Which ACA metal level did you choose?

[Martha]

Bronze. No tax credit so it makes sense. In some places the cost of Silver plans are disproportionately high due to cuts in cost sharing subsidies by the government and decisions by some states to put the burden on the silver plans. In a few states gold is even cheaper than silver, if you don't get the tax credit.

 

[Texas Proud]

We've been using ACA plans since it started in 2014. Our MAGI income is just at 250% so we do not get any Cost Saving Reductions on a Silver plan. Those come into play for lower incomes and mean smaller co-pays and smaller deductibles and Max Out Of Pocket.

We always chose a Bronze plan, sometimes an HDHP with HSA if available. Except for 2017 when there was a Silver plan with decent office copays of $30-$45 and all of our Tier 1 Rxs were paid at 100%. The "free" Rxs and low copay on office visits made it worth it for the increased premium cost of about $100/mo for the 2 of us.

This year that Silver plan changed to us paying for Rxs and the premium cost jumped quite a lot so we went back to a bronze plan, a HDHP with HSA.

When I look at this every year I make a spreadsheet of our typical costs - 3 or 4 office visits each, 1 or 2 specialist visits (usually ophthalmology), 1 or 2 bloodwork panels each, all of our current Rxs and maybe just a guesstimate for $1000 of diagnostic something for each of us, because stuff happens. I look at previous costs and make a column of what this would cost with a Silver plan with office copays compared to a column of paying full "allowed amount" for that expense. Add in a years worth of premium payments for each plan and also look at the risk of paying Maximum out of Pocket for your options.

For us, the difference usually is the cost of office visits. With a Bronze plan we pay $105-$145 for an office visit. With a Silver Plan we would pay $30-$45. Everything else in both options would be in the deductible. And in our price range Bronze or Silver deductibles are in the $6000+ range.

If you have an HDHP with HSA available remember to consider that your ACA MAGI amount will be smaller after the HSA contribution so your subsidy will be larger and your premiums smaller. This can make a huge difference in your costs, so compare accurately.

Be sure to consider your worst case scenario of Maximum Out Of Pocket plus 12 premium payments.

One of the other reasons I went with Silver is that the more normally priced Bronze had restrictions of 2 or 3 office visits with copay... if you went more you paid 100% for that visit... silver with CSR does not have any limit...


The big problem with any of the ACA plans is that very few docs are taking them... and that included Gold.... IMO, the different levels only affect what you pay, not what they pay the doc... so if they do not take ACA BCBS it does not matter what metal level you choose...

 

[bingybear]

You'll have to run the numbers, but that may be the year to upgrade from bronze to silver, gold or platinum.

Yes, it is in the plans. I'm not sure how to evaluate the other metals vs just bronze with higher deductible as I don't know what is completely as this will be the first replacement. I expect that is a few years out... but don't have a solid idea of exactly how many.

 

[pb4uski]

I think you could use the spreadsheet that Michael posted in post 14 of this thread for the year you expect to so the replacement.

 

[Texas Proud]

Yes, it is in the plans. I'm not sure how to evaluate the other metals vs just bronze with higher deductible as I don't know what is completely as this will be the first replacement. I expect that is a few years out... but don't have a solid idea of exactly how many.

One of the things you have to look at is the deductible and max OOP... now the silver is much better option for me but the first couple of years the bronze was a much better option...


When you compared the premiums paid and max OOP, it would have been cheaper for any major medical problem with the bronze... IOW, the difference between the OOP max for silver and bronze was less than the higher premiums...

 

[bingybear]

One of the things you have to look at is the deductible and max OOP... now the silver is much better option for me but the first couple of years the bronze was a much better option...


When you compared the premiums paid and max OOP, it would have been cheaper for any major medical problem with the bronze... IOW, the difference between the OOP max for silver and bronze was less than the higher premiums...

If it just a mix of premiums and max OOP, then it will be easy. I will also consider the network.

When working (before ACA) the company came out with a HDHP in addition to the low deductible plans. Being engineers we analyzed the plans. We found the HDHP was better if you had little health expense or if you had a really bad year. In between there was a range where the low deductible plan was better.

