ACA : Silver plan with CSR or Bronze with HSA

[retire-early]

For this year, I had a silver plan which was also eligible for a HSA.

For 2022, no silver plan in my state's insurance marketplace has HSA.

I can either enroll in a silver plan with cost-sharing reductions or in a bronze plan with HSA eligibility.

In both cases I pay about similar premiums.

The website is estimating $600 silver vs $1300 bronze in out-of-pocket expenses.

Which would you choose?

 

[badatmath]

Okay, so I am not very bright. Why would you want the bronze? What happens to the HSA money when you change plans?

 

[retire-early]

HSA is not tied to a plan nor a health insurance company.
It's like an IRA in that respect.
Once the plan I am on is not eligible, I cannot contribute any longer.

 

[Aerides]

Everyone has different priorities for the plans they pick. For me, my list includes the following:

Is the plan EPO/PPO, not HMO, is there out of network coverage if I need it
Is my Primary Doc and preferred hospital included
Is my (insert specialist you really value) included
Is the premium decent
Is the total OOP and deductible decent
Is it HSA eligible (if no, does the price outweigh the loss of the tax savings)
Is is a provider I have actually heard of before this year

I don't care from bronze/silver/gold, I care about the details. Getting a match for all of the above significantly reduces my options.

 

[retire-early]

The premiums are comparable.
There is no out-of-network with either plan.
The main difference is a $6000 vs $400 deductible.

 

[SecondCor521]

I personally assign some value to the ability to do an HSA contribution, because it lets me do more Roth conversions.

But if I didn't care about that and the premiums were comparable, then I'd go with the lower deductible (which I'm assuming is the Silver CSR).

 

[pb4uski]

For this year, I had a silver plan which was also eligible for a HSA.



For 2022, no silver plan in my state's insurance marketplace has HSA.



I can either enroll in a silver plan with cost-sharing reductions or in a bronze plan with HSA eligibility.



In both cases I pay about similar premiums.



The website is estimating $600 silver vs $1300 bronze in out-of-pocket expenses.



Which would you choose?

It sounds like it boils down to paying more in deductibles and co-pays for a HSA... with a range of $0 to $6,000 and an expected value of $700 difference in deductibles and co-pays.

While I really like HSAs and the ability to do more in Roth conversions, I wouldn't pay $700 for it so I'd go with the silver plan.

 

[RunningBum]

An HSA is worth your contribution * (state tax% + fed tax% + at least 8.5% for subsidy).

The premiums are comparable.
There is no out-of-network with either plan.
The main difference is a $6000 vs $400 deductible.

That $400 deductible would probably send me to the silver plan. I know that they ask you want level of care you expect, but I pretty much ignore that and figure out what each plan will cost me at each level. For you, the bronze would be better at $0 and very low amounts because of the HSA. At maybe around $2000 the silver is better with the low deductible and whatever else cost savings reductions gives you. With those CSRs the silver may be best even after the bronze deductible is met. I look at max OOP for worst case too.

 

[retire-early]

If I go in and select High usage of the insurance versus Low usage,
my maximum out-of-pocket expenses is $2000 with the Silver with CSR versus $7050 with the Bronze with HSA.
The deductible is $1000 vs $6000.


If I am as lucky healthwise as this year, then the Bronze plan makes sense.
If am not as lucky, then the Silver plan makes sense.

This is like trying to predict the stock market.

 

[ShokWaveRider]

I find one cannot make a HC decision based on what one's health was for a given year. One could get a disease, get hit by a car, or other random occurrence that adversely affects one's health for a long time. one just does not know.

So Bronze is out, Silver wins because of the subsidies currently for DW who is only 62. Unfortunately premiums TRIPLED in cost for 2022 and that is with the best subsidy available. Funny as in mid year 2021 premiums halved. No logic, I thought there was some kind of ACA adjustments that would have reduced premiums. Go Figure.

 

[PaunchyPirate]

I find one cannot make a HC decision based on what one's health was for a given year. One could get a disease, get hit by a car, or other random occurrence that adversely affects one's health for a long time. one just does not know.

So Bronze is out, Silver wins because of the subsidies currently for DW who is only 62. Unfortunately premiums TRIPLED in cost for 2022 and that is with the best subsidy available. Funny as in mid year 2021 premiums halved. No logic, I thought there was some kind of ACA adjustments that would have reduced premiums. Go Figure.

