Bronze, Silver and Coinsurance/Copay

[zedd]

So the formulas seem to work OK in Excel?

I had no way to test it.

The formulas work great for me. I'm using OpenOffice Calc.

Kudos! Very nicely done!

Using your spreadsheet and the plans available in my state I've done 3 different scenerios with OMAGI of $30k, $35k and $40k. As expected the premium/subsidy varies but what surprised me was how much the deductible and oop varied for seemingly the same plan at different levels of OMAGI.

I can see where this could be a real reconciliation headache at tax time
should one grossly underestimate their OMAGI, gaining cost share benefits, only to have to pay them back at tax time.

 

[audreyh1]

HCSC (corporate overlord for BCBS plans) drafted the first month's premium out of our bank account today. So I guess I'm good to go!

Once I had finished my on-line application, they generate a printable version of an application that you would otherwise submit by mail. That's a bit buggy - not all of the information transferred to the mail-in application correctly. This included NOT checking bank draft as an option, even though all the other information was there. Direct bill was selected instead - huh?

Since DH had exactly the same result during his signup even though we were super careful, we concluded that the application PDF was just something generated for us to see, and not what BCBS actually uses. That's probably why it's not completely debugged.

Anyway - the bank draft thing is apparently working, which is a great confirmation. Although I didn't expect it to happen so soon. I was going to call to follow up on this detail - but now I don't need to! I am actually quite relieved about this early draft because it settles a lot of anxious questions I had.

On the phone about a month ago, I was told this draft would occur on Dec 15th. Not!

Moral of story - make sure you have sufficient funds for an immediate draft.

 

[audreyh1]

Since I told them to contact me by email, I'll see if I get anything in the mail at all.

Well - they at least have to send me ID cards by mail.....

 

[donheff]

This is a digression but may be of interest for some of you who have been waiting to blunder back into healthcare.gov. I logged in yesterday for the first time since week one and my experience was night and day. I was able to click through all the screens presented to me with no need to clear the cache or anything. It still presented some stupid design features (redundancy, strange page formatting, etc) but, while irritating, those issues were not deal killers. Unfortunately, I couldn't test the critical identity verification process (other than to not pass) because I am using false information since I don't qualify (65 yo) and am just rubbernecking.

 

[ziggy29]

HCSC (corporate overlord for BCBS plans) drafted the first month's premium out of our bank account today. So I guess I'm good to go!

I'm not there yet, but today I did receive my "welcome" letter in the mail with my member ID and group number listed. Still haven't paid, but the welcome letter suggests the ID card will be coming shortly.

 

[audreyh1]

I'm not there yet, but today I did receive my "welcome" letter in the mail with my member ID and group number listed. Still haven't paid, but the welcome letter suggests the ID card will be coming shortly.

I got a welcome email

And an email to call in - which ended up being a call to a nurse who was there to get a bit of data on me and advise me on how best to use the network to save costs.

And another thank you email last night that was a plan summary PDF that I had already downloaded.

 

[audreyh1]

This is a digression but may be of interest for some of you who have been waiting to blunder back into healthcare.gov. I logged in yesterday for the first time since week one and my experience was night and day. I was able to click through all the screens presented to me with no need to clear the cache or anything. It still presented some stupid design features (redundancy, strange page formatting, etc) but, while irritating, those issues were not deal killers. Unfortunately, I couldn't test the critical identity verification process (other than to not pass) because I am using false information since I don't qualify (65 yo) and am just rubbernecking.

That's good to hear!

BTW - the BCBSTX site had plenty of oddities. Including a weird date format on one field which I thought I had figured out (but which it turns out I did get wrong - they had updated when DH enrolled online, but he still had trouble).

Anyway - plenty of irritation with the private website enrollment UI, but still got through.

 

[easysurfer]

I applied to a bronze plan directly through BCBS in Oct.

I got a letter about my current plan (the one I'm switching out of) saying effective 1/1, the new rate will be such and such. Then I get an email today showing a summary of the current plan.

That was confusing so I had to call and confirm that yes, starting 1/1 I'll be on a Bronze plan and not this current plan. Should get the new insurance card and packet in mid Dec.

 

[audreyh1]

I applied to a bronze plan directly through BCBS in Oct.

I got a letter about my current plan (the one I'm switching out of) saying effective 1/1, the new rate will be such and such. Then I get an email today showing a summary of the current plan.

That was confusing so I had to call and confirm that yes, starting 1/1 I'll be on a Bronze plan and not this current plan. Should get the new insurance card and packet in mid Dec.

When I signed up, I used my existing login on BCBSTX. They recognized and accepted that for enrollment purposes (user name and password), so I didn't create a separate account for the new plan.

But when I log in to the BCBSTX system, it shows my current plan, of course. I expect on Jan 1 it will magically show the new one.