I will check the all relevant plans assuming I catch the right year

 

[scrabbler1]

We've been using ACA plans since it started in 2014. Our MAGI income is just at 250% so we do not get any Cost Saving Reductions on a Silver plan. Those come into play for lower incomes and mean smaller co-pays and smaller deductibles and Max Out Of Pocket.

We always chose a Bronze plan, sometimes an HDHP with HSA if available. Except for 2017 when there was a Silver plan with decent office copays of $30-$45 and all of our Tier 1 Rxs were paid at 100%. The "free" Rxs and low copay on office visits made it worth it for the increased premium cost of about $100/mo for the 2 of us.

This year that Silver plan changed to us paying for Rxs and the premium cost jumped quite a lot so we went back to a bronze plan, a HDHP with HSA.

When I look at this every year I make a spreadsheet of our typical costs - 3 or 4 office visits each, 1 or 2 specialist visits (usually ophthalmology), 1 or 2 bloodwork panels each, all of our current Rxs and maybe just a guesstimate for $1000 of diagnostic something for each of us, because stuff happens. I look at previous costs and make a column of what this would cost with a Silver plan with office copays compared to a column of paying full "allowed amount" for that expense. Add in a years worth of premium payments for each plan and also look at the risk of paying Maximum out of Pocket for your options.

For us, the difference usually is the cost of office visits. With a Bronze plan we pay $105-$145 for an office visit. With a Silver Plan we would pay $30-$45. Everything else in both options would be in the deductible. And in our price range Bronze or Silver deductibles are in the $6000+ range.

If you have an HDHP with HSA available remember to consider that your ACA MAGI amount will be smaller after the HSA contribution so your subsidy will be larger and your premiums smaller. This can make a huge difference in your costs, so compare accurately.

Be sure to consider your worst case scenario of Maximum Out Of Pocket plus 12 premium payments.

I created a spreadsheet, too. It included copays, premiums, lab costs, and drug costs. Very useful.

 

[ivinsfan]

One of the other reasons I went with Silver is that the more normally priced Bronze had restrictions of 2 or 3 office visits with copay... if you went more you paid 100% for that visit... silver with CSR does not have any limit...


The big problem with any of the ACA plans is that very few docs are taking them... and that included Gold.... IMO, the different levels only affect what you pay, not what they pay the doc... so if they do not take ACA BCBS it does not matter what metal level you choose...

Could you elaborate on this comment? Do you mean you only have access to HMOs or PPOs that have a narrower network? An ACA policy is pretty much the same a regular insurance with the government paying part of your bill.

 

[Texas Proud]

Could you elaborate on this comment? Do you mean you only have access to HMOs or PPOs that have a narrower network? An ACA policy is pretty much the same a regular insurance with the government paying part of your bill.

No, an ACA policy is not pretty much the same insurance... it is a lot less...



Yes, there are only HMOs and PPOs in the ACA plans... but there are a good number of plans available to me as opposed to some other people... but IIRC maybe 4 providers...


I have used BCBS before and now have Molina... when you call a Dr to ask if they take your insurance they ask what kind of insurance you have... when you say BCBS marketplace they say they do not take it... even if they are listed on the website!!! Same with Molina... I just had to change our PCP and called dozens of docs that showed up on a search on my insurance website... many of the names were not available... some had left the group, some groups had disbanded and were reforming, some docs had left over a year ago!!! There were docs that were still there but said they were not taking any new patients from 'THAT' insurance company...



Now, the point I was making on my previous post is that none of the people asked which level of insurance I had, bronze, silver or gold... they just asked the name of the insurance...


BTW, when I had company plans I never had this problem... there were docs that took Humana and/or United Health but it was easy to find a doc.. their websites were more up to date...

 

[Mr._Graybeard]

Could you elaborate on this comment? Do you mean you only have access to HMOs or PPOs that have a narrower network? An ACA policy is pretty much the same a regular insurance with the government paying part of your bill.

The narrower network of the Marketplace plans took me by surprise in 2014. We opted for BCBS because its website showed a broad network of medical groups. When DW went to her PCP, though, she found that the network BCBS represented on its website was different from the network it provided Marketplace insureds. One of the two major suburban hospital networks in our area was not included. DW continued to see her preferred PCP, but we paid out of pocket for each visit (at the negotiated rate, at least).

We kept a close eye on who was in network and who wasn't after that.

 

[ivinsfan]

No, an ACA policy is not pretty much the same insurance... it is a lot less...



