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Old 11-06-2013, 11:31 PM   #21
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I agree. Good article. His analysis is basically what I have done in analyzing my health care plan the last 10 years, especially when the premiums started going sky high. So I asked myself, "What is my max pain in any one year" and insure for catastrophic or worst case scenario. Mainly because I do not go to the doctor often. So why pay high premiums for something not used often. It's a different story if you do use it often.

I use the same thought process with my homeowners and car insurance by jacking up deductibles for lower premiums. I figure so far I'm ahead of the game and if something bad happens I can absorb the cost for that one year or so.
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Looking for input on my health plan
Old 11-07-2013, 02:08 AM   #22
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Looking for input on my health plan

I finally gave up on the Hawaii exchange. (been almost 2 weeks waited for my SSN and citizenship to be verified.) I contacted Kaiser, my existing insurance provider and they were finally able to give me enough info about my choices to make an informed decision.

My two choices are my existing plan which is grandfather Premium were hiked to $377 a month from $337 this year and it not ACA compliant. (that is 12% hike the most ever in the last 12 years) The other plan is Kaiser Bronze 50 plan.

I am 54, I have averaged <2 doctor visits a year for the last 12 years. I have normal blood pressure, border line high cholesterol and border line pre diabetic and am 30+ lbs overweight.

I am finding it hard to make a comparison so I thought I'd get input from the smart folks on the forum. Here comparison of the two plans; existing first Bronze second
Plans Existing Bronze
Premium $378 $243
Deductible 0 6350
Max Out Pkt 3000 6350
Doctors visit $25 $50
Tests 50% $50 per visit
X-Ray 50% $50 per image
ER room $100 20% copay
Urgent Care $25 $50
Hospital/Day $250 20% copay

My existing plan has no drug coverage the bronze plan does. In general I find I can get generics and Walmart or Costco for near $25 and take no drugs on regular basis.

Plan pharmacy (up to a 30-day supply) Generic: $25 maint./$25
other Brand: 50% After $750/$1,500 brand deductible, but still if I get sick the drug plan is better than nothing.

So it cost an additional $1500 a year for my existing plan. It seems to me that a a 2-3 nights at the hospital on the bronze plan would almost certainly max out the $6350, but with my existing plan it may only cost $1000. Of course I have no idea if Kaiser will continue to offer this plan next year. (It seems to me though it is hardly junk insurance.)

On other hand if I never spend a day in the hospital, than I'll have saved $15,000 until I am old enough to get Medicare and I can certainly afford a couple of years having to fork out $6350

Thoughts?
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Old 11-07-2013, 06:41 AM   #23
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Originally Posted by clifp View Post
So it cost an additional $1500 a year for my existing plan. It seems to me that a a 2-3 nights at the hospital on the bronze plan would almost certainly max out the $6350, but with my existing plan it may only cost $1000. Of course I have no idea if Kaiser will continue to offer this plan next year. (It seems to me though it is hardly junk insurance.)

On other hand if I never spend a day in the hospital, than I'll have saved $15,000 until I am old enough to get Medicare and I can certainly afford a couple of years having to fork out $6350

Thoughts?
I found the spreadsheet Animorph built (post 85 in this thread Bronze, Silver and Coinsurance/Copay ) to be very helpful.

Have you looked at any other insurer? The larger insurers (BCBS, AETNA, etc) have all the ACA policy information available and quotes directly on their websites.

It doesn't matter if Kaiser renews the plan next year, if they don't you get a new one on the exchange. The ACA compliant plans include a group of essential health benefits that may be of interest, including low or no cost health care services that your current plan may not cover.
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Old 11-07-2013, 07:18 AM   #24
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Thanks I checked out spreadsheet. I was too lazy to build one myself, but I can make a few changes on this one to make it a bit more accurate . Interestingly enough at $<2,000 medical expense, the Bronze plan was cheaper than the existing one, at $15K the price difference the existing was being $1,700 a year less and at $6350 worth of medical expense the difference was $3,400 in favor of the existing plan.

Hawaii has only two providers HMSA (BCBS) and Kaiser. Our rates are pretty reasonable compared to what others are paying in other states. I have been looking for things that the ACA covered that my existing one didn't cover and I really couldn't find any I needed. I don't care about maternity benefits, birth control, Viagra etc. My existing plan had better mental health benefits, (useful after we tear our hair out trying to figure everything out.). For everything else the existing plan was even cheaper.

I compared my existing plan to a ACA Platinum plan with Kaiser which cost $406 month ($28/month more.) The Platinum plan had cheaper tests and X-ray, maternity benefits, and drug plan which was $5 or $10 for drugs and Dr visits were $10. But for every thing else my existing plan had lower co pays and max out of pocket of $3,000 vs $4,000 for the platinum.

All I conclude is that maternity benefits and drug benefits are quite expensive.
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Old 11-07-2013, 09:29 AM   #25
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How is this advice? He said that he didn't need the government site, not that no one might need it.

Ha
Agreed. However, I still thought some mention of subsidy would be appropriate in an article focused on total net HC costs. I suspect that next yr we will be reading sad tales of folks paying full HI premiums for plans outside Exchange who otherwise would have been eligible for significant subsidy.

And bamsphd is right that HI/Exchange situation in NC is not same as other states. Last time I checked, for my state info on private HI insurance sites & Exchange (I did get through!) were not always showing same details for specific Exchange Plans (e.g. same name & premium but not same deductible/OOPmax). I suspect (& hope!) both Exchange & private sites are being regularly updated during this initial roll out.
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Old 11-08-2013, 08:19 AM   #26
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Another post regarding the cost of doctor visits under the ACA:

http://theretirementcafe.blogspot.com

I got his name wrong: it's actually Dirk Cotton.
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Old 11-08-2013, 10:44 AM   #27
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Originally Posted by Tandemlovers View Post
Another post regarding the cost of doctor visits under the ACA:

The Retirement Cafe

I got his name wrong: it's actually Dirk Cotton.
That article was even more apropos. I think this graph summarizes the true annual costs very well. This is for a NC family plan:



The premiums you save can be used to pay medical costs directly when you need to. And high deductible HSA eligible plans might save you even more in taxes.
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