I also found the AV calculator that the insurers are using.
Centers for Medicare & Medicaid Services
1st link
Centers for Medicare & Medicaid Services
1st link
Bronze, Silver and Coinsurance/Copay
- Thread starter audreyh1
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audreyh1
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Could they possibly not be considering an individual's tax savings into account in their models?
The actuarial models don't use the subsidized cases either from what I read.
I'm not sure this matters to me as a customer. The Bronze plans are HSA qualified period. I don't see an option for Bronze HSA versus Bronze non-HSA plan I can purchase.
The actuarial models don't use the subsidized cases either from what I read.
I'm not sure this matters to me as a customer. The Bronze plans are HSA qualified period. I don't see an option for Bronze HSA versus Bronze non-HSA plan I can purchase.
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ziggy29
Moderator Emeritus
OK, let's try this again: once you've met the deductible, sure, anything that results in a lower premium AND lets you contribute to an HSA looks better.
But the problem is that few of know this will be the case going into any given year. And it ignores the concept that one deductible may be $2000 and the other may be $6000.
Am I missing something?
ziggy29
Moderator Emeritus
Audrey, when I look at the plans, the Bronze PPO plans are showing up as HSA-eligible but the bronze HMO plans are not. And maybe it's different in my county, but the only HSA-compatible plans I'm seeing are the two Bronze-level PPO plans offered by BCBS through the Exchange. I don't know if this is a bug or if there is something about the HMO plans that don't meet all the technical criteria for HSA eligibility.
Yes, how they arrive at the actuarial value of a plan.
The deductible, co-pays, coinsurance all go into a formula that makes up the AV of a plan - correct?
A high deductible would subtract from the AV of a plan, correct?
So now we have the ACA requiring a minimum essential standard - so if the low deductible plan and the high deductible plan have the same AV (e.g.60%) then the AV would have to made up somewhere else in the pay-outs - yes?
ziggy29
Moderator Emeritus
Oh, I see what you are saying -- I think. The AV is based on a percentage of the non-subsidized premium, so sure, the more you can be subsidized, the better the "effective" AV to the policyholder in terms of their own costs. And yes, HSA contributions reduce your MAGI and can increase your subsidy, so sure, it increases the AV as a percentage of the premium you specifically pay. But it doesn't change the AV in terms of the unsubsidized premium.
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audreyh1
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You're right - just the Bronze PPOs.
I haven't looked into detail on the Bronze HMOs. I know absolutely nothing about the HMO network in our area. The plans are cheaper, and even though they have high deductibles like the PPOs, they seem to offer more in-network office visits, etc. before you start having to pay towards your deductible. Maybe this no or low copay stuff is what limits a plan from being HSA eligible?
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The detailed numbers of AV calculations only makes sense from the insurance company point of view. i.e. if they insure 10,000 people on the average they payout 60%, 70%, or 80% of the premium in actual medical reimbursements.
For individual customers, unless you can repeat your average year with the same age randomly 10,000 times makes no sense. Probability also does not make much sense if it is truly random. i.e. you may have 2% chance of breaking your leg, but you cannot predict which year it's going to be.
So all you can go by is your vague expectation based on *known* health conditions, past history, and most importantly your risk tolerance. High deductibles gives you a high hurdle, but gives you the certainty that you won't go bankrupt.
One often overlooked aspect of this high deductible (HSA) gambit is psychological; there is some proof to believe that this results in people postponing necessary healthcare expenses to their detriment because in essence they have to "play doctor" in determining whether a paid visit is truly necessary. A full-up payment is a greater psychological hurdle than a known co-pay amount.
The free preventative care clause of ACA even for HDHP plans alleviates this to a great extent, but not completely.
Here's the spreadsheet I created to compare a few health plans. It simply compares the costs of several plans for a given level of medical charges for the year, assuming you pay premiums, a deductible, and then coinsurance amounts, with a maximum out of pocket amount that includes both the deductible and coinsurance. Not a lot of detail. You enter the plan data and it creates a table that shows you costs for various levels of medical charges. It's pre-loaded with real plans I was looking at directly from BCBS.
You can see one plan is best with low medical charges, one is best with high charges, one or two are best within a particular range of charges, and one was actually not too far off from the best at all charge levels.
You can see one plan is best with low medical charges, one is best with high charges, one or two are best within a particular range of charges, and one was actually not too far off from the best at all charge levels.
Yes. HSA plans pay nothing until you meet your out of pocket deductible, I believe.
ziggy29
Moderator Emeritus
I suspect that might be right. A plan that has no copayments might not be HSA compatible.
Still, one of the BCBS Bronze PPOs offered in Texas has a $6000 deductible and a $6000 OOP max (i.e. no copays effectively, you either pay all or nothing)... and it's HSA compatible. So again, I'm confused.....
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One of the important requirements for a plan to be HSA compatible is it CANNOT pay ANY benefit until the minimum deductible is met.
The *ONLY* exception is ACA mandated preventative care.
The *ONLY* exception is ACA mandated preventative care.
NW-Bound
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That's exactly how my pre-ACA plan works. I pay 100% up to $10K/yr, then the insurer pays 100%.
That does not apply to this pre-ACA plan.
I think I am going to stick with my plan for 1 more year while this ACA settles out. It appears that my insurer will not drop this plan.
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There is a max limit for oop for it to be HSA compatible. If your $10K/yr figure is for an individual plan, then I am not sure it would qualify for HSA as the limit is $6,250. The family limit is $12,500.
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audreyh1
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Sorry, a plan that HAS cheaper copays might not be HSA compatible.
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audreyh1
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That's my understanding too, unless that max oop limit is for both you and wife.
Thanks for this animorph. I have never learned Excel.
