Comparing Platinum, Gold, Silver, Bronze Plans

[Senator]

From what I see, all major portions of the different metal plans are identical, if purchased through the same company (i.e. Blue Cross, Medica, etc.). The only difference that I can see is the premium, deductible, and max out of pocket costs.

I am a disabled vet (10%), so my main healthcare plan will be from the VA, as it is only ~5 miles from my home. I am planning on getting a private policy just in case I am rushed to the hospital and sit there for a while. I would want the private plan to cover those costs until I can be transferred to the VA. I do not want to deplete my assets due to a major medical emergency that I recover from.

If I can plan for it, or I am lucid enough to tell an ambulance driver where to take me, I can get to the VA emergency care. There is such a thing as getting reimbursed from the VA for private emergency care, but it is not a 100% guarantee at this point. At the VA, I am 100% covered for anything I go in for. Pharmacy is a maximum of $8 per prescription per 30 days.

If I plan for the max out of pocket costs of a private plan, will I be getting the same care no matter what metal plan I choose? Am I missing anything?

Are there any other differences between the metal plans other than the premium, deductible and max out of pocket?

 

[MichaelB]

Are there any other differences between the metal plans other than the premium, deductible and max out of pocket?

The nice thing about the essential health benefits is how much easier it is now to compare plans. Still some differences:

Copay / coinsurance is different. How you get to the total out of pocket requires some nimble spreadsheet effort. In addition, network size will be different, also out of network coverage. These last two can be difficult to compare and can have a big impact.

 

[Senator]

The nice thing about the essential health benefits is how much easier it is now to compare plans. Still some differences:

Copay / coinsurance is different. How you get to the total out of pocket requires some nimble spreadsheet effort. In addition, network size will be different, also out of network coverage. These last two can be difficult to compare and can have a big impact.

Do most of the plans have the same "out of network" emergency coverage?

If I am traveling in the USA, and have an incident, does the emergency generally get covered? From what I see, they generally are. There is a larger co-payment, but once I max out the out of pocket I think the coverage is the same in or out of the network.

I am not worried about a urgent care visit, but a major ambulance issue. I am thinking Blue Cross has the largest network, so I will likely go with them.

 

[MichaelB]

Do most of the plans have the same "out of network" emergency coverage?

No. Not all plans have out of network coverage. Those that do, typically PPOs, have separate deductible / copay / total out of pocket that are additional to the in network amounts. When an insurer does pay an out of network claim, it usually only pays based on "customary charges" which is they determine. Any way you look at it, going out of network is a bad deal.

If I am traveling in the USA, and have an incident, does the emergency generally get covered? From what I see, they generally are. There is a larger co-payment, but once I max out the out of pocket I think the coverage is the same in or out of the network.

Emergency care is covered everywhere. Any care given after that is subject to the specific policy and network. There has been some media coverage that insurers not covering "real" emergency care.

I am thinking Blue Cross has the largest network, so I will likely go with them.

BCBS all appear to have a 3 tier network approach for individual policies. HMO, restricted, and BlueCard. The one you refer to is BlueCard. It is a large network, but also pricey. Look at the policies available in your zip code to make sure it is available.

 

[Johnora]

As I sit less than a year from retirement this is one of the most important subjects I need to get comfortable with. I too get a little confused over the different insurance options but quickly noticed that the higher value metals had the higher value plans. With that said we each need to tailor one to our personal health situation at the time. I too am looking at Blue Cross and have narrowed it down to half a dozen plans so far. They are all a few hundred $$ cheaper than getting COBRA or even getting put on my DW health plan. Hopefully I will pick up some good information and become better educated thru this forum before I need to make that call.

 

[pb4uski]

Generally speaking if your health is good then you are best off with a bronze plan. The higher level plans can be more useful if you have some chronic health issues.

To compare plans I compare premiums plus deductibles assuming a certain level of utilization. In our case we are relatively healthy and our claims are typically only about $3,000 a year so bronze is most cost effective for us.

 

[Johnora]

Generally speaking if your health is good then you are best off with a bronze plan. The higher level plans can be more useful if you have some chronic health issues.

To compare plans I compare premiums plus deductibles assuming a certain level of utilization. In our case we are relatively healthy and our claims are typically only about $3,000 a year so bronze is most cost effective for us.

Thanks, I have been looking them over and doing side by side comparisons as well. It still amazes me that there are so many different plans out there.

