Join Early Retirement Today
Reply
 
Thread Tools Display Modes
Old 11-20-2013, 07:06 AM   #121
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
Quote:
Originally Posted by audreyh1 View Post
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.
MichaelB is offline   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 11-20-2013, 07:50 AM   #122
Thinks s/he gets paid by the post
 
Join Date: Jul 2012
Location: Mississippi
Posts: 1,894
Quote:
Originally Posted by audreyh1 View Post
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.
rbmrtn is offline   Reply With Quote
Old 11-20-2013, 07:54 AM   #123
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
Quote:
Originally Posted by MichaelB View Post
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.
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-20-2013, 07:55 AM   #124
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
ziggy29's Avatar
 
Join Date: Oct 2005
Location: North Oregon Coast
Posts: 16,483
Quote:
Originally Posted by rbmrtn View Post
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.
__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)
ziggy29 is offline   Reply With Quote
Old 11-20-2013, 07:59 AM   #125
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
Quote:
Originally Posted by rbmrtn View Post
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....
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-20-2013, 08:01 AM   #126
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
Quote:
Originally Posted by ziggy29 View Post
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.
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-20-2013, 09:14 AM   #127
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
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".
MichaelB is offline   Reply With Quote
Old 11-20-2013, 09:21 AM   #128
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
ziggy29's Avatar
 
Join Date: Oct 2005
Location: North Oregon Coast
Posts: 16,483
Quote:
Originally Posted by MichaelB View Post
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.
__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)
ziggy29 is offline   Reply With Quote
Old 11-20-2013, 09:36 AM   #129
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
Quote:
Originally Posted by ziggy29 View Post
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).
MichaelB is offline   Reply With Quote
Old 11-20-2013, 09:59 AM   #130
Dryer sheet aficionado
 
Join Date: Nov 2013
Posts: 41
Quote:
Originally Posted by audreyh1 View Post
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!!!
jowi is offline   Reply With Quote
Old 11-20-2013, 10:47 AM   #131
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
Quote:
Originally Posted by jowi View Post
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.
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-20-2013, 10:49 AM   #132
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
ziggy29's Avatar
 
Join Date: Oct 2005
Location: North Oregon Coast
Posts: 16,483
Quote:
Originally Posted by jowi View Post
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.
__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)
ziggy29 is offline   Reply With Quote
Old 11-20-2013, 10:50 AM   #133
Thinks s/he gets paid by the post
 
Join Date: Feb 2007
Posts: 3,679
Quote:
Originally Posted by MichaelB View Post
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.
__________________
Married, both 69. DH retired June, 2010. I have a pleasant little part time job.
Sue J is offline   Reply With Quote
Old 11-20-2013, 10:52 AM   #134
Administrator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Chicagoland
Posts: 40,586
Quote:
Originally Posted by Sue J View Post
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.
MichaelB is offline   Reply With Quote
Old 11-20-2013, 10:55 AM   #135
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
Quote:
Originally Posted by Sue J View Post
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.
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-20-2013, 11:10 AM   #136
Full time employment: Posting here.
sailor's Avatar
 
Join Date: May 2005
Location: Atlanta suburbs
Posts: 898
Quote:
Originally Posted by jowi View Post
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)
sailor is offline   Reply With Quote
Old 11-20-2013, 12:10 PM   #137
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
audreyh1's Avatar
 
Join Date: Jan 2006
Location: Rio Grande Valley
Posts: 38,008
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)
__________________
Retired since summer 1999.
audreyh1 is offline   Reply With Quote
Old 11-20-2013, 12:54 PM   #138
Full time employment: Posting here.
 
Join Date: Dec 2009
Posts: 526
+1

Thanks!
zedd is offline   Reply With Quote
Old 11-20-2013, 01:11 PM   #139
Thinks s/he gets paid by the post
walkinwood's Avatar
 
Join Date: Jul 2006
Location: Denver
Posts: 3,506
Quote:
Originally Posted by audreyh1 View Post
...
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.
walkinwood is offline   Reply With Quote
Old 11-20-2013, 01:16 PM   #140
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
ziggy29's Avatar
 
Join Date: Oct 2005
Location: North Oregon Coast
Posts: 16,483
Quote:
Originally Posted by walkinwood View Post
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?
__________________
"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)
ziggy29 is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


» Quick Links

 
All times are GMT -6. The time now is 12:46 AM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2024, vBulletin Solutions, Inc.