The ACA open enrollment period for almost everyone will be ending in the next week. After this Sunday, anyone who is looking for individual market insurance will need a special enrollment period. So get enrolled. And be ready to think about zero premium plans(**). Zero premium plans are common and they prompt a need to figure out what the relevant comparison is for decision making and prioritization.
Interesting that a plan with $6,000+ or $12,000+ up-front deductible, in almost all cases, is considered “acceptable” insurance. It’s not insurance, it’s nothing short of major medical emergency coverage for the average person. These plans ‘deter’ care!
— Antonio Paulo Pinto (@appinto17) December 10, 2019
The critical question from an analytical point of view is compared to what?
One way to look at this is that zero premium Bronze plan with a $6,000 to $7,900 deductible and maximum out of pocket limit is vastly superior to the alternative of a zero premium plan with an infinite deductible, higher cost per unit of service and no potential pre-deductible services. In that case, Bronze is great.
The other way to look at a zero premium Bronze plan is that it has a $6,000 to $7,900 deductible and out of pocket costs while Silver and Gold plans may have monthly premiums but potentially far lower out of pocket costs. Spending $0 on premiums for a Bronze plan or $12/month for a CSR-94 plan with a $600 deductible changes the analysis. Bronze is, most likely really bad.
There is a middle case of a zero premium bronze plan and a $150-$200 month Silver 73 or low Gold plan with a $3,000 deductible. In those scenarios, for people with bottom 60% health expenditures, it is very unlikely that they will incur enough claims where the cost sharing differences matter much less where the cost sharing is different enough to make up for the extra premiums that were used to buy lower cost-sharing.
Everyone who is likely to be subsidy eligible, go look. Zero premium plans are widely available and provide at least hit by a meteor protection.
** DISCLOSURE: I have a zero premium paper coming in the near future. My co-author and I also just got funding to do even more wicked awesome stuff in this domain.