Covered California Bronze Plan, who did you choose?

[RetiredAndLovingIt]

I live in Southern California and am considering a Bronze plan with an HSA for 2020. This year I have Blue Shield HMO. I only went to the doctor 4 times, I have high blood pressure so need regular checks otherwise my health is good. My choices are Health Net or Kaiser. I would pick Kaiser in a minute except my long time doctor is not with them so Health Net is the other option if I want an HSA, I have a few more choices if I pick a plan without one.
Has anyone used Health Net, if so would you recommend them or not and why?
If not who do you use for your Bronze Plan and are you happy with them?
If I choose a Bronze plan and get sick I assume I am stuck with it for the entire year. What if I found out in December I was ill and wanted to change before the first of the year, could I?
I do qualify for a Silver plan at a reasonable rate so I'm torn between sticking with Blue Shield or trying to save some money and change to a cheaper plan this year and also be able to make a higher Roth Conversion since I can write off the contribution to the HSA savings account. I have a week to make this decision, all comments welcome.

 

[ocean view]

I’m in N. Cal and 2020 will be my third year in Kaiser Bronze HSA plan.

For a family of 3 the SLCSP in my zip code, which is also Kaiser, is $22k deductible/yr, no subsidy. The HSA plan is $16.8k. So the question I have to answer is whether I expect my cost for visits, of which I pay 100%, to be greater than $5.2k. Based on my prior history, it may be close, as we are moderate users. But the added HSA contribution benefit puts it ahead. It’s a risk I’m willing to take.

Can you look at 2019 EOBs and determine what $ benefit you received from your current plan? Would the actual cost of services exceed the difference in premiums?

I know the Covered CA literature makes it sound like you have a short window in which to choose, but I believe you can change your plan selection up until early January 2020. It’s worth a call to them to find out.

btw, I know not all Kaiser care is equal, but my family has been very pleased with Kaiser. We switched over when we retired and had to buy from the exchange. The non-Kaiser plans were at least $8k more.

 

[RobbieB]

We (husband and wife) are on the Kaiser bronze HSA plan (no subsidy) here in the central valley of CA.

Cost is $1200/mo. Next year I'm going Kaiser Medicare senior advantage for $18/mo.

Woo-Hoo!

 

[RetiredAndLovingIt]

Thanks for the response. In 2019 I have an HMO so I never see any bills, I just make my $35 copay, 4 this year. I had 1 x-ray visit , the lady told me she was not going to take my $75 copay as the actual cost of the service was a lot less than that, so just wait for and pay the bill which I have not seen yet.

Prescriptions less than $100, cash price was cheaper than the copays.
By my count even if I paid $200 per doctor visit on a Bronze plan my total out of pocket would have been $900 which is way less than my premium cost.
In 2018, 7 doctor office visits, 30 copay on each. According to the EOB, Insurance paid $66 on each visit so total cost would have been $700, again my premiums were way more than that so that's why I'm thinking Bronze with subsidy and HSA plan will work for me. My bronze premium cost is only a few dollars and I do understand there is no guarantees, my good health could change at any time.
Do you get any free doctor visits with the Kaiser bronze plan before the deductible kicks in?

 

[RetiredAndLovingIt]

We (husband and wife) are on the Kaiser bronze HSA plan (no subsidy) here in the central valley of CA.

Cost is $1200/mo. Next year I'm going Kaiser Medicare senior advantage for $18/mo.

Woo-Hoo!

Wow, that's a great price, how much will your copays be? I had Kaiser 34 years ago when my son was born, I think it cost me $50 copay for the total 9 months of the pregnancy. My daughter has them now and loves them to. I just wish my doctor was with them, I've been with him for close to 25 years now.

 

[ocean view]

Do you get any free doctor visits with the Kaiser bronze plan before the deductible kicks in?

There are a handful of annual “health maintenance” visits that are covered 100% (free), as mandated by ACA — annual physical, mammogram, Pap tests, flu shots, colon cancer screenings are the ones we use. Otherwise we pay 100% of the cost until we reach our deductible of $6900 individual/$13,800 family. I came close one year to the individual limit.

Really what I’m paying the premium for is to get negotiated rates.

 

[swakyaby]

I’m in California as well and currently have Blue Shield bronze HDHP with HSA ppo. It has the exact same coverage, deductible, and max OOP as the Healthnet bronze ppo plan with HSA. Since Healthnet premiums for 2020 are quite a bit less, I will likely sign up with them. For DH and I, this type of plan has worked out best. Our out-of-pocket expenses have not exceeded $1000, and certainly have not come anywhere close to the high deductible. And the negotiated rates for pharmacy and lab tests are significant. Having an HSA does help lower your MAGI, so that’s a plus as well. Your first primary care visit is covered, but you do pay for any subsequent visits. It sure beats my unsubsidized COBRA premiums last year.

 

[rodi]

So cal bronze HSA user here... Myself and my sons are on Kaiser bronze w/HSA.

I have posted in the past about the bronze/hsa woes... I started on an HSA /bronze plan in 2015. I hit full deductable and at/close to max OOP for 2015, 2016, 2017. Last year I was about $500 < deductible for my 'expensive' kid. This year we are looking good... but life could intervene, medically and blow the budget again.

That has nothing to do with Kaiser - they have provided great coverage.... but the HDHP with HSA is a gamble. When my boys were younger there were multiple broken bones from sports injuries, an amelo blastoma requiring jaw surgery, and some other issues that involved a hospitalization. With the jaw surgery we hit the deductible and max OOP for the entire family so December I had everyone going to the doctor to get *any* little thing taken care of.