I would double and triple check your work. This doesn't seem to make sense unless there is a real healthcare fiasco going on in your geographic area.

 

[ShokWaveRider]

I would double and triple check your work. This doesn't seem to make sense unless there is a real healthcare fiasco going on in your geographic area.

Trust me, It has been triple checked. Not just by me, I use a trusted healthcare broker every year. There is no way round it.

 

[Aerides]

^
I'm in FL, same as SWR. My same plan was chopped from ~400 to ~100 with the ACA/ARP changes earlier this year, but for 2022, despite the ARP still being in effect it's going to be ~250. Not quite triple, but enough. We are using the same income estimate for 22 as 21.

And we are looking at a better plan for next year. I'm perfectly happy with our plan but based on a situation DH found this year, we'd like an expanded choice of some providers, which means a plan around ~700 per month... still Bronze still HighD. We found out the hard way our closest and best hospital is Not in our current network. Adding it while keeping other providers is proving to be a challenge...168 plans down to 6.

DH is not happy with that choice, but I'm leaning towards biting the bullet for one year as this would mitigate a recurrence risk, then going back to our old plan for 2023.

That's the thing to keep in mind. No matter what you pick, you're only locked in for a year. If you don't get it right it's not forever!

 

[PaunchyPirate]

Trust me, It has been triple checked. Not just by me, I use a trusted healthcare broker every year. There is no way round it.

So what changed? The underlying price of your current plan tripled (forgetting any calculations of income or subsidy)? Or your income changed so that a subsidy drastically changed? Of course some of the increase is because you aged a year.

In Pennsylvania, the average rate increase if like 3% this year for same-age policy comparison.

 

[PaunchyPirate]

^
I'm in FL, same as SWR. My same plan was chopped from ~400 to ~100 with the ACA/ARP changes earlier this year, but for 2022, despite the ARP still being in effect it's going to be ~250. Not quite triple, but enough.

And we are looking at a better plan for next year. I'm perfectly happy with our plan but based on a situation DH found this year, we'd like an expanded choice of some providers, which means a plan around ~700 per month... still Bronze still HighD. We found out the hard way our closest and best hospital is Not in our current network. Adding it while keeping other providers is proving to be a challenge...168 plans down to 6.

DH is not happy with that choice, but I'm leaning towards biting the bullet for one year as this would mitigate a recurrence risk, then going back to our old plan for 2023.

That's the thing to keep in mind. No matter what you pick, you're only locked in for a year. If you don't get it right it's not forever!

Keep in mind that what most states did (and healthcare.gov?) for 2021 was retroactively credit subsidies back to January even though the legislation passed in what, May? Most exchanges didn't get their ARP software calculations update done until June or July. So they lumped all of the January thru June subsidy increase into the second half of the year. This gave a somewhat false illusion as to how large the ARP legislation impacted you personally. It doubled up your subsidy for 6 months or so. January 2022 you are back to regular ARP-influenced subsidy reductions.

 

[SecondCor521]

Keep in mind that what most states did (and healthcare.gov?) for 2021 was retroactively credit subsidies back to January even though the legislation passed in what, May? Most exchanges didn't get their ARP software calculations update done until June or July. So they lumped all of the January thru June subsidy increase into the second half of the year. This gave a somewhat false illusion as to how large the ARP legislation impacted you personally. It doubled up your subsidy for 6 months or so. January 2022 you are back to regular ARP-influenced subsidy reductions.

ARP passed in March. My state exchange said they'd recalculate in April, to take effect in May, but in my individual case they only adjusted it in September. But from the looks of it, they didn't try to double up as you describe - they just recalculated the new higher subsidy from that point forward. I guess they figured people would get the January through whenever month extra back in their tax refund.

For me, 2021 was a premium of $509 and a subsidy that varied from $660 to $308 to $319. For 2022, the premium went up to $541 and the subsidy coincidentally is also $541. Same Bronze HSA plan.

 

[PaunchyPirate]

ARP passed in March. My state exchange said they'd recalculate in April, to take effect in May, but in my individual case they only adjusted it in September. But from the looks of it, they didn't try to double up as you describe - they just recalculated the new higher subsidy from that point forward. I guess they figured people would get the January through whenever month extra back in their tax refund.

