An actual reporting

[Mulligan]

My spreadsheet software couldn't import Animorph's formulas, so I created my own - a different design. I analyzed total cost for the following medical expense scenarios: Essential visits only (free), 4 doctors visits beyond essential, $4000 med bills, $6500 (hits max OOP right away in some plans), $10000, $15000, $20000. For our scenarios, the Bronze were the winners by far in the lower billing cases, and in the highest expense scenarios were only more expensive by a few hundred dollars, even compared to a Silver plan with half the deductible.

Another reason for me to feel fortunate that I have no health issues and on no meds, The strategy will be easy for me. Find the lowest cost crappiest network Bronze HSA
Plan I can find. Then remember to change plans if the situation ever warrants.

 

[Rpharmer]

Eureka! I finally got signed up on Healthcare.gov this morning. I started a totally new application with new email, password, etc. I have an HSA policy with Blue Cross of NC (the only real insurance company option in North Carolina.) My 2013 plan with a $5000 deductible was $240. This plan is being terminated and the closest 2014 plan was an HSA plan with a $5500 deductible and a premium if $552. On the exchange I am getting the same plan (Bronze) for $165. Eureka!!!

Congratulations! Very glad for you, and I hope we read of many more success stories in the coming weeks.

 

[Hamlet]

sheesh1, are you saying that your premiums for two 58 year olds combined are currently $709/month?

That seems amazingly cheap, even for two people with perfect underwriting. It makes me wonder if there is some fine print in your existing policies that would limit their effectiveness as insurance.

There are an awful lot of insurance policies out there that don't actually provide much insurance when push comes to shove.

We are both 58 years old, have separate individual policies, no access to employer sponsored care and do not qualify for a subsidy. I have a one year extention on old plan. My husband does not.

2013 Anthem BC/BS Premier Plan. Both of our plans have $3,500 deductibles, 0% coinsurance.
Premiums for both= $709/mth = $8,508/yr.
Deductible x2 = $7,000

2014 Anthem BC/BS (Old Premier for me, Silver for husband)
Premiums for both = $12,888/yr
Deductibles x2 = $9,500

2015 Projected
Premiums for both = $16,440/yr (Both Silver)
Deductibles = $12,000

The prices for us are the same on or off exchange. Anthem in Virginia is making them the same. Not sure what we will do, meaning don't know if we will go to Bronze or join a self pay system that has waivers. Am thinking about that but it is so foreign to me, so not sure it has the comfort level I need.
Not sure why our premiums are so high unless it is because we have crossed the 55 year old break. Neither of us have any pre-existing condition that kept us from underwriting before.

 

[Rpharmer]

Another reason for me to feel fortunate that I have no health issues and on no meds, The strategy will be easy for me. Find the lowest cost crappiest network Bronze HSA
Plan I can find. Then remember to change plans if the situation ever warrants.

Yes. I guess it will be prudent to become especially vigilant about our health status as each open enrollment period approaches.

I wonder about the so-called "young invincibles" who think that they'll be able to enroll anytime, or even after the fact (like, on their smartphone in the ambulance.) Hopefully their parents or grandparents are visiting this site! Good topic for Thanksgiving (or not...)

 

[gozer]

Since I was planning for retirement, I did price out plans for purchase from eHealthInsurance in 2013, even though I actually had company subsidized coverage. I had two options I was considering. One was 600/month and the other was 325/month. The difference was deductible and max out of pocket. The silver ACA plan I am considering for next year will cost me about 900/month without subsidies. If subsidies survive the legal challenges, I will actually only pay around 150/month.

The ACA plan I am looking at has lower deductibles and max out of pocket than even my current work subsidized policy. While it does have coverage I don't actually need, I understand the reasons for this.

 

[audreyh1]

Here is the analysis for myself. The plans are chosen from the ones available in my county in TX. The plans are available off exchange - though most are also available on. I didn't analyze HMO plans or Gold plans. The quotes are directly from each insurer for a female non-smoker, age 54 (turning 55 in 2014).

