<p>Now I see why California carefully selected the plans offered on the exchanges. Choosing among 138 plans? That’s frightening. People faced with making that choice are going to seriously consider just choosing no plan.</p>
<p>Does the BS prohibited UC hospital situation mean that someone with BS would be better off purchasing the UC student insurance if their child attends a UC?</p>
<p>TatinG, could you provide a link to the LA Times article from today? People should remember if your providers are not on the exchange in Ca., then they won’t be on the plans off the exchange either. One doesn’t have any real choices in Ca. anymore.</p>
<p>Poetgrl, I think there’s been some misunderstanding of what I posted about Bronze being a better option – as of 2014, all plans whether on or off exchange will fit in the metal tiers. So when I refer to a metal tier, I am referring to both on- and off- exchange policies. Many companies are offering a wider range of policies off-exchange within each tier than what can be purchased on-exchange (and is subsidy eligible). </p>
<p>The bottom line is that any insurance company will build the benefits into their premiums - that’s just how it is done and how it always done. The question is alway going to be to weigh the difference in premium costs with the potential benefit offered by the more expensive plan. The insurance company has the advantage of superior actuarial information - they know the stats, they know the costs. The only advantage a policy buyer has is better knowledge of their own medical needs – if you know that you need a prescription medication that costs $600 per month, for example, then you are able to factor in the benefit of an insurance plan that lets you buy a generic for $50 month and perhaps conclude that the your drug benefit in the first few months will be enough to compensate for the annual premium difference.</p>
<p>Interesteddad said that he generally doesn’t have significant medical expenses, so statistically he is better off to buy the cheapest policy in any market, on or off exchange, given the ACA cap on out-of-pocket expenses. The math is still the same: minimum costs v. maximum. There’s always a gamble: a potential that Interesteddad might buy the Bronze plan and then 2014 will be the year that his medical expenses just happen to hit the mark where he would have been better off with a higher premium, lower deductible plan. But the odds are against that. </p>
<p>All insurance is a gamble. The insurance company is making a risk assessment and pricing its policies accordingly. </p>
<p>I agree that the various provider networks can be confusing and it’s important to check that aspect of a policy. But the premium vs. benefit part is simple math, and I find it to be relatively easy math as well. I simply created a spreadsheet on Excel and plugged in some basic info and created an easy chart that tell me what level of medical expenditures would make the higher tier categories a better deal.</p>
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<p>Are you sure? Is the full cost premium of the lowest cost Bronze on the exchange for your region less than 8% of your income?</p>
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<p>I think that’s just the inflation-index increase – the maximum out-of-pockets were in the laws governing HSA’s to start, the ACA numbers were modeled on those – but there is an inflation index so those will go up from one year to the next. $5950 was the out-of-pocket max for 2011. The IRS does the math and issues an announcement each year as to what the limits are for the following year.</p>
<p>I don’t find the math even slightly taxing. It’s very easy to see the way, in this state, they get everyone of a certain age to pay the same amount of money with the combo of premiums and deductibles. </p>
<p>The only thing to do is pay the lowest premium if you don’t use any healthcare. </p>
<p>Here it all adds up to the same eventual expense before you reach your oop limit. </p>
<p>Clearly they’ve decided that this is what they need to pay their bills. I’m not confused about the math, just the networks.</p>
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No, because some UC plans don’t cover treatment at UC hospitals either. The UC hospitals are teaching hospitals, but that’s not the same as the student health clinic on campus. The hospital might not even be particularly close to campus – I attended UC Davis as an undergrad. UC Davis Medical center is in Sacramento, about 20 miles away from campus. Most students didn’t have cars and wouldn’t have had a way to even get to the hospital. (That was a long time ago, I don’t even remember where students would go if they needed more than routine care – but there are hospitals that are closer). </p>
<p>Many of the employer plans offered to UC staff don’t include the UC hospitals either.</p>
<p>A good way to see which plan is better is to make an Excel spreadsheet as calmom explains, and then graph total money spent by you on the y axis versus total covered health costs on the x axis, with a different color for each plan you’re evaluating. Then it’ll be easy to see, for each possible health cost scenario, which plan would be the cheapest.</p>
