lacey said. She paid $300 per month and received $216 in enhanced premium tax credits (EPTCs). For 2026, with the EPTCs expired, her premiums were estimated at $583 per month for a bronze plan with an $8,000 deductible and only a $78 tax credit.

“My heart is healthy,” she said. “My husband and I do not require a lot of health care, and our children are covered by MaineCare thanks to expanded eligibility.” At the time, Lacey’s husband was covered through his employer, but adding her to his plan as a spouse would have cost $600 a month. She looked into the affordability exemption that allows people over 30 to qualify for catastrophic plans, which requires premiums to reach 7.97% of income. She did the math: her estimated premium came to 7.7% of her household income.

“Unfortunately, based on the cost estimates I am currently seeing on CoverME.gov, I plan to go uninsured in 2026,” she said. Those costs kept Lacey from getting coverage for 2026.

Her message to lawmakers is direct. “I urge the Federal Government to do everything it can to help Maine families like mine afford health coverage,” she said. “We may not always be this healthy. We may experience an unexpected medical event, or we could get injured. Not having coverage could be expensive. But these days, having coverage is becoming more and more unaffordable and out of reach.”

In a 2026 update, Lacey shared, “My husband got a new job and the insurance was affordable enough to add me on. My coverage just started 8/1. The kids still qualify for MaineCare, thank God.”