Yes, there are only HMOs and PPOs in the ACA plans... but there are a good number of plans available to me as opposed to some other people... but IIRC maybe 4 providers...


I have used BCBS before and now have Molina... when you call a Dr to ask if they take your insurance they ask what kind of insurance you have... when you say BCBS marketplace they say they do not take it... even if they are listed on the website!!! Same with Molina... I just had to change our PCP and called dozens of docs that showed up on a search on my insurance website... many of the names were not available... some had left the group, some groups had disbanded and were reforming, some docs had left over a year ago!!! There were docs that were still there but said they were not taking any new patients from 'THAT' insurance company...



Now, the point I was making on my previous post is that none of the people asked which level of insurance I had, bronze, silver or gold... they just asked the name of the insurance...


BTW, when I had company plans I never had this problem... there were docs that took Humana and/or United Health but it was easy to find a doc.. their websites were more up to date...

That sounds like an issue with the insurance company and their provider listings..we are rural and have run into narrower networks but that's on all plans not just the ACA marketplace plans.

Sorry though it sounds like a real pain to work with.

 

[ivinsfan]

The narrower network of the Marketplace plans took me by surprise in 2014. We opted for BCBS because its website showed a broad network of medical groups. When DW went to her PCP, though, she found that the network BCBS represented on its website was different from the network it provided Marketplace insureds. One of the two major suburban hospital networks in our area was not included. DW continued to see her preferred PCP, but we paid out of pocket for each visit (at the negotiated rate, at least).

We kept a close eye on who was in network and who wasn't after that.

Is this a state specific thing ? for example on MNSure.. Medica will sell individual plans only thru the state exchange so the subsidized and unsubsidized plans are identical.

 

[MichaelB]

There is no such distinction between ACA, employer provided plans, and individual plans available prior to the ACA. There are tens of thousands of different employer plans in the US, because most insurers design plan offerings specific to employers. Some have broad networks and others are very restricted. Over the past decade, insurer / employer plans became more restrictive as a way to offset rising costs.

The breadth and depth of an insurance network has nothing to do with the ACA. It is the preferred method insurers use to design and offer lower cost policies, because network design is opaque, very difficult to analyze and compare. Even now, there is no discussion of network design for employer plans, yet this is as much a problem for consumers. It is not possible to compare networks, even when looking at different policies from the same insurer, because insurers do not make that information public. They only have a tool to search for a service provider because it is required, and it usually is cumbersome.

Some insurers in some states offer limited network plans. BCBS Texas is a good example. Other insurers in other states offer the same broad network plans used by large groups. BCBS Florida is an example. This is not because of the ACA, it reflects the effort by the state insurance regulator to maximize options for consumers.

 

[ivinsfan]

There is no such distinction between ACA, employer provided plans, and individual plans available prior to the ACA. There are tens of thousands of different employer plans in the US, because most insurers design plan offerings specific to employers. Some have broad networks and others are very restricted. Over the past decade, insurer / employer plans became more restrictive as a way to offset rising costs.

The breadth and depth of an insurance network has nothing to do with the ACA. It is the preferred method insurers use to design and offer lower cost policies, because network design is opaque, very difficult to analyze and compare. Even now, there is no discussion of network design for employer plans, yet this is as much a problem for consumers. It is not possible to compare networks, even when looking at different policies from the same insurer, because insurers do not make that information public. They only have a tool to search for a service provider because it is required, and it usually is cumbersome.

Some insurers in some states offer limited network plans. BCBS Texas is a good example. Other insurers in other states offer the same broad network plans used by large groups. BCBS Florida is an example. This is not because of the ACA, it reflects the effort by the state insurance regulator to maximize options for consumers.

And of course due to open enrollment when they misrepresent their network you are stuck on the plan for an entire year... Hum, makes you wonder if the bad information is deliberate.

 

[Mr._Graybeard]

There is no such distinction between ACA, employer provided plans, and individual plans available prior to the ACA. There are tens of thousands of different employer plans in the US, because most insurers design plan offerings specific to employers. Some have broad networks and others are very restricted. Over the past decade, insurer / employer plans became more restrictive as a way to offset rising costs.

