<p>Yeah. All the stuff like copays and co-insurance only applies to the middle ground of annual expenses between your deductible and your annual max. Basically:</p>
<p>From $0 to your deductible $, you pay 100%
From annual max and above, insurance pays 100%
In between, you split the costs based on copays or co insurance.</p>
<p>On my current plan, it was cheaper to have the same $5950 deductible and max-out-of pocket. Since I never come close to the deductable, I was never going to benefit from lower co-pays, but the premiums were thousands more per year.</p>
<p>But that’s all old news now. I like my plan, but I can’t keep it. Basically, nobody can keep their old plans except under some kind of “grandfather” clause that varies depending on the type of plan. In my case, I can keep my old plan for 12 months after the last renewal date, which brings me to July 2014. I hope the exchanges are working by then.</p>
<p>That works only if they each have a $6350 deductible – which could be possible, but then there would be no difference between each of the plans. (or at least the Bronze would need that - perhaps others could have someone smaller deductibles to make the math work out)</p>
<p>ACA specifies the actuarial levels of each plan – for example, Bronze has to be the actuarial of insurance paying 60% of expenses, Silver has to be 70%, Gold has to be 80%, Platininum has to be 90%. That’s not the copays – that’s the predicted average split for all policies. So they need to project and average out expenses for their insured pool, and then set the costs and benefits for each level so the right level is struck.</p>
The exchanges are working now, but the web sites may not be. For healthcare.gov – you can call 1-800-318-2596. I’ve called the California exchange 800 number a couple of times and did not have significant wait time. </p>
<p>If they have to, I’m sure they can hire more people to man the phones. It’s old tech, but it certainly is doable.</p>
<p>“From $0 to your deductible $, you pay 100%
From annual max and above, insurance pays 100%
In between, you split the costs based on copays or co insurance.”</p>
<p>Yeah, I get it now. Very difficult for me to to wrap my head around as I have a PPO and if I stay in network besides our monthly premium and co-pays we don’t pay anything else. We have never paid one penny of our deductible (which I think is $2000 per person.) I have had several out patient surgeries and was hospitalized once and we’ve never paid a thing for those - not even a co-pay. </p>
<p>I did go though fertility treatment 20 something years ago and none of that covered at the time at all. Cost us $80K. A few years after we stopped that and adopted my plan started covering it.</p>
<p>Dstark – I think that the networks are the same within companies at all levels. Without a subsidy the Bronze is clearly a better option for someone with low end expenses, but there’s a psychological impact of the way that they are structured. That is, the high deductible just sounds scarier; the higher co-pays just seem more expensive.</p>
<p>I took a great online class at Coursera in Behavioral Economics with Dan Ariely that was full of examples of that sort of stuff. (Cool information from a marketing perspective).</p>
<p>Actually, here, if you do the math, ALL policies in the state have some configuration, with the exception of one gold plan, which gets the family plan up to 22000 out of pocket.</p>
<p>There is one plan that is at 18,000, but more up front. For us, the best strategy is to spend the least up front, but still have access to the best selection of doctors.</p>
<p>The bronze plans also get the family up to 22000 out of pocket. </p>
<p>I did the math. only this one plan is less at the backside, but wayyyyy more up front.</p>
<p>six of one, half a dozen of another. Either way it’s the same.</p>
<p>Talking to an apparatchnik on the phone isn’t what I need. These policies are so complicated that you really have to sit and think through how much you will pay out of pocket for the premiums plus the first $1000 of health care cost, the premiums plus the first $2000 of health care costs, and so on and so forth up the ladder.</p>
<p>In a normal year, I’m likely to have under $500 in health care costs OR $20,000+ (if I were to be hospitalized from an accident/illness. I need the details of the plans to shop effectively. I probably know more about it than the person I would talk to on the phone.</p>
<p>Fortunately, the Blue Cross website here in NH has a functioning website that lists all of their available plans – both on the exchange or not. At least at first glance, I’ll be able to buy an exchange plan that is only slightly more expensive with only slightly higher max-out-of-pocket than my current plan.</p>
<p>Just from a cursory look, it appears that Blue Cross has simply taken all of their high out-of-pocket (~$6000 annual for a single person) and dumped them into the exchanges. Those plans suit me because I use so little health care that I’m really looking for insurance protection against the big stuff. I don’t run to the doctor with every runny nose. The only medication I take is $4 a month at WalMart. So, I don’t want to pay higher premiums to have better coverage on the nickle and dime stuff. I don’t like having to pay $150 for a doctor visit, but I like it better than paying an extra $400 a month in premiums to save the $150 each for a couple of doctor visits!</p>
<p>Bronze and Silver plans not the same because those fortunate enough to not use a lot of health care services wont get to the out of pocket max or even use all of the deductible.</p>
<p>I too took that Dan Ariely course on Coursera course, the one on behavioral economics. It was really good, with much better production values than other Coursera courses. They must have spent a ton of money setting up that class. It’ll be offered again; I recommend it.</p>
<p>Through the exchange, I can get a zero deductible plan from Carefirst for $596 per month. $1000 deductible is $532. $2500 deductible is $482 a month. My current grandfathered-in plan has a $500 deductible, with no prescription coverage, and is $552. The network of physicians is the same so no change in doctor choice.</p>