My broker has a long list of plans from three insurance companies. All with names such as “Best Buy HMO HSA 5400.” She said she will have details on what plans cover by this weekend. If I can narrow down the plans I’m interested in, she can tell me more. Well, beyond the premium, deductible and OOP for each plan, I can’t tell anything - how am I supposed to be able to narrow down the list?
She knows your family situation, right? I think you hit the $ biggies, it just means addl deciding points like Rx coverage, how counseling copays run, ED cost (eg, $200 vs 10 or 20%.) At least, this was the sort of extras I considered.
I do not know if this is helpful for anyone considering buying health insurance off the exchanges. But today is the first day our employer (big company, salaried but company has union employees) company self insures.
HSA. Deductible individual $1500 family $3000. 20% after oop max $7000. Last year oop max was $6000. The company contributes $1400 to HSA.
Our cost $47/per pay period
Employer cost $420/per pay period
Traditional plans are offered but are $156-$186/per pay period. I suspect employer cost is roughly the same.
We will contribute $6250 per year to our HSA which is the maximum we can.
Dental insurance
Our cost $8.60/pay period
Employer cost 30.50/pay period
I understand how incredibly fortunate we are to have employer health insurance. And that they pay so much.
I thought it might be interesting to others how much a company pays to insure its employees.
“Well, beyond the premium, deductible and OOP for each plan, I can’t tell anything - how am I supposed to be able to narrow down the list?”
Do you have preferred providers you want to continue seeing? Are they on some and not others?
That is one feature I really like about buying insurance off the exchange. I like to research and compare and I feel like everything is at my fingertips for doing so.
@“Cardinal Fang” Thanks for the heads up on being able to preview plans.
I have a question for @“Cardinal Fang” or @calmom –
My S has had a silver plan with cost sharing reduction for the past 2 years. Last year the plan premium was $405. After his subsidy of $230, he paid $175 out of pocket. This was a Florida Blue Cross EPO with the Blue Options network. He could have gotten a cheaper plan using the Blue Select network but none of his doctors are in that network - it’s very limited.
This year his plan premium for the same plan has jumped more than 100% from $405 to $814! @-) His subsidy will be about $365, leaving him to pay $449 out of pocket – about 157% more! His income only increased by about $1000, so that doesn’t explain the huge jump.
I thought that @“Cardinal Fang” said that silver plan folks wouldn’t end up paying more in 2018 than they did in 2017 because subsidies would rise the same amount as premiums. Did I misunderstand?
@deb922 — are you sure you can contribute $6250 to the HSA since your employer will be contributing $1400? I have not looked at this in a few years, but I thought it was a combined max.
Yes it is a combined max. $6900 max for 2+ participants plus $1000 extra because we are over 55. Minus the $1400.
Actually it looks like I can add another $8 per pay period lol.
It seems that the limit to contribute has increased this year. I always have contributed the max that we can.
So… the reference plan for the subsidy is the 2nd cheapest Silver. If you bought the 2nd cheapest Silver last year, and the 2nd cheapest Silver this year, and you’re subsidized, you pay the same this year as last year (actually a tiny bit less this year). Your subsidy is based on what the 2nd lowest Silver costs.
But if you buy a plan that is not the 2nd lowest Silver and your plan goes up more than the 2nd lowest Silver did, you will end up paying more.
What does Gold look like for him?
If his income is the same, then the jump in price is probably would probably indicate that whatever plan he has is no longer the 2nd lowest cost silver plan. (the indexed plan).
Florida has 5 insurers who sell exchange plans, though all 5 might not be available in all areas.
But lets take a hypothetical set of primiums for silver plans, from lowest to highest cost:
A. $400
B $500
C $600
D $700
The subsidy is indexed to the “B” level plan – which is $500.
Let’s say that based on income, the person can be required to pay no more than $200 for plan B. That means that the peson will get a $300 subsidy that they can use for any plan.
So, now the person with the $300 subsidy has the choice of these 4 silver plans (amount after subsidy)L
A. $100
B $200
C $300
D $400
If your son qualified for a CSR Silver then I think the maximum he would have to pay for Plan B would be $130 or less. If he was paying $175, then he must have had a plan priced $45 or more above Plan B.