The breadth and depth of an insurance network has nothing to do with the ACA. It is the preferred method insurers use to design and offer lower cost policies, because network design is opaque, very difficult to analyze and compare. Even now, there is no discussion of network design for employer plans, yet this is as much a problem for consumers. It is not possible to compare networks, even when looking at different policies from the same insurer, because insurers do not make that information public. They only have a tool to search for a service provider because it is required, and it usually is cumbersome.

Some insurers in some states offer limited network plans. BCBS Texas is a good example. Other insurers in other states offer the same broad network plans used by large groups. BCBS Florida is an example. This is not because of the ACA, it reflects the effort by the state insurance regulator to maximize options for consumers.

Yes, it all comes down to the insurer. I got tripped up as the Marketplace was being rolled out, and I was dumb about health insurance. BCBS educated me.

 

[Texas Proud]

That sounds like an issue with the insurance company and their provider listings..we are rural and have run into narrower networks but that's on all plans not just the ACA marketplace plans.

Sorry though it sounds like a real pain to work with.

It really is, but it seems all insurance companies are equally bad at keeping their website current...... you think that you have a decent network and then find out it is bait and switch...

And of course due to open enrollment when they misrepresent their network you are stuck on the plan for an entire year... Hum, makes you wonder if the bad information is deliberate.

Yes, you are stuck... but in reality I think that all of the plans are doing the same thing so even if you could move to a different network you will still have the same problem...

Yes, it all comes down to the insurer. I got tripped up as the Marketplace was being rolled out, and I was dumb about health insurance. BCBS educated me.

And I wish that they were REQUIRED to keep their network info up to date.. I have seen Drs listed on their site that had moved more than a year earlier... yes, a year!! And then there are the groups that have dropped the insurance but the site is never updated... as an example our previous PCP was flooded out by Harvey... they still have her listed at her old address one year later... she recently changed groups (hers was bought out) but they kept her in the old group that no longer existed... and a few months ago she moved somewhere else... no update... and since I called maybe 20 recently I can say that over 80% that are listed are NOT in network anymore...

 

[GKieffer]

I’ve done without it all together. No insurance coverage. The plans are ridiculously priced and The only real benefit is if I have a catastrophic event. I’m playing the probabilities. I’m 54 and in good health.

 

[ivinsfan]

I’ve done without it all together. No insurance coverage. The plans are ridiculously priced and The only real benefit is if I have a catastrophic event. I’m playing the probabilities. I’m 54 and in good health.

I wish you well... I'm curious do you have anything to lose? MY DH was healthy until his mitral valve started leaking...5 years and 2 open heart surgeries later he has 500K of medical bills...maybe that's pocket change to you...

 

[GKieffer]

I wish you well... I'm curious do you have anything to lose? MY DH was healthy until his mitral valve started leaking...5 years and 2 open heart surgeries later he has 500K of medical bills...maybe that's pocket change to you...

It’s not. I have plenty to lose. I just have to admit to hating the idea of complying with a law basically designed to screw me. Paying $800 a month, basically funding other’s care while I get almost nothing in return. The government is slowly and systematically robbing the middle class blind. Equal misery for all - except for the government class.

 

[Mr._Graybeard]

I was talking yesterday to a guy I know, a 60-ish carpenter who worked for years for a small building contractor. No health insurance (a website claims that less than 30% of businesses that employ fewer than 50 people offer health insurance; I'm too lazy to try to verify that, so judge for yourself). https://www.peoplekeep.com/blog/the-average-cost-of-health-insurance-for-small-business-in-2017-study

Jeff was healthy as a horse, but he lived to ride. While riding home from Sturgis one year he had a minor mishap on his Harley (minor in that it didn't wreck him for life). He broke his leg and was off work for months. He told me his medical bill (this was 15 years ago) came to $70,000. It all came out of pocket, and Jeff's pockets aren't very deep. They were even shallower while he was tooling around in a wheelchair.

 

[Aerides]

It’s not. I have plenty to lose. I just have to admit to hating the idea of complying with a law basically designed to screw me. Paying $800 a month, basically funding other’s care while I get almost nothing in return. The government is slowly and systematically robbing the middle class blind. Equal misery for all - except for the government class.

At 54 in good health, and uninsured, I do hope you are at least self-funding your annual checkups, taking care of colonoscopy/prostate exams, etc. If I didn't have HI, I'd be at least budgeting the costs of my annuals/ mammogram and bloodwork/physical.