Green means lowest/best under a scenario. Yellow is next best value.

This is a PDF of my personal analysis. I can upload an export to Excel format if someone wants it - hopefully it exports without screwing up formulas.

Notice the line "Total Medical Expenses before reaching Max OOP". I thought this was an interesting differentiator between plans. It only considers medical bills (not premiums - that is included in the "my total cost" analysis below)

You have to be very careful with the formulas. It took a long time for me to get the computation straight for My Total Annual Cost for each scenario. NOTE: My Total Annual Cost does not subtract any potential tax savings from an HSA.

For me - I am only penalized a few hundred dollars for choosing a Bronze plan compared to the others, even when my medical expenses are very high.

 

[modhatter]

Since I was planning for retirement, I did price out plans for purchase from eHealthInsurance in 2013, even though I actually had company subsidized coverage. I had two options I was considering. One was 600/month and the other was 325/month. The difference was deductible and max out of pocket. The silver ACA plan I am considering for next year will cost me about 900/month without subsidies. If subsidies survive the legal challenges, I will actually only pay around 150/month.

The ACA plan I am looking at has lower deductibles and max out of pocket than even my current work subsidized policy. While it does have coverage I don't actually need, I understand the reasons for this.

Wow, that is one big subsidy.

2013 Anthem BC/BS Premier Plan. Both of our plans have $3,500 deductibles, 0% coinsurance.
Premiums for both= $709/mth = $8,508/yr.
Deductible x2 = $7,000

2014 Anthem BC/BS (Old Premier for me, Silver for husband)
Premiums for both = $12,888/yr
Deductibles x2 = $9,500

That is a very low premium for 2013. I paid about $550 a mo 7 yrs ago for a crummy HMO policy.

 

[gozer]

Wow, that is one big subsidy.

That is a very low premium for 2013. I paid about $550 a mo 7 yrs ago for a crummy HMO policy.

For the next six years I live off returned principle with some capital gains and dividends. While I will spend about 60-70K per year, the part of that that which is some kind of income is only 15-25K depending on which investments I sell and how much I just pull from cash. So I am skirting the low limit for subsidies. I will sometimes have to sell more than I need, just to keep my income above the thresholds for the subsidies.

The plans I was looking at before ACA were very high max out of pocket plans. I live in Ohio, our insurance used to be much lower than most. Maybe it still is. We were not required to carry things we didn't need, but many states seemed to already mandate certain things even before ACA. My wife and I are still under 50 years old which may play into the cost. I suspect you live in a higher cost state.

 

[sheehs1]

sheesh1, are you saying that your premiums for two 58 year olds combined are currently $709/month?

That seems amazingly cheap, even for two people with perfect underwriting. It makes me wonder if there is some fine print in your existing policies that would limit their effectiveness as insurance.

There are an awful lot of insurance policies out there that don't actually provide much insurance when push comes to shove.

Hamlet....yes 2013 premiums for both of us are/were $709/month. However, mine has since gone up since my renewal was Sept. 2013. For simplicity sake I put that increase in 2014.

The policies were Anthem Premier which was/is the top of the line private plan (non employer sponsored) that I could purchase at the time. Keep in mind....we BOTH carried $3,500 deductibles. Perhaps, that is why they are not as expensive as you might think they they should be considering our age group.

We also both have/had a health status of 1.
Also, there was no maternity, pediatric or children on this policy.
I can't remember if I excluded other services.
This did include dental but it was only $1,000 coverage. Often thought about dropping it.

I don't consider $8K in premiums before you set foot in a doctor's office cheap.
They both carried a 5 million lifetime cap (each).

I have had Anthem policies since I got out of college either thru my employer or private. Never had a problem with them and they always covered what they said they would. They are the major player in my state.

Edit: Our old plans were not HMO plans. They were PCP and I could go to any doctor I wanted.

