Post your ACA Plan Summary PDF of Benefits for 2018

[ShokWaveRider]

We are in Northeast Florida, lots of docs and specialists here, no shortage at all. All our docs and then some are on the plan. TOOP is $2450.. Zero Premium Silver Plan Florida Blue 1443b.

One thing I should note. This was NOT available for Download on the HC.gov site. The one on the site did not reflect the actual benefits we received, just an overview. Our Agent got this one direct from Florida Blue and sent it to us.

Summary of Benefits attached.

 

[Terhathum123]

We are in Northeast Florida, lots of docs and specialists here, no shortage at all. All our docs and then some are on the plan. TOOP is $2450.. Zero Premium Silver Plan Florida Blue 1443b.

One thing I should note. This was NOT available for Download on the HC.gov site. The one on the site did not reflect the actual benefits we received, just an overview. Our Agent got this one direct from Florida Blue and sent it to us.

Summary of Benefits attached.

What is TOOP?

 

[ShokWaveRider]

What is TOOP?

"Total Out of Pocket"

 

[MichaelB]

We are in Northeast Florida, lots of docs and specialists here, no shortage at all. All our docs and then some are on the plan. TOOP is $2450.. Zero Premium Silver Plan Florida Blue 1443b.

One thing I should note. This was NOT available for Download on the HC.gov site. The one on the site did not reflect the actual benefits we received, just an overview. Our Agent got this one direct from Florida Blue and sent it to us.

Summary of Benefits attached.

Isn't the summary of benefits the same for all ACA compliant policies? The differences are in cost sharing, network and drug coverage.

 

[ShokWaveRider]

Isn't the summary of benefits the same for all ACA compliant policies? The differences are in cost sharing, network and drug coverage.

Not that I saw, the one that the HC.gov offered did not include the "0" deductible. that may be what you are saying. They may have been updated since, but when we applied the one I downloaded had a significant deductible.

 

[bobandsherry]

We are in Northeast Florida, lots of docs and specialists here, no shortage at all. All our docs and then some are on the plan. TOOP is $2450.. Zero Premium Silver Plan Florida Blue 1443b.

One thing I should note. This was NOT available for Download on the HC.gov site. The one on the site did not reflect the actual benefits we received, just an overview. Our Agent got this one direct from Florida Blue and sent it to us.

Summary of Benefits attached.

SWR and I were comparing plans, where SWR can get 1443B for $0/mo in NE FL, in Central FL the plan is $390/mo with same MAGI and ages. Almost pays to move Crazy that a residence being just a few hundred miles difference but still in same state would be so different. Could justify a move

 

[audreyh1]

Isn't the summary of benefits the same for all ACA compliant policies? The differences are in cost sharing, network and drug coverage.

Deductibles, copay % and max OOP will be different among plans. Also, some fixed dollar copays (for example: first three doctor's visits $30, etc.) and HSA eligibility will differ.

 

[MichaelB]

Deductibles, copay % and max OOP will be different among plans. Also, some fixed dollar copays (for example: first three doctor's visits $30, etc.) and HSA eligibility will differ.

Yes, that what I meant by "cost sharing".

Here's a good explanation of "Summary of Benefits and Coverage" (here). The template is standard, required by the DOL. For ACA compliant plans, coverage is mostly the same - almost identical for most plans. Differences are cost sharing, drug formulary, network.

 

[bobandsherry]

Yes, that what I meant by "cost sharing".

Here's a good explanation of "Summary of Benefits and Coverage" (here). The template is standard, required by the DOL. For ACA compliant plans, coverage is mostly the same - almost identical for most plans. Differences are cost sharing, drug formulary, network.

FYI - Link requires a login to view.

 

[MichaelB]

FYI - Link requires a login to view.

Yes. Here's another link to an ABA page on the Summary of Benefits https://www.americanbar.org/content...me/aba_health_law_esource_0712_patterson.html
A snippet:

Content and Form of the SBC
An SBC must describe, among other plan features, the following:

• the principal plan design features, including the cost sharing requirements (deductibles, coinsurance and copayments) for each category of benefit;
• exceptions, reductions and limitations on the coverage;
• renewability and continuation of coverage provisions (for example, under COBRA);23
• examples that illustrate the benefits that would be provided in certain common scenarios;
• if a provider network or prescription drug formulary is used, an Internet address (or similar contact information) for obtaining a list of network providers or information on prescription drug coverage; and
• uniform definitions of standard insurance and medical terms, along with an Internet address for obtaining a complete “uniform glossary” of key terms.

All "Bronze" plans have (mostly) the same coverage, and have an actuarial value of 60%, so the different combinations of deductible, co-pay, co-insurance, total OOP - and premiums - are designed to lead to the a similar total cost to the policyholder, on average. So many cost sharing combinations are confusing and create an image of choice that really isn't there. The real differences are in drugs and network, neither of which is included in the SCB.

As to pricing differences between counties (and states), they are impossible to explain, as there is no transparency in health care costs.