Bronze ain’t bad

The Kaiser Family Foundation is pointing out that roughly a quarter of the currently uninsured could qualify for a $0 premium Bronze plan or better on Healthcare.gov

Bronze ain’t bad for a guaranteed issue, community rated plan.

Bronze plans have high deductibles and out of pocket limits with comparatively lower premiums. They can be very good plans for two cohorts of people.

  • People who have low expected healthcare costs
  • People who know they have very high healthcare costs
  • People who have low expected healthcare costs will be faced with paying premiums for their choices. If their options are a $6,700 deductible Bronze Plan or a $1,500 deductible, $5,000 Maximum out of pocket Gold plan as the next best alternative, the first $1,500 in expenses will be treated the same by both plans. We looked at zones of superiority last week, and this is the minimal inner edge of the Bronze zone of superiority where the next best alternative’s deductible is the same as the Bronze deductible. The zone’s inner edge will vary by the difference in net premium between plans and how the non-deductible cost-sharing is structured.

    The outer edge of the zone of superiority is where the known costs are so high that any plan will be hitting their out of pocket maximum. A million dollar year will max out every plan. And then the decision process is a simple linear optimization to minimize total costs (premiums and out of pocket expenses) subject to a network constraint.

    These conditions are fairly clear and likely (but not guaranteed) to create at least small zones where Bronze plans can be superior to higher actuarial value plans for non-subsidized buyers. The premium differentials can effectively create these zones.

    However on-Exchange, the subsidy dynamics will greatly shrink or eliminate the Bronze zone of superiority. Alfalfa County, Oklahoma has $0 Gold plans for all subsidy eligible adults. At all expense levels, the Gold plan has net equal or lower costs for subsidized adults compared to Bronze or Silver plans.

    This is an extreme example.

    Bronze, in the right situation, is not bad. Don’t discount it as you look for your plans before this Saturday.






    27 replies
    1. 1
      opiejeanne says:

      We just found out in November that we can get Kaiser now. Our pension’s health plan didn’t allow it in Washington right after Kaiser moved up here, but now they do but we missed the open window. Next September we’ll be back with Kaiser, we hope.

    2. 2
      MomSense says:

      My son signed up for a bronze plan.

    3. 3
      Chris Johnson says:

      Fuck it. I will get nothing, as I can’t afford health care in America. I don’t believe for a moment that any of this will actually work.

    4. 4
      WereBear says:

      Good to know. If I am forced to stop working before I can get on Medicare, this might be an option.

    5. 5
      Brachiator says:

      Bronze, in the right situation, is not bad. Don’t discount it as you look for your plans before this Saturday.

      Damn. This is great news.

      It’s too bad that we have a president who is stifling publicity about health care options.

      And I’ve spoken with licensed tax preparer, who should no better, who think that the individual mandate penalty is gone for 2018, so people don’t need to have health insurance coverage.

      Hell, even if I were the healthiest person in the world, if I could get a free health plan, I would jump on it.

      ETA. Hope the Democrats help get the word out. And this could be crafted as a nonpartisan message.

    6. 6
      Burnspbesq says:

      @Chris Johnson:

      Approximately 12 million of your fellow Americans are holding on line two.

    7. 7
      Starfish says:

      The other week, my dental hygienist said that the cheapest plan that she could find on the open market or be offered through her small clinic had a $10k deductible here in Colorado. She said she was going to go without insurance because paying into an insurance plan that does not seem to cover anything did not seem worth it.

    8. 8
      WereBear says:

      @Starfish: I figure that’s a catastrophe plan and what if there is one?

    9. 9
      Thoroughly Pizzled says:

      Huh, this seems like a de facto single-payer plan with high deductibles, arrived at in a roundabout fashion.

      Medicaid for All! Raise the threshold!

    10. 10
      Betsy says:

      I was on a $0 premium bronze plan while I took some time off from a regular job to be self-employed this year. It was a high-deductible plan, so I was potentially on the hook for up to $6,000 “if anything should happen”.