 

[pb4uski]

We will probably end up with a silver plan even though I would have bet against that a month ago. I expected the higher deductible bronze to always be the best case, but after running the numbers through Animorph's spreadsheet I was surprised that the cost differences did not follow that closely. Among the plans I compared the best silver is better (total less cost) than the best bronze in most cases. It is only more expensive when there is no use at all, and then only by a small amount.

I'm finding that the bronze plan is better. My provider has a find you plan tool where you input some generic information on your situation and it provides estimates of minimum, expected and maximum costs. The minimum is premiums only, expected increases based on your answer as to whether you expect any major medical events, and max is the sum of premium and max OOP. You can also input your expected number of primary and specialist visits for the year and the number of prescriptions you are on. I found it useful and for us it looks like bronze has the lowest expected cost.

Do other providers have similar tools? Are there any big gaps between this tool and Animorph's spreadsheet?

BCBSVT

 

[ziggy29]

Ours is a complicated situation, but...

How did your premium and coverage changes with the new law.

1. What kind of deductible you had in 2013 and for how many.
3. What is your new deductible for 2014
4. What was the cost of your plan in 2013
5. What is the cost of your new plan in 2014
6. If you were getting a subsidy, and if your 2014 premium reflects the
subsidy.

What, no #2?

Anyway:

1) Started 2013 with a Megacorp plan with a $2,500 "employee plus spouse" combined deductible and $5,000 OOP maximum. (It was also an HSA-eligible plan and Megacorp contributed $1,000 a year to my HSA.) When I was laid off I took a short-term plan through BCBS to get me to the end of 2013; it had a $3000 combined deductible.

3) DW is being covered by our church (her employer) in 2014 with their equivalent of a "Gold" plan with a $1,000 deductible. I should be eligible for $0 deductible on a Bronze PPO plan through the Exchange because of my American Indian status, but that aspect of the system "no worky" yet -- so until then it will show up as a $6,000 deductible (but I should have no deductibles or copays when they fix this thing).

4) I paid about $90 a month for the Megacorp coverage and $320 for the short-term BCBS policy. COBRA would have been nearly $970 a month, so we passed on it since the old rules about "creditable coverage" for avoiding preexisting condition exclusions no longer applied by the time the short-term policy expired on 1/1/2014. That made taking COBRA -- once a necessary step for 18 months in order to get individual coverage without those exclusions -- a sucker's deal.

5) We are (directly) paying none of the premium for DW; the church is footing the full bill (about $510, which includes dental and a few other benefits). My plan -- the one I think I'll be taking -- is $273 before the subsidy. It *may* be better for us next year to ask that they not cover her at all and gross up her pay so we can both go on the Exchange, but we'll start looking at that around September of next year. For now, we just got her covered and we're waiting for the system to be stabilized before looking at adding her as well.

6) My share of the cost of my plan should be around $115 per month after applying the tax credit. (I could actually get the HMO plan for less than $50 but I want nothing to do with their limited selection of providers and need to use the GP as a "gatekeeper" to the specialists.)

The implementation of ACA has been a nightmare in many ways, but when all is said and done, it is going to make it a LOT easier for me to stay semi-retired.

 

[sheehs1]

Wow, that is one big subsidy.



That is a very low premium for 2013. I paid about $550 a mo 7 yrs ago for a crummy HMO policy.

We could have paid close to that each also. We increased our deductibles which helped.

 

[rbmrtn]

I just mention this, because I suspect that the huge number of folks, like me, transferring from a risk pool to the new ACA system, include many generally healthy folks with limited medical expenses. As a group, we won't necessarily drive up the expenses.

+1 on everything you said. I know a number of folks with no conditions, no prescriptions and rarely use medical services forced into the hi risk pool. You can be rejected for anything and everything they want to use. I wonder if these are the masses of desperately sick they think are going to come crawling to the exchange.

 

[clifp]

My spreadsheet software couldn't import Animorph's formulas, so I created my own - a different design.

