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Old 11-20-2013, 08:06 AM   #121
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Well, drum roll....., I'm getting ready to sign up online - probably tomorrow. Definitely this week.

Here is my analysis for my personal case. I'm most likely to go with the Bronze PPO plan in the first column.

DH and I are signing up separately. Once I sign up, he'll probably sign up next week.
Signing up separately is a good idea. I'll follow suit, less chance of getting stuck in one family policy with aggregate deductibles.

Thanks for posting the worksheet. I'm surprised at the pricing, such differences between Texas and Florida. Your BCBS is a PPO and costs less than Humana. For me BCBS only offers an EPO, which isn't as good, while Humana has an (apparently) wider network at a much lower premium. Even after having worked in corporate pricing, I am always surprised at how businesses position their products and use pricing to drive demand toward (or away from) from specific offerings.
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Old 11-20-2013, 08:50 AM   #122
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Thank you!
Your examples show similar results to what I was calculating. An interesting thing to me is after reaching a certain level of expenses the total annual costs tend to level out, there is not a lot of total cost difference between bronze to gold.

The only thing the higher metal plans give you is spreading the cost sharing between the deductible and the expenses where the OOPM is hit. So if you have low expenses, bronze wins and if you have really high expenses ( $10k+), bronze wins. At least that's what I see.
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Old 11-20-2013, 08:54 AM   #123
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Signing up separately is a good idea. I'll follow suit, less chance of getting stuck in one family policy with aggregate deductibles.

Thanks for posting the worksheet. I'm surprised at the pricing, such differences between Texas and Florida. Your BCBS is a PPO and costs less than Humana. For me BCBS only offers an EPO, which isn't as good, while Humana has an (apparently) wider network at a much lower premium. Even after having worked in corporate pricing, I am always surprised at how businesses position their products and use pricing to drive demand toward (or away from) from specific offerings.
I believe that BCBS has the dominant network in TX by far. Sounds like Humana has the better network in FL.

I get the impression that BCBS operates somewhat independently in each state - they certainly aren't consistent in their approach from state to state.

No, I wouldn't touch an EPO either - too restrictive.

Pretty much we'll probably always go with whoever has the more extensive network, even if we have to pay a bit more. Access and negotiated prices are the most important to us. (Plus the actual insurance to limit OOP expenses)

Another reason we are staying separate is that keeps our insurance decisions separate. Either one of us can change policies without affecting the other.

And our starting point is different. I don't have insurance next year, and DH does but is switching policies. Our sign up process may be slightly different.
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Old 11-20-2013, 08:55 AM   #124
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The only thing the higher metal plans give you is spreading the cost sharing between the deductible and the expenses where the OOPM is hit. So if you have low expenses, bronze wins and if you have really high expenses ( $10k+), bronze wins. At least that's what I see.
I could construct situations where silver barely wins, even without eligibility for cost sharing. But those were rather uncommon cases, and in almost all situations, bronze would still win. And I don't see how Gold or Platinum would ever "win", at least not based on the plans available to me -- and even less so since they are not HSA-eligible like the Bronze and Silver plans can be (which also lets you reduce your MAGI and potentially increase your tax credits).

Of course, if you have income below 250% of FPL and cost sharing kicks in, Silver looks better.
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Old 11-20-2013, 08:59 AM   #125
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Your examples show similar results to what I was calculating. An interesting thing to me is after reaching a certain level of expenses the total annual costs tend to level out, there is not a lot of total cost difference between bronze to gold.

The only thing the higher metal plans give you is spreading the cost sharing between the deductible and the expenses where the OOPM is hit. So if you have low expenses, bronze wins and if you have really high expenses ( $10k+), bronze wins. At least that's what I see.
Yep - pretty much.

And in the occasional intermediate cases, which are perhaps more common than the extreme, the difference can be very small amount if you choose a Bronze plan with a lower deductible.

I suspect TX requires 20% copays or less and that helps the Bronze cases. In other states Bronze has higher copays. Still....
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Old 11-20-2013, 09:01 AM   #126
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I could construct situations where silver barely wins, even without eligibility for cost sharing. But those were rather uncommon cases, and in almost all situations, bronze would still win. And I don't see how Gold or Platinum would ever "win", at least not based on the plans available to me -- and even less so since they are not HSA-eligible like the Bronze and Silver plans can be (which also lets you reduce your MAGI and potentially increase your tax credits).

Of course, if you have income below 250% of FPL and cost sharing kicks in, Silver looks better.
Yep

I think the gold and silver plans mimic what employers used to pay for an ER when they were working, so someone may consider them first. But if someone is paying their own premiums, they get to see how very pricey those benefits can be.
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Old 11-20-2013, 10:14 AM   #127
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The difference between the Humana silver and bronze plans for me is not that great. Around $4.3K in yearly expenses is the point where they are equivalent, silver is better as expenses rise. Less than that, bronze is the better deal. Looking at it over a 5 year period, however, what's the chance both spouses have more than $4K in medical expenses each year? Absent chronic treatment it seems better choose the less expensive policy and use the difference to fund the out of pocket.