 

[GTFan]

If I plan for the max out of pocket costs of a private plan, will I be getting the same care no matter what metal plan I choose? Am I missing anything?

Are there any other differences between the metal plans other than the premium, deductible and max out of pocket?

Yes, the only diff between the plan levels for a particular plan type is the OOP expense (deductible, premium, max OOP etc.). The network and coverage is exactly the same.

Note that there are different plan types per insurer, usually HMO or PPO. HMO is cheaper but has much more restricted networks, but for emergency care everything *should* be in-network until you are transferable. The big issue is going to a hospital that uses out-of-network docs IF there's a chance that they could do surgery that's not considered part of emergency care. We had to appeal to Humana for a surgeon's claim for my wife last year for exactly this reason (she broke her femur while we were vacationing in DC), and Humana agreed to pay the claim. Everything was in-network except for the anesthesiologist and surgeon but they ended up paying for both.

 

[dumpster56]

Just hope one does not get sick. seriously It can still put many into deep financial trouble. Lets look at say a bronze plan. 300 a month with a 10K ded. Need a hernia surgery and a few other issues , do you want a 10,000 bill from the surgeon, anesthesiologist along with 3,600 yearly premium?? That is 13K out of pocket, over 1000 a month. For many in our country it is now a huge debt going forward.The ACA is not affordable. Period.

 

[littleb]

Just hope one does not get sick. seriously It can still put many into deep financial trouble. Lets look at say a bronze plan. 300 a month with a 10K ded. Need a hernia surgery and a few other issues , do you want a 10,000 bill from the surgeon, anesthesiologist along with 3,600 yearly premium?? That is 13K out of pocket, over 1000 a month. For many in our country it is now a huge debt going forward.The ACA is not affordable. Period.

+1

We pay 15,660 per year for our premium and have a 6,500 annual deductible each. Many of our regular dr's ask for some money upfront due to the ACA being passed. How does the average person afford this?

I read an article yesterday that many of the exchanges under the ACA are or will be failing. Stating most people who signed up for the ACA are sicker than people covered under individual plans or employers.

We've had a High Deductible plan for over 10 years and never met our deductible even when it was 2,500.

 

[dumpster56]

+1

We pay 15,660 per year for our premium and have a 6,500 annual deductible each. Many of our regular dr's ask for some money upfront due to the ACA being passed. How does the average person afford this?

I read an article yesterday that many of the exchanges under the ACA are or will be failing. Stating most people who signed up for the ACA are sicker than people covered under individual plans or employers.

We've had a High Deductible plan for over 10 years and never met our deductible even when it was 2,500.

I do not believe they can. Look I have been running seriously for almost 50 years, just turned 60 this year. Yes I have a pension and medical coverage, but I have spent a whole lot of time looking at coverage's. Nutz!!I have taken crazy good care of myself and guess what still had two hernia repairs, various medical issues that just happened, and would have cost me the price of probably 3 new cars over a 10 year period if I did not have insurance. If I was covered by the ACA I would be bankrupt, and as I said I have taken extreme care of myself!!

 

[MichaelB]

The ACA is not an insurance polity, it is a series of regulations that, among other things, makes sure we all have access to insurance and assures us of standards in coverage.

The cost of an individual insurance policy is a reflection of how expensive health care is in the US. It is almost as costly for large group policies. The only difference is when the employer pays, we don't see the premiums.

 

[CoolChange]

FIRE Impacts

Hopefully not being too selfish, I would like to put aside the more general questions about healthcare affordability in the USA and focus for a moment on the impacts to FIRE.

I am looking at this slightly differently and hoping someone will correct my thinking if I am too far off base since this is a significant piece of my budgeted WR or ER.

+1

We pay 15,660 per year for our premium and have a 6,500 annual deductible each. Many of our regular dr's ask for some money upfront due to the ACA being passed. How does the average person afford this?

I read an article yesterday that many of the exchanges under the ACA are or will be failing. Stating most people who signed up for the ACA are sicker than people covered under individual plans or employers.

We've had a High Deductible plan for over 10 years and never met our deductible even when it was 2,500.

I am single and living in a low cost state; so, my numbers are a little less than half of this. And, I have never met my deductible either.

But, I look at much of my health insurance coverage the same as liability, fire, etc. Frankly, I would rather not be using it. (I do not believe I have ever met my auto insurance deductible in my adult life. And, I am not sad about that.)

