<p>“GP, You paid your entire deductible for both you and your wife?”</p>
<p>No, but this seems to be your criteria for comparing how much our respective plans cost. </p>
<p>I merely say that if Plan A premium plus deductible costs almost the same as Plan B, premium only, and the plans are otherwise similar, the Plan A is way better for almost everyone.</p>
<p>LF, I wouldn’t have selected a silver plan because according to Covered Ca it would have cost me $1,400 a month. Paying $16,800 a year for a very limited network is a non-starter.</p>
<p>CF, if I was to buy a comparable plan (to what you have) on Covered Ca, it would cost me close to $2,000 a month for a platinum plan…and I would have ended up with a network 1/3 as large as yours.</p>
<p>You don’t see how screwed up this is?</p>
<p>If I bought a plan on Covered California, I could pay about $1700/month for Gold (for me and my husband) and get the same network I have now, and no deductible. I’d have all the hospitals, and the big medical groups. It’s different in Southern California, I guess, but up here Blue Shield has pretty decent networks and I think Health Net does, too. They’re PPOs, so I’d get some payment if I went out of network.</p>
<p>What is the out-of pocket maximum for your plan?</p>
<p>If you’re talking Blue Shield, no UC hospitals, closed formulary and many specialists have been excluded.</p>
<p>Can you tell me which region or area you are from?</p>
<p>For which plan? I assume it’s $6350 per person, because no plan can have a higher OOP.</p>
<p>your husband’s employer plan</p>
<p>Don’t know. Pretty sure it’s $6350.</p>
<p>GP, there’s too much we don’t know about your situation. I’m clearly not seeing exactly what you are (and I used an Orange Cty zip.) But you put together some scenarios (not all of them extreme, some under your ded) and see what each would amount to. And compare lab, x-ray and ER charges. On the Bronze PPO I am looking at, eg, you pay 30% of a hospital bill after ded, up to the max oop. On the Silver PPO, you pay 20% after ded. That can be a substantial difference- on top of the difference in deductibles. ER is % versus flat fee. And you look at the actual Plan Benefits Summary, too, for the items not covered in the easy summary on the quote page. </p>
<p>“Don’t know. Pretty sure it’s $6350.”</p>
<p>Not trying to be harsh with you, CF, but for all your knowledge of Obamacare it is pretty interesting you don’t know the out-of-pocket maximum of your own health insurance plan. I highly doubt that an employer plan with no deductible would have this high of an out-of-pocket maximum. I would bet you it is much less.</p>
<p>LF, I don’t really want to reveal my zip code here but if you enter 93101 it will reflect the rates for my plans. The plans you are referencing are not HSA plans. The plan I was offered by Blue Shield is similar to the HSA Bronze. There is no copay for the bronze HSA plan. I pay 100% after deductible until I hit the out-of-pocket maximum. The silver plans are out of the question. They run from $1350 to $1,400 a month for a lousy network. Wouldn’t touch that with a ten foot pole. As a matter of fact, all these plans suck.</p>
<p>
This is an innacurate statement about Covered Cal Bronze HSA plans. The HSA Bronze plans have a $4500 deductible; after reaching the deductible, the insured pays 40% of charges until hitting the out-of-pocket max of $6350. (You can double those numbers for a family plan). See: <a href=“Be Well | Blue Shield of CA”>Be Well | Blue Shield of CA;
<p>Mathematically, an individual would reach the out of pocket maximum after incurring $9125 of out-of-pocket costs; at that point insurance would kick in for 100%.</p>
<p>The HSA plan comes with an additional tax break for the taxpayer, because of the tax writeoff for the HSA deposits. For an individual over age 55, that’s $4300. For an individual with a 28% marginal federal tax rate, that’s a $1200 tax savings.</p>
<p>Oh, I just saw where GP said he’d “teach” Fang about the relationship between premiums and deductibles. lol</p>
<p>No, next step for you, GP, is your own. Time to bone up on this stuff. Lay off on the barbs and figure out what you’ll do. </p>
<p>Good catch, Calmom. I confused it with the non-HSA bronze exchange plan which has a deductible of $5,000. I also didn’t mean to say I pay 100% after deductible. I was thinking of my old HSA $5,200 plan which doesn’t have a copay because the deductible and the out-of-pocket maximum were the same. After I hit the deductible with that plan, the insurance company paid 100% of the costs.</p>
<p>I think you meant to say an individual would reach the out-of-pocket maximum after incurring $9,125 of costs. These costs wouldn’t necessarily be out-of pocket for the subscriber as they would also include the insurer’s share of the costs.</p>
<p>The point I was making is still valid. In fact, it only buttresses my point even more. Having to pay a 40% copay after the deductible is worse than my old plan where I paid zero after the deductible. The silver plans are a ton of money for a pitiful network, and the bronze plan is also very unattractive unless you like paying $1,110 a month for a plan with a $9,000 deductible and a $12,700 out-of-pocket maximum for two people.</p>
<p>PS. One of things I regret about leaving the individual market is that I cannot make any HSA contributions in the future. I had been doing this since 2005 (I think that was the first year). I blame Obamacare for this, too. BTW, Calmom seems to love this tax break. I don’t have to remind her which President was responsible for the introduction of HSA’s.</p>
<p>It’s an ill wind and all that…
… 'cause we can keep singing the glory of all the ‘newly insured’ until it is. </p>
<p>Granted, there’s a price…
… but we’ve two patsies (bolded) on the hook for it.
<a href=“Parts of Obamacare site still missing - POLITICO”>Parts of Obamacare site still missing - POLITICO;
<p>I wish I could conduct a human behavior experiment…</p>
<p>Send two groups of people…group A being those who see few problems in the current ACA status. And, those problems that do exist are at best irritants and at most something that will be fixed but it’s not urgent. But group A prefers to just go with the image presented.</p>
<p>Group B - those who look behind the banner headlines, questionable numbers, and massaged budget figures…</p>
<p>I’d like to follow these groups through a tour of Universal Studios. It would be curious to see who simply goes with the fantasy of what is up front, that which one will see in the final product on camera…and who would hang back and try and sneak a peek behind the facades. "Hey honey looooook!!! Main street isn’t really beautiful stores and parks…back here it is a set held up with 2X4’s and the parks are just painted canvases!!! There are those who like the fantasy because it’s a story into which they like to be immersed (yes, I too love a good movie and don’t really question the hows and whys and it just plain feels good)…and those that look behind the scenes (H ruins so many plays because he will go into detail as to how the lights and technical aspects work - and point out all the oops and errors). Regretfully the ACA is not theater or the movies.</p>
<p>Either “The Wizard of Oz” or “The Emperor’s New Clothes” would be good metaphors.</p>
<p>Oh OK, catahoula. We certainly can’t tolerate an insurance system with problems, so let’s just throw the whole thing overboard and go back to what we had. My D will not be able to get insurance at any price, but I guess that’s unimportant. Will that fix things for you?</p>
<p>Geez, you make it sound like sick people never had insurance. We all know sick, insured people. Nonsense.</p>