One interesting aspect, though, is the out-of network, There is a big difference $12K vs $7.5, but I wonder if that isn't a bit of a red herring, or distraction of sorts, especially since the amount is first limited by the well known "customary and usual charges".
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Old 11-20-2013, 10:21 AM   #128
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One interesting aspect, though, is the out-of network, There is a big difference $12K vs $7.5, but I wonder if that isn't a bit of a red herring, or distraction of sorts, especially since the amount is first limited by the well known "customary and usual charges".
It could be. Though I'd think the potential for "balance billing" out of network might be the bigger concern.
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Old 11-20-2013, 10:36 AM   #129
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It could be. Though I'd think the potential for "balance billing" out of network might be the bigger concern.
That's it. The ugly twin side of usual and customary. I am so ready for Medicare. Too bad it's not ready for us yet (3 & 5 years to go).
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Old 11-20-2013, 10:59 AM   #130
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Access and negotiated prices are the most important to us. (Plus the actual insurance to limit OOP expenses)
Do you know of any way to find out negotiated pricing to be able to compare different insurance companies? I'd love to get that info!!!
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Old 11-20-2013, 11:47 AM   #131
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Do you know of any way to find out negotiated pricing to be able to compare different insurance companies? I'd love to get that info!!!
Nope. Without published studies this info is not available. I doubt an insurance company will disclose it without you having a policy, and, you would have to look at a lot of different tests and procedures.
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Old 11-20-2013, 11:49 AM   #132
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Do you know of any way to find out negotiated pricing to be able to compare different insurance companies? I'd love to get that info!!!
Many insurers have a place online where you can estimate the cost of an office visit or medical procedure. But that pretty much always (in my observation) requires you to already be an insured and logging into their site as an insured.
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Old 11-20-2013, 11:50 AM   #133
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Signing up separately is a good idea. I'll follow suit, less chance of getting stuck in one family policy with aggregate deductibles.
How do you sign up separately? When I did ours I had to apply together, we file taxes MFJ and that was the only way to get the subsidy. I did try to go back into the application and see if I could pick different plans for each of us and it wouldn't allow it. This was in mid October when I figured out that I had to start a new account and new application in order to get the whole darn thing to work.
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Old 11-20-2013, 11:52 AM   #134
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How do you sign up separately? When I did ours I had to apply together, we file taxes MFJ and that was the only way to get the subsidy. I did try to go back into the application and see if I could pick different plans for each of us and it wouldn't allow it. This was in mid October when I figured out that I had to start a new account and new application in order to get the whole darn thing to work.
In our case, directly with the insurer, an ACA eligible policy, but no subsidy.
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Old 11-20-2013, 11:55 AM   #135
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How do you sign up separately? When I did ours I had to apply together, we file taxes MFJ and that was the only way to get the subsidy. I did try to go back into the application and see if I could pick different plans for each of us and it wouldn't allow it. This was in mid October when I figured out that I had to start a new account and new application in order to get the whole darn thing to work.
No subsidy. Signing up directly with insurer "off exchange". That we file taxes MFJ has no bearing.
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Old 11-20-2013, 12:10 PM   #136
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Do you know of any way to find out negotiated pricing to be able to compare different insurance companies? I'd love to get that info!!!
Several insurance companies provide cost estimating tools for their members,
but not to general public.

BCBS of MA provides tool to find out what were actual costs of about 200 medical services where you can search for providers based on location.

I have not found an easy cross-insurer comparison.

Can you find friends who have insurance you are looking at and ask them to use tools with your local hospitals? If you give me your zip code and few procedures to check I could run it for you for BCBS. I'm attaching a sample report for Gallbladder surgery within 10 miles of 30097 zip code:


Medical Cost Comparison Guide - Gallbladder Removal, Laparoscopic -
November 20, 2013
Date/Time: 11/20/13 12:01:53 PM 1
GWINNETT MEDICAL CENTER INC
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Distance: 8.39 Miles
678-312-4321
Total Cost Estimate: $13,561.00 -
$18,521.00
Blue Patients: 6
All Patients: 53
EMORY JOHNS CREEK HOSPITAL
6325 Hospital Pkwy
Duluth, GA 30097-5775
Distance: 3.7 Miles
678-474-7000
Total Cost Estimate: $6,563.00 -
$8,331.00
Blue Patients: 7
All Patients: 31
Attached Files
File Type: pdf BCBS_Gallbladder_30097.pdf (5.4 KB, 3 views)
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Old 11-20-2013, 01:10 PM   #137
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This is my analysis exported to Excel format - hopefully the formulas transfer OK. Originally done in Numbers.
Attached Files
File Type: xls Individual ACA HI plan analysis.xls (29.5 KB, 60 views)
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Old 11-20-2013, 01:54 PM   #138
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Thanks!
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Old 11-20-2013, 02:11 PM   #139
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...
I get the impression that BCBS operates somewhat independently in each state - they certainly aren't consistent in their approach from state to state.
True. The Anthem BCBS plans in Colorado have no out-of-network coverage.
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Old 11-20-2013, 02:16 PM   #140
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True. The Anthem BCBS plans in Colorado have no out-of-network coverage.
Interesting. That sounds like Kaiser.

I assume, though, that emergency care is covered in-network until transfer to a network facility can be safely arranged?
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