With Kaiser's HDHP/HSA bronze there is a fee you pay at time of service and you get billed for the balance. Fortunately, the charges are reduced to negotiated rates... Even within Kaiser, the negotiated rates are lower than the 'list price'. For example we might be asked to pay $55 at check in, then get a bill for $135 for the balance.

On Healthnet - my husband is on medicare and has Healthnet as his Fplus provider... He's happy with his providers (In his case, Sharp Reese Steely) ... but the bronze plan may have fewer providers.

With *any * insurance the key is to get a good primary... Kaiser has some great ones, and some crappy ones... I'm sure Healthnet's list has some great ones and some crappy ones.

 

[RetiredAndLovingIt]

Thanks for the info, I was also paying a ton for Cobra last year and then I found this website and discovered how controlling your income can reduce premium costs substantially. I saved $650 moving from Cobra to Blue Shield Silver HMO this year, I still can't believe it. Can I ask what you are paying for a Bronze plan doctor visit, a test or x-ray, I'm just trying to get a rough idea of what my costs might be, I'm assuming it will be about $100+ per doctor visit.

 

[RetiredAndLovingIt]

I was reading the posts on another older thread earlier today about your experiences. I'm a little leery of Healthnet simply because I'd never heard of them before but they do have my doctor that I've been with for 25 years and my local hospitals and hopefully that's all I will need for now. There is no question that Kaiser will be my choice if/when my doctor decides to retire or I hit Medicare age, I had it when my kids were little and they were great even back then.

 

[rodi]

Thanks for the info, I was also paying a ton for Cobra last year and then I found this website and discovered how controlling your income can reduce premium costs substantially. I saved $650 moving from Cobra to Blue Shield Silver HMO this year, I still can't believe it. Can I ask what you are paying for a Bronze plan doctor visit, a test or x-ray, I'm just trying to get a rough idea of what my costs might be, I'm assuming it will be about $100+ per doctor visit.

Cost per visit varies based on the doctor and services provided. $100 might be a bit light... $150 is probably closer to the average.

 

[swakyaby]

Can I ask what you are paying for a Bronze plan doctor visit, a test or x-ray, I'm just trying to get a rough idea of what my costs might be, I'm assuming it will be about $100+ per doctor visit.

Looking over my 2018 bills: For a 2nd primary care visit, the initial charge was $151.00, adjusted by insurance to $107.06. My PCP(primary care physician) did an EKG in her office: charge was $50.00, no adjustment, so still $50.00.

Consult with a gastroenterologist for a screening colonoscopy: initial charge was $342.00, adjusted by insurance to $162. GI doc's fee for the colonoscopy itself was $393.00, adjusted by insurance to $223.79. Facility fee for the procedure was covered 100%.

Lab tests: CBC, glycosylated hemoglobin, comprehensive metabolic panel, Urinalysis, Urine culture, Vit D3, Vit B12, cholesterol, HDL, triglycerides, folic acid, glucose thyroxine, TSH Lab charges $1,319, adjusted by insurance to $126.56.

Followup lab tests 6 months later: urinalysis, Urine culture, folic acid, thyroxine, lipid panel, Vit B12, glycosylated hemoglobin, general health panel, Vit D3. Lab charges $1,239.58. Adjusted by insurance to $133.28.

Forgot about this one: DH had an urgent lumbar spine MRI. Amount billed $1,362. No insurance adjustment, so final charge $1,362. Ouch.

 

[RetiredAndLovingIt]

Looking over my 2018 bills: For a 2nd primary care visit, the initial charge was $151.00, adjusted by insurance to $107.06. My PCP(primary care physician) did an EKG in her office: charge was $50.00, no adjustment, so still $50.00.

Consult with a gastroenterologist for a screening colonoscopy: initial charge was $342.00, adjusted by insurance to $162. GI doc's fee for the colonoscopy itself was $393.00, adjusted by insurance to $223.79. Facility fee for the procedure was covered 100%.

Lab tests: CBC, glycosylated hemoglobin, comprehensive metabolic panel, Urinalysis, Urine culture, Vit D3, Vit B12, cholesterol, HDL, triglycerides, folic acid, glucose thyroxine, TSH Lab charges $1,319, adjusted by insurance to $126.56.

Followup lab tests 6 months later: urinalysis, Urine culture, folic acid, thyroxine, lipid panel, Vit B12, glycosylated hemoglobin, general health panel, Vit D3. Lab charges $1,239.58. Adjusted by insurance to $133.28.

Forgot about this one: DH had an urgent lumbar spine MRI. Amount billed $1,362. No insurance adjustment, so final charge $1,362. Ouch.

Excellent information, thanks for taking the time to look it up. I had a PPO insurance when I was working and I was always shocked at how much they actually paid vs the amount billed by the providers and I was curious if it would be the same with the Bronze plan PPO's

 

[captain3d]

Trying to shop on coveredca.com but just getting endless “finding health plans for you ...” tried Mac pc chrome and Firefox

 

[RetiredAndLovingIt]

Trying to shop on coveredca.com but just getting endless “finding health plans for you ...” tried Mac pc chrome and Firefox

I had that problem as well two days ago but they seem to be back up now

 

[Freedom56]

We have been using OSCAR Bronze EPO for the past two years. It is less expensive that all the other options and is accepted by the doctors we have been seeing annually for the past 20 years. For 2020 we are sticking with OSCAR at $1091 per month versus Blue Shield of California at $1470 per month with the same bronze plan. We only use our doctors for preventive checkups and test once per year. Prior to OSCAR we had Blue Shield and had nothing but problems with them with respect to payments to our providers for our annual checkups.