Choosing a health plan

[slowsaver]

I'm trying to decide which health plan I would choose after retirement.

There are 3 plans from Kaiser that I'm considering. One would cost $116/mo (bronze), the other would cost $414/mo (silver), or $676/mo (gold) -- after my estimated ACA subsidy.

Of course, they have different deductibles and different copays -- with the cheaper one having a larger deductible and larger co-pays.

However, I see that the "out-of-pocket maximum" is the SAME for all plans: $8,200 (individual)  / $16,400 (family).

Given my DH and I do not have any chronic health issues, I think the only time we might hit our deductible is if we had something terrible happen -- which would likely also cause us to hit the "out-of-pocket maximum."

So it seems like a no-brainer that you should take the cheapest plan and be ready to pay the out-of-pocket max every year. The deductible and office visit costs really don't matter.

Am I missing anything?

 

[Aerides]

Well the good news is you can't go wrong because you can change after the first year if you don't like one, for the other. We basically took your approach and stuck with a bronze, HD/HSA plan, so we can continue to add to our HSA for tax purposes.

But don't discount those deductibles as "we'd never!". DH and I were both in the low-consuming no-conditions category:

Year 1 of RE, a suspect blood test sent DH down miles of test and specialists, to find he has a condition that is easily treated, but ate up half his deductible finding out. He also got diagnosed with sleep apnea (after sleep studies from an iffy EKG) so yeah that was the other half.

The next year I twisted my knee funny in the shower, which ended up being several doc visits, an MRI, and then surgery. All that came close but I didn't quite meet my deductible, darn it.

Either way, stuff starts happening. I don't know who it was here who said it, but something like... after 50 it's like a car where the check engine light just starts coming on some times.

 

[Bamaman]

Healthcare in ER: Cannot afford the deductibles and co-pays. Cannot afford to be without health coverage, however.

My wife has had so many surgeries (7) in the last 3 years that we're so thankful for Medicare and Plan F--the Cadillac plan. We couldn't afford the ACA's deductibles and maximum cash outlay.

 

[RunningBum]

I setup a spreadsheet to compare the plans with different levels of usage. The bronze worked best for not much usage, or a lot. There is a pretty good window in the middle where gold is cheaper, but not by much. The bronze was helped by the tax deduction benefit of an HSA. If you can get cost sharing reductions with a silver, that might be the best plan, but I can't get close to 250% FPL for that.

 

[RobbieB]

I always go cheap. The only thing I care about is max out of pocket. That's the one that can ruin you.

Eight grand a year, no problem. Half a million...

 

[PaunchyPirate]

For someone with no current health issues and no need for specific, expensive medications... go with the least cost premium option.

Now in my 3rd year of ACA, I've gone gold all 3 years. I've never even hit my (now) $1000 deductible. BUT, I use an expensive medication that I now get quite inexpensively because of the gold plan lower co-pays on prescriptions. If I were on the bronze plan, my copay be much higher. I create a spreadsheet and model all my "typical" medical expense each year. For me, the bronze and gold end up costing me pretty much the same in overall medical expenses each year. So I go with the gold.

 

[MichaelB]

I'm trying to decide which health plan I would choose after retirement.

There are 3 plans from Kaiser that I'm considering. One would cost $116/mo (bronze), the other would cost $414/mo (silver), or $676/mo (gold) -- after my estimated ACA subsidy.

Of course, they have different deductibles and different copays -- with the cheaper one having a larger deductible and larger co-pays.

However, I see that the "out-of-pocket maximum" is the SAME for all plans: $8,200 (individual)  / $16,400 (family).

Given my DH and I do not have any chronic health issues, I think the only time we might hit our deductible is if we had something terrible happen -- which would likely also cause us to hit the "out-of-pocket maximum."

So it seems like a no-brainer that you should take the cheapest plan and be ready to pay the out-of-pocket max every year. The deductible and office visit costs really don't matter.

Am I missing anything?

Here’s a spreadsheet by our fellow member Animorph that lets you plug in the different combinations of premium, copay, deductible and total out of pocket, along with different health care scenarios, and see the total cost to you. Other members have found it very useful. https://www.early-retirement.org/fo...nd-coinsurance-copay-68965-3.html#post1374536

 

[pb4uski]

... Given my DH and I do not have any chronic health issues, I think the only time we might hit our deductible is if we had something terrible happen -- which would likely also cause us to hit the "out-of-pocket maximum."

So it seems like a no-brainer that you should take the cheapest plan and be ready to pay the out-of-pocket max every year. The deductible and office visit costs really don't matter.

Am I missing anything?

No, you are not missing anything. What you describe is the path that we chose and we only ended up spending $6,800 in deductibles from 2012-2019, inclusive, an average of $850 a year. YMMV but IMO it is a risk worth taking.

 

[slowsaver]

Thanks for all the great responses. I like the idea from Aerides that I can't go wrong because you can change it next year. ;-) But I'll also use the spreadsheet MichaelB pointed to. My DH does use some generic glaucoma medication and has eye checks by
a specialist 2x/year. Hard to tell how much those cost since we're currently under a very generous health plan at work where we have zero deductible and zero co-pays. I can probably find out with some digging.

 

[PaunchyPirate]

Thanks for all the great responses. I like the idea from Aerides that I can't go wrong because you can change it next year. ;-) But I'll also use the spreadsheet MichaelB pointed to. My DH does use some generic glaucoma medication and has eye checks by
a specialist 2x/year. Hard to tell how much those cost since we're currently under a very generous health plan at work where we have zero deductible and zero co-pays. I can probably find out with some digging.

Ah, yes…. Getting specific drug prices in advance of having your coverage is a bit of guesswork. At least where I live. I am able to see which price tier a specific drug falls in for the various insurance companies that provide policies in my zip code using documents available on the companies websites (and or on the ACA exchange website). But they don’t reveal the actual prices. So, I can tell that my most expensive drug is a Tier 2 drug with both of the insurance companies, but nothing more.

So I sign up for a plan that offers Tier 2 drugs at a max of $50 copay. I think the bronze plans would only cover 50% of the drug cost. My drug supposedly costs my current insurance company about $800 for each fill. So I would be paying $400 per month. However, some drug companies may subsidize some portion of my costs. It’s confusing. Especially when you are just in the research phase of you decision.