I won't debate the costs of ACA here, but they pale in comparison to any major health event that can come on far worse if not detected via early screenings.

 

[Texas Proud]

I’ve done without it all together. No insurance coverage. The plans are ridiculously priced and The only real benefit is if I have a catastrophic event. I’m playing the probabilities. I’m 54 and in good health.

It’s not. I have plenty to lose. I just have to admit to hating the idea of complying with a law basically designed to screw me. Paying $800 a month, basically funding other’s care while I get almost nothing in return. The government is slowly and systematically robbing the middle class blind. Equal misery for all - except for the government class.

The problem is in your thinking... that insurance should be a net benefit to you each and every year... that is NOT insurance... it is designed when something bad happens to you that is rare...


You are healthy all your life and then develop cancer... or have a heart attack or even need to have a new heart...



I have paid big money of the years for car insurance and unfortunately I have had to use it every once in awhile, but I would not go out driving without it even though I want to never use it...


I think the bigger problem that has reared its ugly head over the past few decades is the cost of health care... there seems there is nothing that can slow it down... if health care costs were 10% to 20% of what we spend today nobody would be concerned about the cost of health insurance...


BTW, I can remember when I first started working that my HI premium was $10 per month... and this was the price for any single at the company so it was not because I was young...

 

[scrabbler1]

The problem is in your thinking... that insurance should be a net benefit to you each and every year... that is NOT insurance... it is designed when something bad happens to you that is rare...


You are healthy all your life and then develop cancer... or have a heart attack or even need to have a new heart...



I have paid big money of the years for car insurance and unfortunately I have had to use it every once in awhile, but I would not go out driving without it even though I want to never use it...


I think the bigger problem that has reared its ugly head over the past few decades is the cost of health care... there seems there is nothing that can slow it down... if health care costs were 10% to 20% of what we spend today nobody would be concerned about the cost of health insurance...


BTW, I can remember when I first started working that my HI premium was $10 per month... and this was the price for any single at the company so it was not because I was young...

Well put. I was leading a healthy life until 3 years ago when I was 52. I was diagnosed with diabetes as I was being treated for some other health issues which are under control (along with the diabetes) but need doctor visits, lab work, and drugs. The hospital stay and subsequent bills would have cost me $88k without insurance. I would have much preferred to remain healthy while still paying the premiums without making any claims.

I have been paying car insurance for 32 years and have never made a claim. But I would never consider going without it, other than having dropped Collision on my previous car when it got very old and worth little. And I am GLAD I have never needed to file a claim because that means something bad happened to me, my car, or to someone else or his car because of me.

You don't have to have been in the actuarial field as I was for 23 years to know that you are paying for the possibility that you need to use insurance, whether it is health, home, or auto, the 3 most common ones we use in our everyday lives.

 

[GTFan]

It’s not. I have plenty to lose. I just have to admit to hating the idea of complying with a law basically designed to screw me. Paying $800 a month, basically funding other’s care while I get almost nothing in return. The government is slowly and systematically robbing the middle class blind. Equal misery for all - except for the government class.

At the minimum you should look into healthshare ministries unless you don't mind blowing $100k or more on just about any serious event. Or maybe one of those 'short-term' plans that were recently given the go-ahead for 2019.

I do agree that most folks using ACA without a subsidy are getting screwed to some extent, some a lot more than others.

 

[rodi]

To answer the OP's question - we did analysis... looking at all copays, doctor visits per year, etc... and figured the Bronze HDHP with HSA was the way to go. We started ACA in 2015 and hit the deductibles for both kids the first year (almost hit the max OOP for the family). Figuring that was a one-off... we continued on Bronze HDHP with HSA. That was the year older son developed an obscure ameloblastoma requiring jaw surgery. He maxed out his deductible an OOP - but we were under the family deductible/OOP costs. Rolling the dice again - 2017, we did well. And (knock wood) we're still doing well in 2018.

If you go with a high deductible make sure you have money set aside for this purpose - and be willing to refill this bucket as needed.

Healthy family, until we weren't. My kids are active in sports - which is how we ended up with lots of broken bones in 2015. Didn't see the tumor coming in 2016... but it's behind us. Now we're down to check ups and maintenance stuff.