For me, 2021 was a premium of $509 and a subsidy that varied from $660 to $308 to $319. For 2022, the premium went up to $541 and the subsidy coincidentally is also $541. Same Bronze HSA plan.

In Pennsylvania, I was able to manually lower my premium for June by resubmitting my application and forcing the subsidy to be recalculated with the ARP higher subsidy. For July, they had figured out how to automatically calculate everyone’s subsidy plus they figured out how to add in the retroactive amount from January into the rest of year subsidy. So in theory, I shouldn’t be expecting any subsidy over/under at tax time unless I didn’t accurately estimate my income.

For me, 2021 was a premium of $899 and a subsidy that went from $575 to $680 and then to $787.

Good job on your 2022 premium. I’m guessing a significant portion of the premium increase is due to you being a year older. So not a huge increase really.

 

[RunningBum]

Unfortunately premiums TRIPLED in cost for 2022 and that is with the best subsidy available. Funny as in mid year 2021 premiums halved. No logic, I thought there was some kind of ACA adjustments that would have reduced premiums. Go Figure.

Is it the actual premium that tripled, or your subsidized amount? Those are two very different things if you are getting a subsidy. It could mean your payment tripled from $10 to $30 per month but the actual premium increase was trivial.

The ACA subsidy is based entirely on that SLCSP, your income, and the family size. I'm not sure what other kind of adjustment you are expecting.

 

[ShokWaveRider]

Is it the actual premium that tripled, or your subsidized amount? Those are two very different things if you are getting a subsidy. It could mean your payment tripled from $10 to $30 per month but the actual premium increase was trivial.

The ACA subsidy is based entirely on that SLCSP, your income, and the family size. I'm not sure what other kind of adjustment you are expecting.

Premium.

 

[RunningBum]

Premium.

Ouch. Mine doubled the second or third year of ACA. I wound up switching to a different provider that was the old rate, even though they didn't have my doctors. I figured going out of network a few times wouldn't cost as much as the premiums did. I was lucky to have that option.

 

[ShokWaveRider]

Ouch. Mine doubled the second or third year of ACA. I wound up switching to a different provider that was the old rate, even though they didn't have my doctors. I figured going out of network a few times wouldn't cost as much as the premiums did. I was lucky to have that option.

I guess we should thank heaven for small Mercies. DW's Premiums have been basically $0 for the last 3 years, last year it was $62 per month which was reduced to $32pm when one of the last pandemic bills was passed in 2021. (Approx. 3 x 62) It will be $185 pm. in 2022. So I guess we should not complain.

Also with DW's Florida Blue plan she participates in their "Better You Strides" rewards program, that earns $$ Credits towards Premium reductions. This year she earned ~$500 or $600 and still has some left that she will get bac at the end of the year in a Visa Gift card.

So all good really.

 

[retire-early]

I went ahead and cancelled the coverage for the2022 version of my current silver plan and went with another silver plan.
It was odd that the button said Cancel Coverage instead of Change Coverage.
It confused me and gave me pause.
I am not sure what is going to happen with income verification.
I uploaded my 2020 Federal 1040 form.

 

[qwerty3656]

For this year, I had a silver plan which was also eligible for a HSA.

For 2022, no silver plan in my state's insurance marketplace has HSA.

I can either enroll in a silver plan with cost-sharing reductions or in a bronze plan with HSA eligibility.

In both cases I pay about similar premiums.

The website is estimating $600 silver vs $1300 bronze in out-of-pocket expenses.

Which would you choose?

I'm finding the same thing - no Silver that is HSA eligible. Any idea why this is? It's really frustrating

 

[SecondCor521]

I'm finding the same thing - no Silver that is HSA eligible. Any idea why this is? It's really frustrating

In order to be HSA eligible, it has to meet the requirements of an HDHP. An HDHP usually means that, except for a few things like preventive exams, everything must be OOP up to a fairly high deductible.

With Silver plans, especially ones with CSRs, I think they typically cover doctor visits and other things with a copay or coinsurance. Silver plans with CSRs typically have very low deductibles.

The two different types of plans simply have conflicting requirements. The reasons for why that is so, in turn, I think are rooted in political differences, so I won't go there.