When I log into the enrollment system - which is a different website (hcsc.retail.net or some such), it shows my application submitted.

 

[ziggy29]

When I signed up, I used my existing login on BCBSTX. They recognized and accepted that for enrollment purposes (user name and password), so I didn't create a separate account for the new plan.

But when I log in to the BCBSTX system, it shows my current plan, of course. I expect on Jan 1 it will magically show the new one.

When I log into the enrollment system - which is a different website (hcsc.retail.net or some such), it shows my application submitted.

Same here -- in the letter I received today, they recognized and reused my existing member ID from the temporary policy I have through the end of the year, but nothing shows about future coverage starting on January 1. And I probably need to call them to figure out where I need to pay...

 

[audreyh1]

Same here -- in the letter I received today, they recognized and reused my existing member ID from the temporary policy I have through the end of the year, but nothing shows about future coverage starting on January 1. And I probably need to call them to figure out where I need to pay...

Yeah, better call if they hadn't specified how to pay yet. I thought you would get a bill with that first letter if you hadn't already made other arrangements.

 

[ziggy29]

Yeah, better call if they hadn't specified how to pay yet. I thought you would get a bill with that first letter if you hadn't already made other arrangements.

Just did call -- after 20 minutes on hold, I was told that the billing and payment options for plans purchased through the Exchange was going to start on December 7, and I should receive the first bill in the mail and/or make a telephone or online payment after that date.

 

[audreyh1]

Just did call -- after 20 minutes on hold, I was told that the billing and payment options for plans purchased through the Exchange was going to start on December 7, and I should receive the first bill in the mail and/or make a telephone or online payment after that date.

Clear enough.

 

[audreyh1]

I got an email today from the Texas Health Insurance (Risk) pool that the Texas Insurance Commissioner has decided to extend the risk pool insurance until March 31, 2014 to those who qualify.

Since I just got accepted on a new insurance plan effective 1/1/2014 with no limitations due to pre-existing conditions, I don't think I qualify anymore. Just as well ($$).

I think there were Fed funds available to help states transfer their risk pools provided they shut them down by 12/31/2013. I suspect states were given another 3 months extension? Otherwise I don't think TX would have done this.

This means folks on the TX risk pool have another 3 months to sign up if they haven't already.

This apparently went down last Friday. Ironically, I had submitted my application and been accepted last Thursday.
Commissioner extends Texas’ high-risk insurance pool

 

[kmt1972]

I guess an assumption making these cost estimate decisions is that the doctor network are the same between a plan's Bronze and Platinum variations. I assume the difference between the two are the premium, out of pocket, and deductible structure with no difference in the doctor/hospital networks. Has anyone have any experience to confirm or deny this. Of course the answer to this might be on a plan and plan basis but my assumption is that given the same insurance plan, the networks for the Bronze and Platinum variations are the same.

 

[audreyh1]

I guess an assumption making these cost estimate decisions is that the doctor network are the same between a plan's Bronze and Platinum variations. I assume the difference between the two are the premium, out of pocket, and deductible structure with no difference in the doctor/hospital networks. Has anyone have any experience to confirm or deny this. Of course the answer to this might be on a plan and plan basis but my assumption is that given the same insurance plan, the networks for the Bronze and Platinum variations are the same.

I asked BCBS TX this specific question and for the PPO the network is the same across all metal plans.

But I think that varies by state and insurance company.

 

[ziggy29]

I guess an assumption making these cost estimate decisions is that the doctor network are the same between a plan's Bronze and Platinum variations. I assume the difference between the two are the premium, out of pocket, and deductible structure with no difference in the doctor/hospital networks. Has anyone have any experience to confirm or deny this. Of course the answer to this might be on a plan and plan basis but my assumption is that given the same insurance plan, the networks for the Bronze and Platinum variations are the same.

As Audrey said above me, at least for BCBS TX (the only Exchange participant in my county), all the "metals" have the same network in the PPO plans; the difference is in deductibles and OOPM.

There *is* a difference between the HMO network and the somewhat larger PPO network, but within the same kind of plan (HMO or PPO), at least here there is no difference in the network because of the type of "metal".

 

[tulak]

So the formulas seem to work OK in Excel?

I had no way to test it.

I used your spreadsheet in Google Docs and it seems to be working OK. We're not on ACA. I used this to compare my wife's HSA and PPO plans for open enrollment at her work. A few minor tweaks, but it seems to work well.

Thank you!

This saved us a lot of time.

 

[audreyh1]

I used your spreadsheet in Google Docs and it seems to be working OK. We're not on ACA. I used this to compare my wife's HSA and PPO plans for open enrollment at her work. A few minor tweaks, but it seems to work well.

Thank you!

This saved us a lot of time.

You're welcome!

