Silver, Gold or Cobra

[gbstack]

I’m currently on Cobra and I have a pending ACA Silver Plan and Gold Plan for May. I could stay on Cobra until October but the monthly rate is $1099.00. The Silver Plan would be $512.00 and the Gold Plan would be $858.00. The plan is for 3 people.

We are basically healthy. I go for an annual checked and annual blood test along with a couple of PSA tests because it is above 4.0.

My wife does an annual checkup and blood test. She was having some issues with her blood pressure and made many trips to the doctor but they seem to have that under control. My daughter may go for an annual checkup.

I’m leaning towards the silver plan and I was hoping you could share your opinion. Any thoughts would be greatly appreciated.

Below are the plan basics.

Silver
Deductible = $3000.00 per individual and $6000.00 family
Out of Pocket Max = $4,500.00 per individual and $9000.00 family.
Primary care visit - $40.00 per visit for the first 3 visits and 5% for additional visits after deductible.

Emergency room = $200.00 and 5% after deductible.
Hospital stay = 5% after deductible.
Other – 5% after deductible.
Tier 1 drugs = $15.00
Tier 2 drugs = $40.00
Tier 3 and 4 drugs = 5% after deductible

Gold
Deductible = $750.00 per individual and $1500.00 family
Out of Pocket Max = $6,000.00 per individual and $12000.00 family.
Primary care visit - $30.00 per visit – unlimited
Emergency room = $200.00 after deductible.
Hospital stay = $500.00 after
Other = 0% after Deductible.
Tier 1 drugs = $15.00
Tier 2 drugs = $40.00
Tier 3 and 4 drugs = 5% after deductible

 

[Sue J]

Are you considering any Bronze plans? You'll save a lot on the monthly premium. It sounds like you won't be meeting even a low deductible so why pay a sizable premium for a Silver or Gold plan?

In our area some of the Bronze plans are HSA compatible and that gives you a tax deduction, too.

ALL ACA plans have an out of pocket max of 6350 or less, no matter what metal plan they are.

 

[gbstack]

Are you considering any Bronze plans? You'll save a lot on the monthly premium. It sounds like you won't be meeting even a low deductible so why pay a sizable premium for a Silver or Gold plan?

In our area some of the Bronze plans are HSA compatible and that gives you a tax deduction, too.

ALL ACA plans have an out of pocket max of 6350 or less, no matter what metal plan they are.

I should have looked at the Bronze. I will be looking at it next year. The only way I could go with Bronze this year is keep the Cobra until October!

 

[rbmrtn]

The enrollment period is past, so you will stay on COBRA till it runs out, then you can get a new plan. You could have dropped COBRA during the enrollment period.

Basically healthy would lean towards bronze. There was spreadheet posted in a previous thread to compare cost. Unless you are paying for a lot of ongoing services the bronze plans usually come out ahead.

 

[gbstack]

The enrollment period is past, so you will stay on COBRA till it runs out, then you can get a new plan. You could have dropped COBRA during the enrollment period.

Basically healthy would lean towards bronze. There was spreadheet posted in a previous thread to compare cost. Unless you are paying for a lot of ongoing services the bronze plans usually come out ahead.

I have a pending Silver Plan and Gold plan for May, so I can still switch as long as I pay by 5-10-2014. Thanks for the info about the spreadsheet.

 

[pb4uski]

If you all are pretty healthy I would go silver and then switch to bronze during the next open enrollment period.

 

[Texas Proud]

The enrollment period is past, so you will stay on COBRA till it runs out, then you can get a new plan. You could have dropped COBRA during the enrollment period.

Basically healthy would lean towards bronze. There was spreadheet posted in a previous thread to compare cost. Unless you are paying for a lot of ongoing services the bronze plans usually come out ahead.

Actually, with the difference in premiums between Bronze, Silver and Gold, the Bronze plan is the cheapest no matter what happens for my family....

So, I will pay for all of my health care cost until I reach the high deductible, but I am saving over $300 per month... and I would be paying for most of my health care in the other plans...

For me, it was a no brainer which one to choose...

 

[MichaelB]

The higher deductible tends to be the lowest total cost choice. Our fellow forum member Anamorph built a spreadsheet to compare policies with different levels of cost sharing, you may find it helpful in this case. It's here http://www.early-retirement.org/for...-and-coinsurance-copay-68965.html#post1374536

 

[MBSC]

If you all are pretty healthy I would go silver and then switch to bronze during the next open enrollment period.

+1 I also agree as long as you have researched the provider network to see if it includes your current physicians and any hospitals in your area you may need to use.

 

[walkinwood]

Relative costs of plans were discussed extensively in this thread
http://www.early-retirement.org/forums/f38/bronze-silver-and-coinsurance-copay-68965.html

Here are a couple of spreadsheets that members created (in the above mentioned thread)
http://www.early-retirement.org/for...-and-coinsurance-copay-68965.html#post1374536
http://www.early-retirement.org/for...nd-coinsurance-copay-68965-2.html#post1382290

In general, the lowest premium plans seem to win out unless you have really high medical expenses.

 

[Animorph]

I'd be careful of joining a high deductible plan late in the year. Is the deductible prorated for the year? I'll be transitioning in July or August, so I'll have to figure this out fairly soon. I stuck with the low deductible from DW's employer this year, and we'll probably transition to a low deductible ACA plan to finish the year. Then in 2015 we'll go the high deductible route. Unless I can figure out something cheaper.

 

[pb4uski]

I'd be careful of joining a high deductible plan late in the year. ....

IMO this really is only a concern if you have incurred substantial medical costs so far in the plan year (usually calendar).

For example, I haven't spent anything in these first 3 months so I wouldn't view changing plans as being an issue for me since the outcome wouldn't be any different than if I had been on the new plan from the beginning of the year.

 

[Animorph]

IMO this really is only a concern if you have incurred substantial medical costs so far in the plan year (usually calendar).

For example, I haven't spent anything in these first 3 months so I wouldn't view changing plans as being an issue for me since the outcome wouldn't be any different than if I had been on the new plan from the beginning of the year.

True enough, if you don't need to use it. I had a few minor procedures early this year and will have a colonoscopy at the end of the year. I can do without having a $6k deductible for the first half year and then another $6k deductible for the second half.

 

[gbstack]

I'd be careful of joining a high deductible plan late in the year. Is the deductible prorated for the year? I'll be transitioning in July or August, so I'll have to figure this out fairly soon. I stuck with the low deductible from DW's employer this year, and we'll probably transition to a low deductible ACA plan to finish the year. Then in 2015 we'll go the high deductible route. Unless I can figure out something cheaper.

I agree about being careful joining late in the year but I think May could be considered borderline!

 

[gbstack]

IMO this really is only a concern if you have incurred substantial medical costs so far in the plan year (usually calendar).

For example, I haven't spent anything in these first 3 months so I wouldn't view changing plans as being an issue for me since the outcome wouldn't be any different than if I had been on the new plan from the beginning of the year.

Agreed! We have spent around 500.00 YTD!

 

[Texas Proud]

+1 I also agree as long as you have researched the provider network to see if it includes your current physicians and any hospitals in your area you may need to use.

I had to change docs.... ours was not in any of the cheap plans even though he is relatively cheap... he has a good number of medicare patients and they do not pay well...

 

[gbstack]

I’m currently on Cobra and I have a pending ACA Silver Plan and Gold Plan for May.

I paid the May bill today for the Silver Plan. I sure hope things work out as planned!