Which ACA metal level did you choose?

[jpeter1093]

I'm 62 and DW is 60; looking to retire within the next year. I'm curious which metal level you all chose to cover your health care costs until Medicare kicks in?

 

[pb4uski]

If you are relatively healthy, bronze is the way to go. Just estimate your expected claim costs and calculate your total cost of health insurance, deductibles and co-pays for each plan.

Our claim costs are less than $1,000 a year so it is an easy decision for us.

 

[Freedom56]

Bronze PPO with OSCAR this year for $878 per month for both of us with no subsidies. We only see doctors for annual check-ups.

 

[flintnational]

If you are relatively healthy, bronze is the way to go. Just estimate your expected claim costs and calculate your total cost of health insurance, deductibles and co-pays for each plan.

Our claim costs are less than $1,000 a year so it is an easy decision for us.

+1 Same here.

 

[MBSC]

Your post indicates you live in NY, which is community-rated. ACA-compliant Catastrophic Plans are a good value in community-rated states if you do not qualify for premium subsidies and the lowest cost Bronze Plan is more than 8.05% MAGI (affordability exemption). The 2019 threshold is 8.30% MAGI. Cat Plans are not HSA compatible so you may need to run the numbers to see if an HSA compatible Bronze plan is a better value.

Who can buy a Catastrophic plan

Only the following people are eligible:

*People under 30
*People of any age with a hardship exemption or affordability exemption

Reference: https://www.healthcare.gov/choose-a-plan/plans-categories/#catastrophic

To view Cat Plans on Healthsherpa.com you will need to use ages <30 but since they're community-rated everyone under 65 pays the displayed premium. An HMO family plan for two in zip code 12186 is $366.

If your MAGI in retirement is <138% FPL, you will be placed into expanded Medicaid (New York). If MAGI is between 138%-250% FPL, only the Silver Plans qualify for CSR. If you currently have group coverage, COBRA can bridge some of the gap until Medicare.

 

[joeea]

I'm curious which metal level you all chose

Heavy.

 

[Dtail]

Silver Plan in Florida, as the monthly premiums are $146 with no deductible.

 

[FIREd]

I have been relatively healthy and, for the past 2 years, I chose a Bronze HSA plan.

 

[Aerides]

I think it's important that you don't have to pick a plan and stick with it "until MC kicks in". In fact, you can't. You have to re-up every year.

We're going Bronze for our first year for lowest premiums, but we're under 50, with no issues (knock on wood). If that changes and we become bigger consumers of HC, and want lower deductibles, or need particular specialists and provider choices, we'll look at the silvers and maybe even golds down the road.

 

[scrabbler1]

When Oscar raised my premium by 17% for 2018, I checked out a few plans from other companies last November and December. I also looked at plans from other metals (I have Silver).


I have some health issues (Type 2 Diabetes) and I need a plan with good prescription drug coverage, as that is my costliest expense. Switching to a Gold plan has a premium way too high (my ACA subsidy status is shaky, I went over the cliff in 2017), while a Bronze plan lacks sufficient drug coverage. I also have to consider the intangible cost of changing some doctors if I change insurance companies. So I have stayed with Oscar's Silver plan, somewhat reluctantly.

 

[bingybear]

If you are relatively healthy, bronze is the way to go. Just estimate your expected claim costs and calculate your total cost of health insurance, deductibles and co-pays for each plan.

Our claim costs are less than $1,000 a year so it is an easy decision for us.

I guess I must be in good health even with a dual chamber pacemaker. We've done Bronze HSA policies. Usually our PCP will do some tests that are not covered under well care. This year those additions were about 500 for each of us. Throw in my cardiology, pacemaker checks and a follow up with the PCP, we don't make a single deductible yet. Throw in dental (even the year we had 3 crowns between up) still under a single deductible (and yes the dental is not covered).

I expect the year I get my pacemaker changed will blow all the deductible and more.

 

[Texas Proud]

One of the other things to think about is if you can get cost sharing subsidy...