So basically what has now happened is that his plan has gone up more than the lower end plans; perhaps some companies are now offering some lower cost HMO’s and so now there is a much greater cost differential between Plan B and whatever your son has.
So basically here are your son’s options: If your son rarely goes to the doctor and just wants to preserve the ability to see the doctors he wants, then he could go with a Bronze plan and may be able to get a plan for the same network for essentially free or very low premium - basically he’s getting a $365 subsidy that can be applied to any plan. So if there isa Bronze plan for $400, he’s pay $35 to get on that. He’s have to pay a lot more for doctor’s visits or prescriptions, but if he is low volume user he’d be ok.
If your son has chronic health issues that require regular doctor visits or prescriptions, then he might need to switch carriers and go with a lower priced silver,most likely an HMO.
OK, thanks. I think I understand now. He never had the 2nd cheapest silver plan. His was more expensive because it used the better provider network.
Looks like he might need to go with an HMO this time around. 
@patsmom, have him look at Gold. It could be that Gold is not much more expensive, or even cheaper, than the corresponding Silver. And Gold is better.
I will pay $0 for my Bronze plan next year.
Unless he has very unusual or specialized health needs, I’d recommend going with the HMO. I know that we tend to develop an emotional attachment to the doctors we have been seeing, but when it comes down to our actual face-time with doctors is very brief and infrequent.
It might be different if he has to work with a specialist and has unusual medical needs. But I think that for most things the outcome is going to be the same with any doctor of facility.
The Blue Options Silver is $449 with $0 deductible and max OOP of $1250, $2 generic drugs, $1 primary doctor visits and $10 specialist visits. The Blue Options Gold is $482 with $2000 deductible and $5500 max OOP, $20 generics, $40 primary dr. visits and $75 specialist visits. In his case, the silver is the better plan. I was just shocked that the premium doubled this year and his out of pocket cost more than doubled.
@patsmom I saw something similar in my state, in the past (I’m on Medicare, as of last fall.) They seemed to point you to the plans they wanted to promote. When they were pushing HMOs, that was lowest cost overall (all factors.) The next year, a Silver or two were better. Your example is similar. Maybe it varies per income level.
Your example is also a great show of how people should check the pieces.
I’m sorry, @patsmom. I didn’t notice that you mentioned your son had cost sharing reductions. Yeah, he should buy Silver. In all of Florida (I’m looking at the plans right now) Blue Options are the most expensive. And there is a heck of a Silver Switcheroo in Florida-- for people who don’t have cost sharing reductions, Gold and Silver are almost the same price. Sometimes Gold is cheaper.
“The Blue Options Silver is $449 with $0 deductible and max OOP of $1250”
Although the cost is high-ish, those are incredibly low numbers for deductible and OOP, IMO. Is there an option with a lower monthly fee and higher deductible/OOP?
That low deductible and OOP is because it is a CSR qualified plan, available only to buyers whose income is under 200% of the FPL. The CSR onliy applies to silver level plans. So if he wants the low deductible, it’s going to have to be Silver, but based on his income it will be much less if he goes for one of the two lowest price silvers.
Somebody has to pay for those cost-sharing-reductions. If the government won’t pay directly, then insurance companies have to pay, and they have to get those funds out of premium dollars. ACA required that 80% of premium dollars go to patient benefits, so with administrative costs they don’t really have a slush fund to draw on. It’s not as if the insurance claims process themselves.
But obviously that also does limit choice of plan for the lower income exchange buyers.
Again, for us it all boils down to the network of providers. The lowest priced silver plans use a VERY limited network. None of his current docs are on the list and the ones that are just aren’t the ones most folks would pick if they had a choice.
Costs also depend on where in Florida you live. I checked his same plan in a zip code in north Florida and the cost was less than half of what it is down here in south Florida. Maybe he should move…
What makes you think he’d like the providers in north Florida better than he likes the providers in the other plans in south Florida? It’s so expensive in south Florida because the doctors and hospitals he likes are asking for a lot of money.
That reminds me, in my area no individual plans have price-gouging Stanford Hospital or their price-gouging sibling Packard Children’s Hospital. Good hospitals, but not as good as their fees think they are.