If I were to meet my deductible, it would take a large chunk out of yearly budget. But, other areas such as dining out, travel, etc. would probably absorb some of that hit. Regardless, this kind of expense would not bankrupt me. If it would, I would not consider myself FI.

To be completely blunt, if I develop a condition where meeting my deductible yearly is likely, planning for the long end of the longevity tail is probably not realistic. So, my WR could be substantially increased.

The ACA is not an insurance polity, it is a series of regulations that, among other things, makes sure we all have access to insurance and assures us of standards in coverage.

The cost of an individual insurance policy is a reflection of how expensive health care is in the US. It is almost as costly for large group policies. The only difference is when the employer pays, we don't see the premiums.

I hope the facts above are not actually in dispute among this group; but, this is likely a good clarification in any case.

These regulations have removed a large source of worry for my own FIRE: How would I insure myself if a chronic condition were to develop? ACA has largely removed this concern for me.

 

[rayinpenn]

The ACA is not an insurance polity, it is a series of regulations that, among other things, makes sure we all have access to insurance and assures us of standards in coverage.

The cost of an individual insurance policy is a reflection of how expensive health care is in the US. It is almost as costly for large group policies. The only difference is when the employer pays, we don't see the premiums.

Sir with respect I beg to differ.. ACA is a tax plan that penalizes those who work for a living by making them pay higher premiums for those who do not or can not. This is not a political comment but simply a statement of fact.


Sent from my iPad using Early Retirement Forum

 

[MichaelB]

Sir with respect I beg to differ.. ACA is a tax plan that penalizes those who work for a living by making them pay higher premiums for those who do not or can not. This is not a political comment but simply a statement of fact.

.
.

If you want to discuss the merits, fundamentals, or Raison d'etre of the ACA, please start your own thread, let's not take this one off topic.

 

[pb4uski]

....The ACA is not affordable. Period.

I don't think that is true.

In my case, ACA bronze plans were much less than COBRA cost for a HDHI policy so it is not only ACA, it is health care in general.

When I was working I paid about $250/month for a HDHI plan, and the COBRA cost was $900/month. When I ERed, I bought into a small group plan and paid $556/month (In all cases for two of us). So while my personal cost increased from $250/month to $556/month it was only because I lost the employer subsidy.

And given the MLR restrictions put into place by ACA, it isn't health insurance... health insurance is expensive because health care is expensive.

 

[pb4uski]

Sir with respect I beg to differ.. ACA is a tax plan that penalizes those who work for a living by making them pay higher premiums for those who do not or can not. This is not a political comment but simply a statement of fact. ....

You obviously have either no or a very skewed understanding of ACA because you are not even in the right ballpark.

Please explain how ACA makes premiums for those who work higher than for those who do not? Premiums for those who work were high before ACA and continue to be high but they didn't spike dramatically. If anything, ACA has reduced increase for group plans because of less cost shifting.

As Michael indicated, the increases in health insurance premiums is a function of increase in the cost of health care services.

 

[rodi]

There is a big cost difference from state to state and region to region for health insurance. When I worked for Motorola - an employer that had campuses all over the country, the insurance was much more expensive in the CA bay area than anywhere else. (Despite the fact that CA has had medical tort reform since they 80's.) My insurance dropped in price when I moved from PA to CA. And when I worked in PA - the folks who lived in NJ were paying much higher rates than us Philly based folks.

When I started planning for retirement I looked at COBRA rates as a gauge of what I'd pay after I was employed... This was pre-ACA... Each year the costs went up dramatically. (And to add salt to the employee wound - the percentage paid by the employee also went up - so the employee's costs were rising at a super rapid rate.). The ACA didn't change that.

When I retired - my ACA compliant plan cost very similar to the COBRA plan.

As for whether workers are paying for the non-workers... I don't agree. I do agree that higher income (pension, cap gains, rental, whatever the source) folks do not get a tax credit, and lower income folks get a subsidy... but it has nothing to do with employment status.

 

[pb4uski]

Good point rodi and perhaps subsidies was implicit in raypenn's rant and I missed that nuance but you are right... subsidies are a function of income and not employment. Given that IIRC subsidies stop at about $62k for a couple and the average household income is less than that I suspect that a lot of people receiving subsidies are working.