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<p>When I did the application on the website, it did not offer me a catastrophic plan. However, I may have run into one of the so-called “glitches”. I have not given up hope on that front. Assuming I’m allowed to purchase insurance when my grandfathered policy ends on June 30th (and hopefully the law doesn’t say "If you like your plan, you can’t keep it AND you can’t get a new one), I don’t have to do anything at this time. I’m going to let the dust settle.</p>
<p>My health insurance has led me to one spending decision. I was technically due for my next colonscopy this month. But, since I’ve only spent a couple hundred dollars on health car this year, there’s very little chance I’ll hit the deducatable in the next two months. So, it makes sense to do the colonoscopy next calendar year. I’m not terribly concerned about the difference of two or three months either way.</p>
<p>Well, on the math part, I think that the rules pretty much dictate that the premiums have to match the benefits, given the 80% rule. (If they pay less than 80% of the premium dollars out in benefits, they have to refund the difference to their subscribers – if they pay more than 80%, then the money is coming from their own reserves for administrative expenses and any potential profit, so that would be bad planning). The only possible difference would be if they adjusted their models to compensate for anticipated differences in the insurance pools – that is, if they decided that poor people were more likely to enroll in Bronze, and poor people tend to have greater health problems, so more would be spent that way – but with the subsidies, it is the lower-cost exchange Silver plans that will probably end up with all of the marginally poor. The Bronze plans are going to be most attractive to full payers and people who know that their medical usage is low, so if anything that would exert a greater downward pressure on the Bronze premiums.</p>
<p>Are there any states where an insurance provider will use a different network based on the choice of a metal plan?</p>
<p>Interesteddad – keep in mind that under ACA, “catastrophic” is still limited to the same out-of-pocket max. In California, the catastrophic plan is a straight $6350 deductible – no benefits other than the preventive health until that deductible is reached, after that insurer pays 100%. The premium rate is not much lower than the Bronzes, which have $5000/$4500 deductibles on exchange.</p>
<p>If you can keep your current policy until June, you will be able to buy on exchange when your policy expires – loss of existing coverage is one of those circumstances that lets you buy outside of open enrollment. With the numbers you have on your HSA - already a $6350 deductible, you might already have essentially the best you are going to get in terms of “catastrophic.” (See my post on the math above – if the insurance company is going collect $X in premiums, and going to have to pay 100% of all in-network costs over $6350, then there’s not a lot of wiggle room on the math.)</p>
<p>It’s possible that if you have a birthday between January and June that the policy you buy in June will be rated for a year older than you are now. I’m not sure, but I think it goes by the age you will be the first month that coverage is effective, but maybe with ACA they just look at how old you are on Dec 31 of the previous year. I have no clue, actually – somewhere along the line I came across a regulation that said that each year the premium price for an adult will be go higher, “if” the adult has had a birthday in the interim, and I had a hard time trying to imagine a situation where a year could go by without a person having a birthday. But maybe an outside-open-enrollment purchase was what the regulators had in mind.</p>
<p>This shows the different insurance providers in California per region. </p>
<p><a href=“https://www.coveredca.com/news/PDFs/CC-health-plans-booklet-rev2.pdf[/url]”>https://www.coveredca.com/news/PDFs/CC-health-plans-booklet-rev2.pdf</a></p>
<p>I see differences in coverage depending on the region because there are differences in coverage depending on the region. :)</p>
<p>GPs region has fewer choices than mine or CFs or Calmoms. GP…you dont talk for my region.</p>
<p>Okay, here’s my final decision.</p>
<p>In my state there are three plans in each metal tier. One is any doctor anywhere, one is limited and one is restricted. </p>
<p>I chose the private (not on the exchange) bronze level with no network restrictions.</p>
<p>Good luck everyone!</p>
<p>Sounds good. Good luck poetgrl.</p>
<p>I hope you end up getting a big rebate, poetgrl.</p>
<p>Hah! I mostly just hope the insurance company spends the money on the people who need it and doesn’t find a way to fudge the 15%</p>
<p>We can hope. ;)</p>
<p>Poetgrl, I am envious that you have a plan that allows you to choose any doctor. In Ca., there is no such animal.</p>
<p>It’s a big and complicated state, GP.</p>
<p>I don’t envy trying to figure that state out for healthcare.</p>
<p>Good luck to you!</p>