NW-Bound
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It has been HSA qualified pre-ACA for many years that we have had it. And yes, the $10K is for 2 of us.
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It might though even with the lower limit because if they can no longer roll the maximum HSA contribution into the AV (making it appear higher than it actually is) something else would have to give and it might be the OOP limit.
Say NW Bound's plan has an AV of 60% with his max HSA contribution figured in. They can no longer use the HSA in the equation and the same plan now has an AV of 55%. The insurer will now have to give him benefits somewhere else to raise the AV to be a compliant 60%. Lowering the OOP max might be one example.
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Awesome! Just the kinds of answers I was looking for, but I didn't know how to set that up. I only took a quick look at it so far...I hope I can figure it out. So many folks talk of spreadsheets on this board, but not too many are shared. Hats-off to you!
That's a useful spreadsheet. Thanks for another addition to the FAQ. The one I was using had much less granularity in pricing, and the additional clip levels make a difference, much easier to filter, and choose. It's also visually well structured. Add a spouse, project out over 3-5 years (for us, Medicare eligibility), and we can see which policies make sense and also how much we should reasonable set aside to fund in additional to premiums.
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Thank you !
Very useful spreadsheet ! I'll set this up for the plans I am considering and will just need to consider the tax savings if a plan is HSA compatible .
BTW some were wondering about HSA plans needing to be HMO. When I go to ehealth to look at plans and filter for HSA compatable plans I get 6 HMO options, 3 ppo and 3 POS . So apparently the plan type is not an issue for HSA plans . We have had an HSA compatable plan for years (POS).
However the only insurer through the exchange that I think may have our Doctors is BCBS . It seems all our BCBS options are HMO. I'd rather not go there but I'll do it to keep the Doctors.
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It seems like I'm using the spreadsheet correctly, but I'm getting some "interesting" results.
I kind of expected that plans with the lowest premium cost would be cheapest overall to "operate" as long as your medical utilization was low, but the higher premium plans would have an advantage if you needed more services. But that doesn't seem to be true, based on what I've seen in the spreadsheet (if I'm doing this right). It seems like coinsurance isn't really worth very much in a lot of cases.
Blue Value Bronze 5500 is in the sheet, rows 9 through 12, as ($1,065, $5,500, 0%, $5,500). That one has a deductable the same as out of pocket max, so there really is no coinsurance. I expected that one to "win" if my expenditures were low, but lose if expenditures were high, but it wins hands-down (which makes me wonder if I'm doing this right). The second best one appears to be Blue Value Silver, which I have in there as ($1,167, $3,000, 30%, $6,350).
One thing I'm probably doing wrong is that the deductable and out of pocket max are for one person, and the prices are for a policy on a couple and 18yo. I don't know how the family/individual deductable and oopm works. If one person needed big-time care and blew through $5,500, I need to see if the insurance company would start paying, or if we'd need to hit the family deductable/oopm.
Sorry for the half-baked post, hehe. Time for dinner!
I found a bunch of SBC's for some of NC's ACA plans:
I kind of expected that plans with the lowest premium cost would be cheapest overall to "operate" as long as your medical utilization was low, but the higher premium plans would have an advantage if you needed more services. But that doesn't seem to be true, based on what I've seen in the spreadsheet (if I'm doing this right). It seems like coinsurance isn't really worth very much in a lot of cases.
Blue Value Bronze 5500 is in the sheet, rows 9 through 12, as ($1,065, $5,500, 0%, $5,500). That one has a deductable the same as out of pocket max, so there really is no coinsurance. I expected that one to "win" if my expenditures were low, but lose if expenditures were high, but it wins hands-down (which makes me wonder if I'm doing this right). The second best one appears to be Blue Value Silver, which I have in there as ($1,167, $3,000, 30%, $6,350).
One thing I'm probably doing wrong is that the deductable and out of pocket max are for one person, and the prices are for a policy on a couple and 18yo. I don't know how the family/individual deductable and oopm works. If one person needed big-time care and blew through $5,500, I need to see if the insurance company would start paying, or if we'd need to hit the family deductable/oopm.
Sorry for the half-baked post, hehe. Time for dinner!
I found a bunch of SBC's for some of NC's ACA plans:
Code:
Price Deduct Coinsur OOPMax SBC
1628.19 0 50.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf
1497.87 2800 30.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf
1488.15 3500 30.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf
1481.57 0 50.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf
1462.05 5000 30.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf
1387.83 3500 30.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf
1372.09 3000 30.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf
1167.47 3000 30.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf
1264.64 5000 20.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000.pdf
1264.24 2600 50.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2600.pdf
1170.08 5500 0.00% 5500 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500.pdf
1150.81 5000 20.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf
1150.45 2700 50.00% 6350 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf
1064.8 5500 0.00% 5500 https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf
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audreyh1
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Basically, sengsational, what I'm seeing is that it doesn't make sense to go to a silver plan that has low copays - $30/$35 per doctor visit, when such a plan costs me $100 or $120 more a month. I'd rather pay the full price of the doctor's visit out of pocket - $100 or $125? Probably a bit less as negotiated by the PPO. Might be more like $89 or something.
Add on top of that - the Bronze plans is HSA eligible, the Silver not (due to the cheap copays). I can expect to save 25% by putting away money each year in my HSA. This is a big deal! This is even if I don't have any medical expenses!!!!!
The max OOPs are essentially the same.
Audrey
Add on top of that - the Bronze plans is HSA eligible, the Silver not (due to the cheap copays). I can expect to save 25% by putting away money each year in my HSA. This is a big deal! This is even if I don't have any medical expenses!!!!!
The max OOPs are essentially the same.
Audrey
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