      But then again, when I had had “really good insurance” through a government employer, I still racked $4,000 in deductibles and co-pays from a brief hospitalization.

      So the no-premium plan was actually a pretty damn good deal.

      ETA: (Thank you, President Obama — thank you. Thank you. Thank you.)

    11. 11
      Fair Economist says:

      Any plan, even a garbage plan when you aren’t going to hit your deductibles, is far better than going bare, because the doctors and pharmacists are not allowed to hit you with ripoff pricing. I suspect the large majority of the 4 million skipping free insurance don’t realize this and are thinking since they don’t expect to hit their deductible there’s no point. There is a big opportunity for education here.

    12. 12
      PhoenixRising says:

      @Chris Johnson: Hope you don’t get a life-threatening disease you’e never heard of that can only be treated by a group of 3 specialists in a faraway city! I can tell you from experience that an ACA plan will keep you in your home instead of a van down by the river. But up to you. Some people learn from observation, some from their own mistakes and then there are those who have to piss on the electric fence…

    13. 13

      This is good to know. I’ve been on Kaiser’s bronze for several years – I’m in that very low category, but have a lot of activities that would be terrible if I was hurt (cycling, hiking, you know, walking 300 lbs of dogs).

      I am now at a place where I could move up to silver, but have not had it in me to go through the hassle – last time I tried to change things up, the Colorado website kicked me off ALL my healthcare and it was a total hassle to get back on it.

      Medicare for all!

    14. 14
      daveNYC says:

      @WereBear: Depends on if she could afford the $10k deductible in the first place. Plus how much she’d be paying for the policy. Free insurance is nice because it’s free, but unless you’re dead certain that you’re going to get into a car accident, there’s a lot of reasons why people might go with no insurance.

    15. 15
      Starfish says:

      @Fair Economist: Yes. I did not have time to have that discussion with her.

    16. 16
      Starfish says:

      @TaMara (HFG): There was someone else here who lost their Kaiser doctor because they were kicked off a plan to some paperwork screwup.

    17. 17
      Brachiator says:

      @daveNYC:

      Free insurance is nice because it’s free, but unless you’re dead certain that you’re going to get into a car accident, there’s a lot of reasons why people might go with no insurance.

      This is the kind of faulty thinking that trip up a lot of people.

      “If I have free or cheap insurance, I might have a$10K deductible. Damn, I don’t want to pay for a policy and then pay $10K on top of that, because I never get sick and don’t need insurance anyway.”

      So, this theoretical $10K hit becomes “real.”

      But how could anyone possibly be “dead certain” that they were going to have a car accident? But perversely, some people, currently healthy and accident free, are dead certain that nothing will happen to them in the future. This makes the theoretical $10K deductible seem even more like a burden to be avoided.

      And so, they give more weight to the potential cost they know than to the possible costs of an illness or catastrophic accident.

    18. 18
      Barbara says:

      @TaMara (HFG): I don’t want Medicare for all because I know too much about Medicare, nonetheless, I do want universal health care such that everyone is assigned to something even if they don’t choose and there is never any question that the big stuff will be covered and no one will be afraid to get or provide services because someone is not insured. Our system is mind numbing. This morning I called the “COBRA” vendor to get information and figure out how to keep paying for my daughter, and I feel like a weight has been lifted from my shoulders because the guy was so knowledgeable and helpful, something that is not at all assured from my prior experience. Anywho, here I am, someone who is a real expert in this stuff and I was still hyperventilating about how I am going to make sure one of my kids has coverage next year, and what if I miss payments or deadlines or get confused about how long she will be eligible for COBRA. A lot of people don’t make decisions on purchasing coverage at least in part because decisions are so difficult and confusing.

    19. 19
      Kelly says:

      All our available HSA plan are Bronze. If I plug in myself as a low utilizer and my wife as a medium utilizer we get an estimated yearly cost of $4417 on our Kaiser plan, which is about half of their nearest Silver plan. This is about how 2018 worked out. If I plug in both of us as high utilizers I get an estimated yearly cost of $16,123 vs Silver at $21,127, Gold at $23,139.