Those who do not work or chose not to would likely be covered by Medicaid both before and after ACA.

 

[Johnora]

.
.

If you want to discuss the merits, fundamentals, or Raison d'etre of the ACA, please start your own thread, let's not take this one off topic.

+1

 

[Looking4Ward]

Plan choice is obviously driven by cost. I personally wonder how much needed health care is now deferred due to the potential cost of high deductibles and will become more serious health issues over time.

I've got a $2K deductible, $6K max OOP. This year I'm trying to schedule and address as many things as I can (rotator cuff surgery, neuroma in one foot, basal cell carcinoma requiring MOHS) so that I can reach my deductible in one year and have insurance cover the rest.

Which means in other years I tend to defer care due to the original concerns that drove my decision to choose a particular plan level - the cost beyond premiums. And I may not be the only individual who does that.

 

[Johnora]

There is a big cost difference from state to state and region to region for health insurance. When I worked for Motorola - an employer that had campuses all over the country, the insurance was much more expensive in the CA bay area than anywhere else. (Despite the fact that CA has had medical tort reform since they 80's.) My insurance dropped in price when I moved from PA to CA. And when I worked in PA - the folks who lived in NJ were paying much higher rates than us Philly based folks.

When I started planning for retirement I looked at COBRA rates as a gauge of what I'd pay after I was employed... This was pre-ACA... Each year the costs went up dramatically. (And to add salt to the employee wound - the percentage paid by the employee also went up - so the employee's costs were rising at a super rapid rate.). The ACA didn't change that.

When I retired - my ACA compliant plan cost very similar to the COBRA plan.

As for whether workers are paying for the non-workers... I don't agree. I do agree that higher income (pension, cap gains, rental, whatever the source) folks do not get a tax credit, and lower income folks get a subsidy... but it has nothing to do with employment status.

Great points, when I look at insurance quotes they always ask for your zip code upfront so you get appropriate quotes from your area and price. Here in Idaho they even drill down to the specific parts of the state as rates differ.

My current job (FIRE in 10 months) will let me stay on with COBRA for 10% over what they pay now which would run about $900 a month for what is termed a "Cadillac Plan". I can jump over to my DW's plan fro about $710 a month which is also a premium plan or jump into the insurance marketplace for a middle silver plan in the 500's or most bronze plans for even less than that.

All politics aside, this is the single most frustrating part so far is trying to determine future medical costs. I too believe that the insurance costs are driven by the health care costs.

Lets us never forget that there are two very important parts of a successful ER. Your financial health and your physical health and it takes both to really enjoy it all. I make investments in both!

 

[MichaelB]

Thanks, I have been looking them over and doing side by side comparisons as well. It still amazes me that there are so many different plans out there.

The multitude of options is excessive and very confusing. In reality, there are just a few plans, but each has many different ways to pay. For example, BCBS of Florida has 27 options but really only 3 plans. An HMO, a plan with a local, restricted network of service providers, and a plan with the large, nation-wide network, and they all cover the same health conditions. Each of those plans has many different combinations of premium, deductible, co-pay, co-insurance and out-of-network coverage.

A number of forum members wrote MS Excel spreadsheets to compare the different combinations and estimate the total yearly cost. A tool like this makes is much easier to choose.

 

[travelover]

............As for whether workers are paying for the non-workers... I don't agree. I do agree that higher income (pension, cap gains, rental, whatever the source) folks do not get a tax credit, and lower income folks get a subsidy... but it has nothing to do with employment status.

I never understood why a person with employer paid health insurance got it tax free while a person who bought their own insurance paid for it with after tax dollars. That almost sounds like a subsidy.

 

[Senator]

I originally stated this thread to see if there are differences between Platinum, Gold, Silver and Bronze plans.

I know there are cost differences, and at this point I am not worried about that.

I was worried about having a bronze plan, and then going to the Doctor and having the Dr. say, too bad that isn't covered. If you would have purchased the upgraded plan, it would have been. You purchased the heart friendly plan, not the cancer friendly plan.

It appears that the plan coverage is NOT like an extended automobile warranty. Some auto warranty plans cover electronics, some do not.

I can plan for playing the max out of pocket costs, as it would be a catastrophic event. I would be happy to be alive and pay for what I was provided. If I can plan for something, and all I need is enough planning to tell an ambulance driver to take me to the VA, I am covered.