I analyzed total cost for the following medical expense scenarios:
Essential visits only (free), 4 doctors visits beyond essential, $4000 med bills, $6500 (hits max OOP right away in some plans), $10000, $15000, $20000.

For our scenarios, the Bronze were the winners by far in the lower billing cases, and in the highest expense scenarios were only more expensive by a few hundred dollars, even compared to a Silver plan with half the deductible.

For me the bronze ACA plan was the best also. I have never spent more than $500 in a year on medical care (beyond premiums) in my life, and while that will undoubtedly change. I don't have clue when it will. The $ saved from the premium I figure will add up to more than modest saving that a silver or gold ACA plan would provide if I got modestly sick.Since the OOP is the same for all plans the bronze is cheaper if you get really ill..

On the other hand my grandfather plan is significantly better than any ACA plan. Is it worth the extra $1,500/year probably not but the sheer hassles of dealing with exchange is making think; screw it, I'll stick with the existing plan.

I am curious is there any mechanism to prevent people from starting with a bronze plan and then upgrading to better plan if they develop a chronic condition?

 

[ziggy29]

I am curious is there any mechanism to prevent people from starting with a bronze plan and then upgrading to better plan if they develop a chronic condition?

No, but most folks can't do this until the next open enrollment period. (When it's working properly, American Indians and Alaskan Natives should be able to change monthly. That and the no cost-sharing under 300% of FPL provisions are related to treaty obligations for Indian health care, as I understand it.)

 

[audreyh1]

For me the bronze ACA plan was the best also. I have never spent more than $500 in a year on medical care (beyond premiums) in my life, and while that will undoubtedly change. I don't have clue when it will. The $ saved from the premium I figure will add up to more than modest saving that a silver or gold ACA plan would provide if I got modestly sick.Since the OOP is the same for all plans the bronze is cheaper if you get really ill..

On the other hand my grandfather plan is significantly better than any ACA plan. Is it worth the extra $1,500/year probably not but the sheer hassles of dealing with exchange is making think; screw it, I'll stick with the existing plan.

I am curious is there any mechanism to prevent people from starting with a bronze plan and then upgrading to better plan if they develop a chronic condition?

Even with my options, for high medical expense cases, the total cost of bronze plans ended up costing less than $300 more annually compared to a more comprehensive, low-deductible silver plan. So for TX, at least, I'm not seeing the financial incentive to pay higher premiums.

There will be open enrollment every end-of-year period, so people can "upgrade" or switch plans if there is a financial benefit.

But, IMO, you will probably just be trading premiums for expenses in these plans. The lower deductible, lower co-pay plans come with a much higher premium. Especially plans with a lower max OOP. As they probably should.

 

[audreyh1]

+1 on everything you said. I know a number of folks with no conditions, no prescriptions and rarely use medical services forced into the hi risk pool. You can be rejected for anything and everything they want to use. I wonder if these are the masses of desperately sick they think are going to come crawling to the exchange.

That's what I wonder.

 

[Mulligan]

That's what I wonder.

After reading various reasons why some people have been rejected, my definition of "unhealthy" must be a lot different than the insurers definition.

 

[audreyh1]

After reading various reasons why some people have been rejected, my definition of "unhealthy" must be a lot different than the insurers definition.

I think so. I have heard so many conditions that seemed so trivial. So many people who had no chronic disease or imminent operation or anything that really that needed treatment.

It was apparently just easier to tell people no.

I wonder in my case, since the insurer also managed the state risk pool, whether they had a motivation to push people into that instead. Who knows how profitable the risk pool may have been for them?

 

[clifp]

Well that seems like an easily exploited feature, for chronic diseases like diabetes or high blood pressure. Although to be fair people may have been able to upgrade existing policies with the same carriers before ACA.

 

[audreyh1]

Well that seems like an easily exploited feature, for chronic diseases like diabetes or high blood pressure. Although to be fair people may have been able to upgrade existing policies with the same carriers before ACA.

I see higher premiums with no or little break in the max OOPs for the higher metal plans, so it's not clear to me that the chronically ill folks will really save much by "upgrading".