I am able to keep below a certain level and get CSR, so I went with the silver plan... with the changes made last year the net difference between a bronze and silver after subsidy was not that great and getting CSR is a big benefit...




https://obamacarefacts.com/2018-cost-sharing-reduction-subsidies-csr/

 

[Sue J]

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.

 

[MichaelB]

I'm 62 and DW is 60; looking to retire within the next year. I'm curious which metal level you all chose to cover your health care costs until Medicare kicks in?

This post (here) has a spreadsheet that allows you to compare the total cost of different policies. You input premium and cost sharing info (deductible, co-pay, total out of pocket) and it will show you the total amount you pay assuming different levels of medical spending.

Typically, the policies with higher cost sharing show less total cost. This is to be expected, as the policyholder is taking more financial risk. It pays to compare.

 

[RobbieB]

Bronze HDHP with HSA

 

[UnrealizedPotential]

I currently have a bronze plan. I'm not sure what I will do in November. I will just have to weigh everything and see how it comes out. I am not thrilled with the plan I have now, so I will most certainly change it for next year.

 

[davebarnes]

Bronze, HMO, Kaiser, Denver
$750/mo for 61 female

 

[bobandsherry]

Silver Plan in Florida, as the monthly premiums are $146 with no deductible.

Depends on area in Florida. Ailver was not reasonably priced for me. Compared same plan with another who lived elsewhere in Florida, his was $0 cost, mine would have been $7000+ for the year, same MAGI level.

I went with Bronze at $0 cost.

 

[Dtail]

Depends on area in Florida. Ailver was not reasonably priced for me. Compared same plan with another who lived elsewhere in Florida, his was $0 cost, mine would have been $7000+ for the year, same MAGI level.

I went with Bronze at $0 cost.

Surprised at that large of a difference. I live in Tampa and in general the pricing appears to be more expensive in larger populated areas than say Ocala for example.

 

[ivinsfan]

I took a Bronze because last year even with a CSR figured in the total possible out of pocket for the Sliver higher then the premium plus deductible for Bronze and I can fund my HSA for 9 months in 2018...

 

[bobandsherry]

Surprised at that large of a difference. I live in Tampa and in general the pricing appears to be more expensive in larger populated areas than say Ocala for example.

I live in Tampa area as well, Hillsborough County. Compared prices with someone who lived in Tallahassee. You can go to HealthSherpa com and look at prices for different areas. I also found that Jacksonville area was much less, same pricing as Tallahassee.

 

[Dtail]

I live in Tampa area as well, Hillsborough County. Compared prices with someone who lived in Tallahassee. You can go to HealthSherpa com and look at prices for different areas. I also found that Jacksonville area was much less, same pricing as Tallahassee.

I am in the 33647 zip code, also in Hillsborough County. My MAGI is 20k plus it is for one person at 57 y.o. Still surprised...

 

[pb4uski]

Your post indicates you live in NY, which is community-rated. ACA-compliant Catastrophic Plans are a good value in community-rated states if you do not qualify for premium subsidies and the lowest cost Bronze Plan is more than 8.05% MAGI (affordability exemption). The 2019 threshold is 8.30% MAGI. Cat Plans are not HSA compatible so you may need to run the numbers to see if an HSA compatible Bronze plan is a better value.

To view Cat Plans on Healthsherpa.com you will need to use ages <30 but since they're community-rated everyone under 65 pays the displayed premium. An HMO family plan for two in zip code 12186 is $366.

If your MAGI in retirement is <138% FPL, you will be placed into expanded Medicaid (New York). If MAGI is between 138%-250% FPL, only the Silver Plans qualify for CSR. If you currently have group coverage, COBRA can bridge some of the gap until Medicare.

Vermont has community rating as well and we have had a catastrophic policy for many years now... the coverage and benefits are substantially similar to bronze and the network is identical... cost is about 1/2 of a similar bronze plan and the annual increases have been more modest, which adds up over time.

 

[VanWinkle]

Silver plan as it has both premium and cost subsidies for our income level. You have to use the silver plan for the cost subsidies.

 

[pb4uski]

.... I expect the year I get my pacemaker changed will blow all the deductible and more.

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