Last minute ACA paralysis

[tmitchell]

Hi folks. Sorry for all these posts about healthcare but this was my first year dealing with it and it kind of boggles the mind. I've got until tomorrow to finalize my plan for 2024 and I could use some of your experience. Maybe I'm trying to optimize something that just can't be fully.

I'm debating between the following plans (with some caveats below):

Blue Shield HDHP $470/mo, $7050 deductible **this is my current one

or,

Blue Shield Bronze $455/mo, $6300 medical deductible, $500 drug deductible
Blue Shield Silver $700/mo, $5400 deductible
Kaiser Bronze HDHP $73/mo, $7050 deductible
Kaiser Bronze $100/mo, $6300 deductible
Kaiser Silver $229, $5400 deductible

I'm 56, and in good health except for a very low dose of BP medicine that's less than $1/mo. Other than that, the only time I go to the Dr is for annual medical and eye exams, and I usually buy a pair of glasses each year. I'm also due for a colonoscopy next year, which is why I'm considering a Silver plan in 2024.

I posted in another thread how my PCP is starting to charge a $500/yr fee, just to go to the practice. He also only accepts Blue Shield PPO, which is quite expensive. I like him a lot and also my eye doctor, but I'm now wondering if I shouldn't just move over to Kaiser and save a ton of money. If I want to pay cash to see my current PCP for some reason, it's $300/visit. I've read that people generally are quite happy with Kaiser. I'm thinking that if for some reason my health takes a turn and I don't like Kaiser, I can always switch back in 2025.

This year in addition to the monthly premium I spent another $3k on things the plan didn't cover, like certain routine tests. So nearly $10k for a relatively healthy person.

So I'm wondering: do I just go Kaiser Bronze for catastrophic and pay out of pocket in case I really need a second opinion?

BTW my relatives on Medicare told me they spend $0 on any healthcare, which makes me question the value of pumping up an HSA over the next 8 years. Given how this is going I'm considering just pulling the money I've spent back out of there and move towards liquidating it.

Sorry for the long post but wanted to paint the picture. I appreciate any thoughts here as it's driving me crazy.

 

[MichaelB]

Is the Kaiser plan is an HMO?

If it is and you went with it you still could see your current PCP, pay cash and still save a boatload of money. However, if you do need anything you need to see your assigned HMO primary Doc and get authorizations for all care.

 

[tmitchell]

Is the Kaiser plan is an HMO?

Yes, and the Blue Shield ones are PPO.

 

[MichaelB]

The PPO gives you access to a broad network of providers and you can see any without prior authorization (assuming you can get an appointment).

With the HMO you much have a primary care physician assigned, and the PCP must pre-authorize all other care. Any care you receive from a provider not in the HMO network will have to be paid entirely by you.

Choosing between them is a roll of the dice. If you see your PCP once a year and get no other care, the HMO saves lots of money. If you need care you’re limited to the network providers and bureaucracy of pre-authorization.

You make one important point, which is if you don’t like your choice, you can always change next December.

 

[sengsational]

I justified the HSA for myself knowing that you can pay Medicare premiums with HSA funds, and there will probably be medical expenses, like concierge doctors, that can be paid from HSA funds.


I've always been unable to justify silver or gold plans. There are specific ranges of spending where they could be cheaper, but at low utilization, bronze won out. And at high utilization, bronze wins out (you're buying the max out of pocket). If you were concerned about which doctor would be in-network, then that might drive your decision, but if you're flexible and probably won't need to deal with the "pack 'em in, move 'em out" mentality of the corporate driven medical system, then just buy the cheapest max out of pocket.

 

[cathy63]

...So I'm wondering: do I just go Kaiser Bronze for catastrophic and pay out of pocket in case I really need a second opinion?

Some people like Kaiser, some hate it. I was born in a Kaiser hospital and have had health coverage through them for most of my life. I've tried the other options and really prefer Kaiser. I myself have never had serious health problems, but my sister and parents have and they've always had very good care at Kaiser and on occasion at outside facilities they were referred to (my Dad had a quad bypass at Seton Hosp in SF that was paid for by Kaiser). However, there are plenty of people who will tell you no excellent doctor would ever work for Kaiser so you're only going to see hacks and quacks there. The MDs I've talked to about this are there because they would rather do medicine than run a business and they like having more predictable work schedules.

It's not really "catastrophic" coverage though, that's a specific thing that is different from a Bronze ACA plan.

Also, you can always get a second opinion at Kaiser. Just ask for one if you want one. You can also go outside for a 3rd opinion and pay for it yourself if you wish, but you might as well get the second opinion that's covered by insurance first.

BTW my relatives on Medicare told me they spend $0 on any healthcare, which makes me question the value of pumping up an HSA over the next 8 years. Given how this is going I'm considering just pulling the money I've spent back out of there and move towards liquidating it...

Your relatives should take a look at their 1099-SSAs sometime. They might be surprised to see that their Medicare premiums are being deducted from their SS benefits. Those premiums can be reimbursed from their HSAs. You can also reimburse yourself for dental work, hearing aids, glasses, OTC meds, and a long list of other things. It's pretty unlikely that they're actually spending $0 on qualified medical expenses every year.

 

[GoBears]

Probably too late for you, but I was confronted with the same choice last year. I elected to go with Kaiser rather than Blue Shield and my doctor at John Muir Health. My father (age 94) is also a long-time Kaiser member.