      So we’re sticking with Kaiser Bronze HSA. We move our healthcare expenses out of our MAGI which helps get a monthly subsidy of $1263 and we can pay Dental and Vision out of the HSA which also reduces our MAGI.

    20. 20
      Kelly says:

      @Barbara:

      I don’t want Medicare for all because I know too much about Medicare

      I’ll be on Medicare in 2021. Who’s the David Anderson of Medicare?

    21. 21
      WereBear says:

      I want Medicare for all because the private industry alternative refused to pay for diagnosis because “nothing can be done” and no matter how many studies I have shown my doctor and he prescribes accordingly, they are sticking to it and I have to pay for it myself.

    22. 22
      Chris Johnson says:

      @Brachiator: The problem is, it’s pointless even doing a 0$ monthly with $10,000 deductible if I will not ever be able to pay a $10,000 deductible. I’m just going to die if anything happens, much like if I lived on some small desolate island and a coconut fell on my head. In a way it’s comforting.

      I will never have to commit suicide if I just fall over dead one day or get sick and never get better. I will no longer be in the world where Donald Trump is president and ‘runs things’, and what time I do have will not be occupied by having private insurance refuse services until I die anyway. If there are ten thousand other people feeling likewise, I’m not one bit surprised.

      Total failure. David Anderson himself doesn’t understand half of what this industry is up to. It is because they are not practicing in good faith and he’s assuming a certain amount of good faith. The whole thing is a mechanism for extracting money. There’s no point in going along with it. One possibility is continuing to live so far under minimum wage that I continue to qualify for Medicaid: right now I have no interaction with the health industry at all, and if I got stuck in a situation that didn’t kill me and needed to have access to health care, I could probably damage my business until it no longer threatened to make me over $1200 a month. This year it’s not even that.

      Any private insurance is a death sentence unless you’re wealthy enough to keep paying their tithe, and even then they will fuck with you in their worst need because that’s what the industry is for. You’ve got to have serious resources to take on that adversarial relationship, and by definition when you are asked to fight you are at your most compromised and vulnerable. I think many people are just not having it.

      Things like herd immunity and the consequences of an entire population avoiding any health care for cost reasons are a separate problem: one that would be damn good to investigate. For now, let’s hope there isn’t a plague.

    23. 23
      Barbara says:

      @WereBear: You have the same appeal rights that Medicare FFS beneficiaries do.

    24. 24
    25. 25
      Brachiator says:

      @Chris Johnson:

      The problem is, it’s pointless even doing a 0$ monthly with $10,000 deductible if I will not ever be able to pay a $10,000 deductible.

      Bullshit. It’s not like you have to pay $10,000 up front before you get any medical treatment. And in the real world, not opting for insurance means that you will end up in the ER and getting treatment for free as you run from paying your bills.

      Total failure. David Anderson himself doesn’t understand half of what this industry is up to. It is because they are not practicing in good faith and he’s assuming a certain amount of good faith. The whole thing is a mechanism for extracting money.

      More bullshit. I am not one of those people who want to eliminate insurance companies and make the government an endless pool of money for health care.

    26. 26
      llk says:

      @Brachiator: I agree. As someone who was blacklisted by health insurance industry for years before ACA, this attitude infuriates me. I needed it but couldn’t get it. It’s easy to claim helplessness and screw it when you have no actual illnesses yet. Those of us who HAD chronic illnesses and were blacklisted completely and had zero recourse know what a huge difference ACA makes to many people. I hate this kind of attitude. I understand it but I think it’s lazy morality. Kind of like people who say why vote anyway cuz we live in an oligarchy already. Yeah we do. So let’s throw away one small right we still have that may some day help to change the status quo. Maybe that’s not a fair analogy, but it feels similar to me.

    27. 27
      llk says:

      Also, thanks David Anderson for all your helpful advice and info. Hugely appreciated by many lurkers like me.

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