Bronze, Silver and Coinsurance/Copay

[audreyh1]

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.

 

[MichaelB]

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".

 

[ziggy29]

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.

 

[MichaelB]

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).

 

[jowi]

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!!!

 

[audreyh1]

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.

 

[ziggy29]

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.

 

[Sue J]

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.

 

[MichaelB]

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.

 

[audreyh1]

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.

 

[sailor]

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

 

[audreyh1]

This is my analysis exported to Excel format - hopefully the formulas transfer OK. Originally done in Numbers.

 

[zedd]

+1

Thanks!

 

[walkinwood]

...
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.

 

[ziggy29]

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?

 

[MRG]

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

+1
They even use different vendors to meet their needs. Just selling software or services to one BCBS does not get you into any of the others. May help open a door, or it may not.

MRG

 

[bamsphd]

DH and I are signing up separately. Once I sign up, he'll probably sign up next week.

I'm not sure that is permitted if you want a premium subsidy. I asked healthcare.gov online chat:

Can a married couple apply for two individual policies instead of one family policy without changing their combined premium subsidy?

The response was:

[4:00:54 pm]: Arias
A married couple would have to apply as a family.

 

[bamsphd]

No subsidy. Signing up directly with insurer "off exchange". That we file taxes MFJ has no bearing.

Missed that. Yes, if you don't care about the exchange, then do what you want.

 

[walkinwood]

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?

Yes.
From their brochure

Out-of-network (or nonparticipating) refers to doctors, hospitals and other health care providers that are not contracted with your health plan to provide services at a negotiated rate. Our plans do not offer out-of-network benefits (with the exception of emergency and urgent care). This means you will pay the entire cost for any service you get from out-of-network providers.

 

[bamsphd]

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.

I think the PPACA's out-of-pocket maximum mandate combined with the actuarial restrictions tends to cause that. Though there is definitely some wiggle between the plans, they are much closer than I would have predicted.

In my state we only have one provider, all the plans are HMO, and almost all the providers are in-state or just over the border. If you travel you only have ER and urgent care coverage. In addition to non-HSA plans, we do have two Bronze HSA plans and a Silver HSA choice. If I did not make any typos, below are the numbers for the highest deductible Bronze plan, and the Silver HSA plan.

	Bronze	Silver	difference
Our Annual Family Premium	$7,164	$8,702	$1,538
OOP Max	$12,700	$8,000	$4,700
Medical Deductible	$11,000	$5,000	$6,000
Drug Deductible Indv	$5,500	$2,500	$3,000
Drug Deductible Family	$11,000	$5,000	$6,000
Co-insurance most items	0%	10%	10%

The differences in deductible and OOP max makes Silver the better choice for a pessimist, though the Bronze plan is obviously a better deal until the Silver plan's lower deductible causes insurance to pay out the premium difference.

 

[audreyh1]

Insurance web sites have their bugs too.

Apparently my application has been accepted and I am enrolled, even though a couple of things didn't get transferred correctly from the on-line enrollment UI to the application they printed for me at the end (after already submitted).

 

[bamsphd]

Looks like I misunderstood the original healthcare.gov chat answer. The relevant part of my latest chat confirms ziggy29's answer that you must apply together, but can have separate plans.

See thread ACA: "Recommended Health Plan Groups" (Family versus 2 Individual Policies) for more details.

 

[MichaelB]

This is my analysis exported to Excel format - hopefully the formulas transfer OK. Originally done in Numbers.

Nice spreadsheet.

 

[audreyh1]

Nice spreadsheet.

So the formulas seem to work OK in Excel?

I had no way to test it.

 

[MichaelB]

So the formulas seem to work OK in Excel?

I had no way to test it.

Well, I've only done a little testing, but so far it looks good.