I’m glad I had the opportunity to evaluate Kaiser. They do some things really well - mail order pharmacy, low Rx costs, very good doctors, laboratory services, vaccines, and quick access to specialists once you get the referral all come immediately to mind. However, at Kaiser I felt like a number. I had to wait 8 days for an “urgent” care appointment for an ear infection and then another 10 days to see my PCP when the infection didn’t clear up after the first dose of antibiotics. My dad’s PCP doesn’t really have time to discuss more than two concerns at any appointment and at 94 I always have a list. She also does not seemed attuned to his dementia (Kaiser has memory care specialists). The local Kaiser ER is overcrowded. On the other hand, over the last 30 years or so Kaiser did get my dad through Covid, a broken leg, two hip replacements, surgery for spinal stenosis, and surgery for a broken arm. So, it is a mixed bag.

Ultimately, I switched back to Blue Shield for 2 months in 2024 and then it will be Plan G. I opted for Plan G because of flexibility (we may relocate out of a Kaiser service area) and the simplicity my disabled wife has in obtaining care locally at John Muir, her neurologist in Nevada, a local pain management practice, and a specialist at Stanford. No pre authorizations required. My cost for Plan G will be around $140 a month + Plan D compared to $65 a month for the “”Cadillac” Kaiser Medicare Advantage plan. I’m willing to spend the extra.

So, I say try Kaiser to see if you like it. There are definite pluses and minuses. You will be dealing with a bureaucracy but with significant cost savings compared to Blue Shield. If you don’t like it, you can always switch back.

 

[Texas Proud]

The PPO gives you access to a broad network of providers and you can see any without prior authorization (assuming you can get an appointment).

With the HMO you much have a primary care physician assigned, and the PCP must pre-authorize all other care. Any care you receive from a provider not in the HMO network will have to be paid entirely by you.

Choosing between them is a roll of the dice. If you see your PCP once a year and get no other care, the HMO saves lots of money. If you need care you’re limited to the network providers and bureaucracy of pre-authorization.

You make one important point, which is if you don’t like your choice, you can always change next December.

Not always that you can see anybody without prior authorization.... my DW had BCBS and she needs a referral...


We used to have one that did not, but the new plan is much cheaper and DW does not need much healthcare...

 

[Accidental Retiree]

Some people like Kaiser, some hate it. I was born in a Kaiser hospital and have had health coverage through them for most of my life. I've tried the other options and really prefer Kaiser. I myself have never had serious health problems, but my sister and parents have and they've always had very good care at Kaiser and on occasion at outside facilities they were referred to (my Dad had a quad bypass at Seton Hosp in SF that was paid for by Kaiser).



Your relatives should take a look at their 1099-SSAs sometime. They might be surprised to see that their Medicare premiums are being deducted from their SS benefits. Those premiums can be reimbursed from their HSAs. You can also reimburse yourself for dental work, hearing aids, glasses, OTC meds, and a long list of other things. It's pretty unlikely that they're actually spending $0 on qualified medical expenses every year.

My brother in law recently joined Kaiser Medicare in Riverside County, CA, and we were surprised to see that the 164.90 premium is NOT deducted from his SS payment.

I called to ask about it, and the Kaiser CS rep told me that the plan he selected has no premium in his county.

He also gets some vision and dental coverage under this plan.

He was elated and then visited his new doctor and was very impressed by the “one stop shop” aspect of Kaiser.

Kaiser Medicare plans are highly rated in CA, and that rating, combined with no cost and ease of use, made my BIL very happy.

 

[FLSUnFIRE]

I'm not sure I'd let the colonoscopy be a decision factor. At least for HDHP, it falls under preventative care and is probably covered 100% over 50 (I'd check the docs to be sure). As long as I'm pretty healthy I'm likely to stay on a bronze HDHP PPO/PPE (and even if my health declines I may).

 

[Another Reader]

I grew up near where Kaiser began. It was about to fail when the UC Berkeley faculty decided to participate. In over 60 years, I have known no one that loves Kaiser after a serious illness. Misdiagnosed cancers, stillborn high risk babies because the surgery was deemed unnecessary, a Covid buddy that was laughed out of the hospital with a dying gall bladder multiple times until one surgeon saw the bloodwork and got her into surgery immediately. I could go on, but why?

Kaiser has excellent PR and has cozied up to all the right folks in the various regulators and overseers. I would never go to Kaiser for anything serious. In your shoes, I would spend more for the choice of doctors and facilities. Price is irrelevant if you have a serious problem.

 

[grayv]

My brother in law recently joined Kaiser Medicare in Riverside County, CA, and we were surprised to see that the 164.90 premium is NOT deducted from his SS payment.

is that because of a Kaiser giveback?


since that number matches the standard medicare part B premium, check to make sure the part B premium is still being paid.

 

[RetiredAndLovingIt]

My brother in law recently joined Kaiser Medicare in Riverside County, CA, and we were surprised to see that the 164.90 premium is NOT deducted from his SS payment.

I called to ask about it, and the Kaiser CS rep told me that the plan he selected has no premium in his county.

He also gets some vision and dental coverage under this plan.

He was elated and then visited his new doctor and was very impressed by the “one stop shop” aspect of Kaiser.

Kaiser Medicare plans are highly rated in CA, and that rating, combined with no cost and ease of use, made my BIL very happy.

The Kaiser Medicare Advantage premium is free unless he adds $15-20 monthly for higher vision, dental and hearing benefits. Kaiser does not bill him for the part B Medicare premium but he should be paying it somehow. Does his Medicare card show he has both part A and part B?
I think it's now $174.90 for Part B at least that's what I'm paying this year. I'm in San Bernardino county and also with Kaiser Medicare Advantage and my Kaiser just increased from $15 last year to $21 this year (I think)

 

[tmitchell]

Thanks everyone for contributing to this. I've got a few hours to mull it all over before I pull the trigger one way or the other. You've given me plenty to think about.

It's annoying health care is so troublesome for so many!

 

[tmitchell]

Kaiser Bronze it is for 2024! Figured I’d give it a shot and see. I can always see my PCP with cash if need be.

Thanks again to everyone who weighed in.