ACA Plan Choice - What am I missing?

[Willers]

I need your collective wisdom on this one.

I'm RE'ing soon and have been spending quite a bit of time looking at ACA plans. Given my assumption that I won't qualify for cost sharing (requires a silver plan) it appears that the best deal is always the lowest cost bronze plan.

With the set out-of-pocket maximums it seems that getting a more expensive plan to lower deductibles/copays is like prepaying on a benefit that you may or may not need.

I can't seem to come up with a scenario where anything else is less expensive.

I feel like I have to be missing something really obvious. Help!

 

[MichaelB]

I feel like I have to be missing something really obvious. Help!

You're not missing a thing. Here's a spreadsheet (link) that Anamorph built that helps you compare the total cost of a policy, including premiums, deductibles and all cost sharing. I've used it for exactly this purpose and found it very helpful.

So far I have found lots of differences between the total cost of the policies, and the HSA policies have the total lowest cost, but that is specific to my zip code.

 

[walkinwood]

I agree with MichaelB and also use a Bronze HSA plan.
Your choice may change you have a chronic condition that needs expensive or frequent treatment. The spreadsheet should help you make that decision.

 

[MichaelB]

Your choice may change you have a chronic condition that needs expensive or frequent treatment. The spreadsheet should help you make that decision.

Excellent point about the chronic conditions, one that should always be repeated, especially if one needs prescription medicine. The ACA standardizes coverage but insurers have different drug forumlaries, and the differences in specific drugs covered can mean thousands of $$ in higher costs not covered by insurance. (edit to add the part initalics)

 

[Sue J]

I feel the same way that you do about Bronze plans vs Silver. Take a look at your worse case scenario. That would be your 12 months of premiums plus your Max Out Of Pocket. In our situation the Bronze HDHP with HSA makes the most sense because you are not prepaying for care you might not need but if you do need it you are protected by the MOOP.

When I've compared the worse case scenario for this year and last year the only ones better than our Bronze HDHP with the HSA were very high cost Silver or even Gold plans. But I would never consider those due to the high monthly premiums even though in a worse case scenario the coverage is much better. I'm willing to take the chance that I won't have the worse case scenario every year (although I did in 2014 and reached MOOP). This turned out to be a $1500 difference.

Now that we've been using the ACA for 2 years and looking toward our options for 2016 I've found that we look at premium price and the network coverage as the most important. Picking an HDHP with an HSA makes a HUGE difference to us because I shop for coverage based on the pre HSA income and then if we choose an HSA eligible plan and fully fund it (lowering our ACA MAGI income) we get a nice tax refund and also a credit of a good portion of our ACA premiums. This is because out ACA MAGI is smaller than on our application which results in a higher subsidy than we had all year. I could use the after HSA income to shop for a plan but I'd rather be conservative in my estimated income just in case we end up not funding the HSA to the max.

Lots to consider.

 

[Ian S]

While cost-sharing applies only to silver plans, of course, premium subsidies can be applied to any plan, bronze, silver, gold or platinum. I agree with Sue J that network coverage is one of the most important factors to consider and AFAIK, it's not part of how the plans are graded. With a limited network, you run a greater risk of being stuck with out of network charges and "balance billing" that may not be considered in calculating your MOOP costs. Here's an example of a balance billing horror story: Gilbert Hospital complaints mount as $13,000 bill stuns customer

 

[Sue J]

Be extra careful in researching the network.

For 2015 we had a choice between 2 plans from the same insurer that looked identical, except for one letter in the plan name. The price for one was about half of the other. The coverage, deductible and MOOP were the same. The difference was a narrower network. The hospital in our neighborhood was out of network but a hospital in the same system in the city 15 minutes away was in-network. A nearby blood lab was out of network but the one around the corner was in network (and cheaper "allowed amounts" too!).

The narrower network worked out just fine for us, they had everything we needed.

 

[pixelville]

If you are somewhat Excel savvy, you can also try to use this health insurance comparison model that takes into account taxes, HSAs and different spend levels.
http://www.early-retirement.org/forums/f38/fyi-health-insurance-options-comparison-model-74215.html

 

[Willers]

Thanks everyone. I didn't really consider that the coverage specifics would be that different. I expected that it was more about % of prepay and simplicity. That was the piece I was missing.

I'll check out the sheets referenced/linked to see what is best.

 

[Texas Proud]

The monthly difference between the low cost bronze plan and low cost silver was about $500 per month.... so as long as only one person hits max OOP, I am at break even with the bronze...


I am betting that the bronze cost will go up big time again this year... up 40ish% from last year to this (also going from PPO to HMO) and I am guessing another 20% this coming year...


I guess I could put this in the pet peeve... my listed PCP had moved over a year ago... just signed with her this year... and the network STILL has her listed in my city... looked for another and NONE came up taking new patients... lucky for me the group that my PCP was in was willing to take us... went to new PCP and am very happy with the doc....

 

[rbmrtn]

Here's a link I posted in another thread some time ago when this subject came up. I thought it had a good summary of making the case for bronze. I also went bronze using this info and the spreadsheet mentioned earlier

Bronze May Be the Most Precious Metal Under Obamacare | Hull Financial Planning

 

[gauss]

An additional thing that I look at with this is the following.

Related to, but separate from, the network coverage issue is the dominance in the market of the insurer relative to the providers. If you have a dominant insurer in your market and all other things equal, I would consider going with them in the fact that I would expect them to negotiate lower rates from the providers.

This information is difficult to get to, given that I believe it is proprietary, but if you are already a customer of an insurer you can likely check on their standard (negotiated) costs of procedures by phone in advance or after the fact by viewing on the insurance provided EOB statement.

I have done this and compared the negotiated costs to that found on healthcarebluebook.com to confirm that my dominant insurer was negotiating fair prices from the patients point of view.

-gauss

 

[AnIntentionalRoad]

We had a bronze plan our first year of ACA and had lots of issues finding providers in-network. Then, some of our providers who were in-network when we signed up in December stopped taking the bronze plan by April, leaving us to find new providers or pay more.

We live in an affluent Chicago suburb, not in a rural area.

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