 

[modhatter]

Years ago, I had a policy with BCBS. I had it for over 30 yrs. Then one day I was looking in the mirror, and noticed I had these lumps on ea. side of my upper neck just below my ears. Went to doctor who sent me to Oncologist, who scheduled me to have one node removed and biopsied.

Luckily it came back negative. The following year I got a notice from BCBS that my insurance was going from about $300 a month to $600 (rounded figures). I did not know why and they did not explain. Other than this incident, I had never had any claims except regular doctor visits etc. (Yearly check up, pap smears etc.)

The following year I got a notice from them it was going up to $900. I was about to cancel it after trying to get new insurance when I got a letter from them canceling my policy. (called rescission)

I wound up getting a new policy eventually (at a very high cost) but had to agree to an exclusion concerning cancer for six years. I had no choice so I did so. Thirteen years after my biopsy, I came down with Lymphoma. Luckily by then I had just gotten Medicare, so all was covered.

I'm only telling you this story to let you know what thin ice you can be on when you have an individual policy. That is why I am so thankful for the new laws interacted within the ACA. I am protected now because I have Medicare, but I still fretted for all those like me before ACA.

No one imagines this could happen to them. But if you hint of any kind of serious expensive illness, it could have been you too.

So if you are among those whose premium went up with the new ACA plan, I would say try and accept it because you don't know how much more you are really getting.

 

[rbmrtn]

I'm only telling you this story to let you know what thin ice you can be on when you have an individual policy. That is why I am so thankful for the new laws interacted within the ACA. I am protected now because I have Medicare, but I still fretted for all those like me before ACA.

Yes, all too common. You never really know if you have insurance until you try and use it.

 

[donheff]

I watched my nephew go thru a horror story like that Modhatter which is why I am a fan of the ACA. It is a seriously flawed law (I would prefer a single payer system covering all of us) but it is leagues above the capricious system we have been living with.

 

[Mulligan]

Years ago, I had a policy with BCBS. I had it for over 30 yrs. Then one day I was looking in the mirror, and noticed I had these lumps on ea. side of my upper neck just below my ears. Went to doctor who sent me to Oncologist, who scheduled me to have one node removed and biopsied. Luckily it came back negative. The following year I got a notice from BCBS that my insurance was going from about $300 a month to $600 (rounded figures). I did not know why and they did not explain. Other than this incident, I had never had any claims except regular doctor visits etc. (Yearly check up, pap smears etc.) The following year I got a notice from them it was going up to $900. I was about to cancel it after trying to get new insurance when I got a letter from them canceling my policy. (called rescission) I wound up getting a new policy eventually (at a very high cost) but had to agree to an exclusion concerning cancer for six years. I had no choice so I did so. Thirteen years after my biopsy, I came down with Lymphoma. Luckily by then I had just gotten Medicare, so all was covered. I'm only telling you this story to let you know what thin ice you can be on when you have an individual policy. That is why I am so thankful for the new laws interacted within the ACA. I am protected now because I have Medicare, but I still fretted for all those like me before ACA. No one imagines this could happen to them. But if you hint of any kind of serious expensive illness, it could have been you too. So if you are among those whose premium went up with the new ACA plan, I would say try and accept it because you don't know how much more you are really getting.

What a horrible experience Mod! I have never had a health issue to file a claim, but I have heard terrible stories like yours. I am curious as from what I understood even though you were in an individual policy, you are actually assigned to some type of subgroup in it. I was under the impression they could only raise your rates in the same manner as everyone else in your "group". And if you got cancelled, everyone else in that group,got cancelled also. Is that your understanding? Was your whole "group" cancelled or you individually? My terminology isn't strong, but I thought the rescission term was used individually because the insurer claimed a person lied on their health disclosure. Seems like 30 years would exempt you from that. I guess many of these companies just did what the heck they wanted to do to protect themselves instead of the customer. Of course each state may have different rules for these things.