Kelly in comments on Wednesday laid out his family’s insurance options.
Window shopping healthcare.gov I see we’re down to 3 insurance companies here in Marion County, Oregon. Best I can recall we had 8 or 10 a couple years ago. Kaiser has increased it’s price advantages. I can get a Kaiser Gold plan w/$2000 deductible for $17 less than Moda silver w/$7000 deduct and $27 less than Providence w/$5000 deductible. That would be a compelling bargain but my wife does not like Kaiser and the clinic is 30 to 45 minutes away vs our local docs that are 10 minutes away. Much to think about.
I agree, there is a lot to think about.
In some regions where there is only a single insurer that offers a single network and a variety of flavors of the same HMO or PPO, the choice is simple. If Gold is cheaper than Silver and the same premium as Bronze then buy Gold instead of Silver or Bronze. That is the easiest decision case and it is highly dependent on your income and the county that you live in.
Kelly’s case is more complex. He sent me some more details and him and his wife are more likely to be grandparents than expecting an infant. They qualify for subsidies. The least expensive Bronze plan has a post-subsidy premium of $30 a month and a $13,100 combined deductible/maximum out of pocket cap. The total cost of care for the year between premiums and deductible would be a maximum of $13,500.
The Gold plan that he references has $6,800 in premiums per year and a maximum out of pocket of $14,000. The Moda Silver plan has annual premiums of $7,000 premiums for the year and a maximum out of pocket of $14,700. The big difference between the two plans is the deductible. The out of pocket maximums are roughly the same but the Gold plan is set up so that the first $5,000 in expenses for Kelly would cost him $1,000 of deductible and $1,267 in co-insurance for a total of $2,267. The Moda Silver would make Kelly pay $2,500 in deductible and $875 in additional co-insurance so that first $5,000 bill would mean a $3,375 check out of his pocket. If he was hit by a meteor, Gold and Silver are roughly the same annual cost and Bronze would be cheaper if he knows that he is getting hit by a meteor.
But he is considering other other very relevant factors. A happy wife going and nearby doctors are very valuable things that might be worth an extra $17 a month.
These are tough choices to make and they require a lot of thought as to what you value and what hard constraints you face.
Right now, take your time and window shop. See what is out there. See what you qualify for. Identify what you must have given your life circumstances and probable health. Finally, get help and take your time working through this. There are seven weeks to looks and six weeks to buy, a decision is not needed on the first day.
Eural Joiner
Sorry to immediately derail your original post but I’ve got a question – a few days ago my FB feed, which has a handful of my Trump supporting friends still on it, exploded with outrage as they all began receiving letters from Blue Cross with enormous rate increases for January next year. They, of course, immediately began screaming about “O-vomit-care” (yes, that’s what they call it now) and blaming the increases on having to carry non-working/illegal/lazy people, blah, blah, blah. I pointed out it was mostly due to Trump taking a bludgeon to the ACA payments without a Congressional fix which they passed off as Obama loving nonsense. I’m in South Carolina. My question: do you have a basic read on these rate increases? (For example, one guy – an independent small businessman – just saw a jump from $600/month to over $900!). Thanks!
David Anderson
@Eural Joiner:
Great question.
First I would tell them to shop around. All Exchange insurers have to send a letter to their current customers saying that “Next year, we are mapping you to Plan X that looks a lot like what you have now. Plan X would cost $ZZZZ”
The plan in the letter is the default plan but not the only plan available. In South Carolina, BCBS-SC is “Silver Switching” where they are loading all of the CSR costs onto their Silver plans. The plan that he is mapped into might be an On-Exchange plan that he buys Off-Exchange. If he looks for the Off-Exchange only clone, he will see a much better premium. It will still be an increase but it will be a much smaller increase.
clay
David, the WSJ has an article about how a lot of people will have access to insurance with free premiums. The basic argument (as I understand it) is: since Trump cut the CSR payments, insurers raised their Silver premiums. But the ACA allows for subsidies tied to the cost of Silver premiums, so these subsidies will rise above the costs of some plans in many markets. Thus, the subsidies can pay entirely for the premiums of those plans.