I didn't subtract the tax savings from HSA in my analysis - considering that "gravy" over and above the premium savings if I chose to open an HSA account. So you might want to be sure to carefully look at before and after-tax savings with the HSA.

 

[tulak]

You're welcome!

I didn't subtract the tax savings from HSA in my analysis - considering that "gravy" over and above the premium savings if I chose to open an HSA account. So you might want to be sure to carefully look at before and after-tax savings with the HSA.

I noticed that part. I also had to adjust the tax savings amount to exclude the $1000 catch-up, since she's not 55 yet. The other piece I had to adjust was the yearly employer contribution to the HSA. I did this by a quick and dirty update to the monthly premium, which made the monthly premium a negative number. After making this change, everything still looks correct.

At first I wasn't sure the HSA was a better deal, but after putting in the numbers it's a clear winner. It ends up cheaper until $15k in medical expenses and the worst case - up to Max OOP - we end up paying $852. The HSA tax savings gives us $832. I think we can swing the extra $20 if that ever happens (hopefully not!).

 

[audreyh1]

On billing:

(you can skip to the last 2 paragraphs of this post and avoid the preamble)

For my new policy I had funds withdrawn on 11/25 for my first payment due - yay! At least that much had worked.

Then, last week (in Dec) - I got a bill (invoice) for the same amount due on 1/1/14. The invoice date was 12/12/14 which was odd. They gave a web address on the invoice for paying on-line. I went to that site, which is the regular bcbstx.com/member site - and there was absolutely nothing about paying the bill. I figured I would call billing once my previous insurance bill had been processed.

Well, now there is no use in calling BCBS, as there is no streamline for talking to the billing department. Their wait time is currently over an hour just like everything else.

Fortunately, I logged in and checked the member website again, and VOILA! a "Payments & Billing Tab" appeared, and in there was my invoice, and also credit for the 11/25/13 withdrawal saying my current balance is $0. As well as a way to make payments via bank draft.

My husband, who did not get an invoice for some reason, nor had an initial payment drafted, is able to now see his bill via that web site and pay it. I've been waiting for his bill too and wondering about the delay since he was only a couple of days behind me in signing up.

 

[easysurfer]

I got an invoice today for the amount due on 1/1/14.

But when I applied I had signed up for automatic withdrawal.

So, if all goes well, my expectation is that come around 1/1 the automatic payments should stop from my old bcbs policy and get pulled for my new bcbs policy. If that isn't the case, I expect to be on the phone with bcbs

The invoice I received is a bit misleading as that doesn't say anything about if one has signed up for automatic payments.

 

[audreyh1]

I got an invoice today for the amount due on 1/1/14.

But when I applied I had signed up for automatic withdrawal.

So, if all goes well, my expectation is that come around 1/1 the automatic payments should stop from my old bcbs policy and get pulled for my new bcbs policy. If that isn't the case, I expect to be on the phone with bcbs

The invoice I received is a bit misleading as that doesn't say anything about if one has signed up for automatic payments.

Yes, that is frustrating - to get an invoice asking for payment when one has signed up for automatic bank draft.

I would understand it if they said on the invoice that it would be drafted automatically. That would be a nice confirmation - especially if they said WHEN it would be drafted.

We're hoping too!

BTW - my husband DID finally get an invoice in the mail yesterday.

He tried to go ahead and pay it online yesterday, but the system wouldn't let him. After he entered the bank info, he got the message "Premium could not be submitted". Our guess is that the system knows the bill will be automatically drafted, so it won't allow it to be paid on-line.

It sure would be nice to be told that though! And to know when it will be drafted.

 

[easysurfer]

Yes, that is frustrating - to get an invoice asking for payment when one has signed up for automatic bank draft.

I would understand it if they said on the invoice that it would be drafted automatically. That would be a nice confirmation - especially if they said WHEN it would be drafted.

We're hoping too!

BTW - my husband DID finally get an invoice in the mail yesterday.

He tried to go ahead and pay it online yesterday, but the system wouldn't let him. After he entered the bank info, he got the message "Premium could not be submitted". Our guess is that the system knows the bill will be automatically drafted, so it won't allow it to be paid on-line.

It sure would be nice to be told that though! And to know when it will be drafted.

Yes. It's quite confusing. Like you said, it would have been nice if there was a note saying something like "you are signed up for automatic withdrawal."

 

[easysurfer]

I get 3 letters from BCBS yesterday. One was just about their privacy, so I barely skimmed that. The other was notifying me that since I signed up for automatic payment on the new insurance effective 1/1, that the first payment is scheduled for pulling from my checkbook tomorrow, 12/26. So, I guess the wheels are turning. The other letter, was a reminder that my old policy's rates are going up starting in Feb. Now I just hope BCBS doesn't double dip from my checking account to pay for both new and old as the old policy should be gone by 1/1.