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"Minimum Coverage" PPO Plan
Old 12-08-2014, 03:19 PM   #1
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"Minimum Coverage" PPO Plan

My 2014 Bronze PPO plan from Covered CA will no longer be offered in 2015 through Covered CA.

Instead, if I want the same plan, I can enroll directly through the insurer, at a higher cost, approximately 20% more than my 2014 premiums.

That's just so I can keep my same doctor/medical group (though they are in negotiations with the insurer to remain on their PPO network).

So I went to the insurer's site, entered my zip code and entered my birthdate and one of the plans they offer is a "Minimum Coverage" PPO Plan which has much lower premiums, approximately $130 less than the Bronze PPO Plan for 2015.

It has a higher deductible, $6600 vs. $5000, as well as higher out of pocket max, $6600 vs. $6250.

But the first 3 office visits are "free" meaning the plan would pay for them? It also has the preventive care, which seems to be separate from the first 3 free visits (which could also be urgent care visits, not routine office visits):

https://www.healthnet.com/portal/sho...ction?id=53222

So the savings on the premiums are the primary draw for me. I also have been averaging a couple of doctor's visits per year for a long time, have no active prescriptions.

But I thought these kinds of bare bones, below Bronze-level coverage, only applied to people under 30 years of age or some other categories? Wondering whether the insurer's site is correctly presenting "legal" (compliant under the ACA) plans.

When I go to coveredca.com, they only show me strictly the metal plans.

If my needs for medical services remain consistent with recent history, 3 "free" visits (again, still not certain about this one) are in some ways better than what's offered under the Bronze plans.

The only bummer is that none of the plans offered by the insurer are HSA-eligible so I may in the end have to get a higher-premium plan just to get the HSA advantages.
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Old 12-08-2014, 04:13 PM   #2
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As I recall when looking there wasn't much difference between bronze and catastrophic
Compare the Cheapest Health Insurance Plans: Bronze vs. Catastrophic - US News

I would guess it didn't filter correct for you at the insurers site vs coveredCA.

My bronze plan has 3 "free" PCP visits with a deductible just below the $6600 limit. I imagine the slightly lower deductible changes the actuarial value just enough to classify it as bronze versus catastrophic.
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Old 12-08-2014, 07:00 PM   #3
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The Bronze plans do not offer free PCP visits as far as I can see.

If you get 3 visits (either PCP or some urgent care visits) as well as the preventive care, it might be enough for some people in good health.

It's interesting, one of the PDFs that you can download for this "Minimum Coverage" PPO plan says "Catastrophic" in the file name.
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Old 12-08-2014, 07:05 PM   #4
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I would want to see if the minimal coverage plan is ACA compliant in writing.
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