I was wondering what your take on this is?
Eural Joiner
@David Anderson: Thanks – I’ll pass along your advice and see if it helps. Honestly, he and his friends tend to react rather angrily to any and all ideas to help. They suffer financially (and health wise) and then scream about Obama and Democrats and “those people”!
wvng
In WV the choice is between metals, not providers. In my area we only have one.
I went Copper last year because we are currently healthy and don’t anticipate significant medical costs (he writes while frantically knocking on wood). In the end, if there are significant bills, then the net cost is about the same between metals. I don’t understand why people don’t understand that.
My wife went on Medicare last year, and I will this year in August
dr. bloor
@Eural Joiner: Not an apples-to-apples comparison, obviously, but I’m looking at a 15% premium increase and a 5% bump in the deductible for my family’s off-exchange BC/BS silver plan next year in Rhode Island. As David said, the logical response to a 50% premium increase is to look at the alternatives.
MomSense
Not sure what I’m doing yet but I know that I need a vision benefit this time. I don’t even think that was an option with any of the exchange plans last year so I have to do some research.
David Anderson
@clay: 100% my argument. We’re actually just seeing the data for the first time.
clay
@David Anderson: But… is this good or bad? I hate to reduce a complex situation to that, but I don’t really understand the implications here.
Obviously it can be good for families who have that option. But is it good for the health of the insurance markets? Is it good for the health of the ACA. Is it bad for the federal budget? I need to know what to think about this.
Another Scott
Richard-David Mayhew-Anderson quoted in The Hill.
They grow up so fast! (sniff!)
Cheers,
Scott.
peej01
I just checked the prices on the Maryland exchange this morning to see what the price increase announced this week had done to the rates. Thanks, President Trump. I can now get a Gold plan for less than a Silver plan. Of course, if I wasn’t subsidized, I’d be howling about the price increases. They were already going up substantially before the CSR adjustment. We have a choice of two carriers, one of which is Kaiser. Since I don’t want to change my doctors, I’m effectively left with CareFirst (BC/BS), which has higher rates. I have a chronic disease for which I take a very expensive drug to mitigate the side-effects associated with this disease. I usually hit my deductible within the first few months of the year. Since my medical costs have an expensive floor, it’s relatively easy for me to pick an insurance plan.
Kelly
Wow my moment in the spotlight!
I’m looking at the Bronze HSA numbers this morning. Because the HSA contributions reduce our modified adjusted gross income the monthly payment after subsidy is less than it seems. After subtracting $8900 HSA contribution from my income estimate ($6900 familiy HSA allowance plus 2 $1000 over 55 allowances) Kaiser is $3.45 after subsidy, nearly free. Providence comes in second at $107.85. Moda last at $233.85. All are Bronze $6550 individual, $13,100 family deductible. That deductible is big chunk of money but manageable for us.
HSA can also be used to pay dental with pretax dollars.
Hmmm even more to think about.
Victor Matheson
Just one comment on Kelly’s situation. I know that Kelly is not blaming Obamacare for this situation, but all too often the ACA haters have taken situations like this and said, “See, Obamacare is responsible for all of these disruptions and people have higher prices and they can’t see the doctors they want and so on and so on…”
Obamacare has clearly not solved all of these problems, but it is important to note that before Obamacare, people like Kelly had exactly the same problems on a regular basis. Rates increased at a high rate and doctors frequently switched which insurance plans they worked for as well. This is a fundamental problem with health care in the United States, but it shouldn’t be considered a symptom of Obamacare.
Kelly
@Victor Matheson: Before was worse than that. My beloved has a couple preexisting conditions. She had no insurance when we met and we could only get very expensive kind of crappy high risk pool insurance later on.
James
What happens to the subsidy when one person become medicare eligible during the year?
David Anderson
@James: really good question and I don’t know