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<p>So, some companies entered the 2014 market with cheap prices. Some intentionally lowballed to get market share, figuring that a lot of people wouldn’t bother to change plans when they raised prices for 2015; that could be a sound marketing move. Others misestimated their costs.</p>
<p>In any case, smart shoppers shop again this year.</p>
<p>I think it would be beneficial if posters identified their State of residence and possibly a more narrow geographic region. </p>
<p>I was clicking around the CA off exchange individual market options. For my area there are three providers: Anthem BC, Blue Shield, and Healthnet. One of the plans (I think it was Healthnet) says it is a MSP-PPO. Okay, I get the PPO part but had to google MSP. Turns out it is ‘Multi State Plan’. A reasonable assumption would be that this means the plan covers you if travel outside of CA. I played around with their provider network link and it brings up hospital facilities in Reno, NV. (just picked a random place). Okay, so…this lends credence to my assumption as to the meaning of MSP. However, when I selected a different plan offered by the same company and identified as only PPO - it ALSO brought up the Reno facility.</p>
<p>Can anyone shed light on this?</p>
<p>I found this online, somewhere I’m not allowed to quote from, and I couldn’t find a better source. But I think it’s right. Supposedly this is an explanation given by Anthem Blue Cross, about Multi-State Plans.</p>
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<p>So, basically, if this is right, having the “Multi-State Plan” designation doesn’t mean anything useful, and in particular it doesn’t mean that subscribers can get care in more than one state.</p>
<p>@cardinalfang: Thanks! Good thing I didn’t apply the ‘reasonable person’ mentality. Good Grief. I’m sure I won’t be the only one who gets the assumption wrong.</p>
<p>On another note…</p>
<p>I am currently taking the generic version of a particular medication. All is well. However, there is reason to believe I should increase the dosage. There are well known and well documented problems with the higher dosage generic version. The FDA pulled several brands off the market - the sustained release portion wasn’t working. Seems the generic delivers an overdose when first taken and then poops out later. The name brand is not covered at any level by our insurance. Since I had used the higher dosage name brand several years ago, I thought …aw heck…let’s splurge and pay for it. So, I called Costco…drum roll…a 30 day supply for members is…$804! </p>
<p>So…I called the non- US pharmacy thru which I am already receiving another prescription…and…drum roll…a 30 day supply is…$53! A quick call to my Dr’s office with an explanation of the situation and an electronic prescription is winging its’ way off shore.</p>
<p>I agree that a reasonable person would think a multi-state plan would mean the subscriber could get care in more than one state. </p>
<p>That same reasonable person would wonder why Americans have to pay 15 times more than Canadians for the same drug.</p>
<p>Wow…I guess that make me reasonable! I will have to inform H, he has been doubting my claims in this regard lately! :)) </p>
<p>:)</p>
<p>I went on Covered California today to see how it was working. Under preview plans I put in our stats of $100k income, family of 5 living in a norcal suburb. It tells me I would have to pay $5 for a Kaiser plan after subsidy. I thought I made a mistake. I redid it with another zip code and $110,000 income with the same results. Now I am positive this is incorrect as I did it earlier in the week and the premiums were around $380 - $450. </p>
<p>A Bronze Kaiser plan? What was the premium before the subsidy?</p>
<p>Those results are because with a larger family, the subsidy is enough to pretty much cover the cost differential between Bronze & Silver premiums. Most people in that situation are going to choose the Silver plan – the subsidy is keyed to the 2nd lower cost Silver. So, for example, if the benchmark plan has a premium of $1500 per month, and the family is eligible for subsidies to reduce that amount to $500, then they can opt to apply that $1000 a month subsidy to a lower cost plan. So if there is a Bronze plan that costs $1005 a month, that subsidy will bring their cost down to $5.</p>
<p>I don’t think that most larger families would go for that plan because of the higher deductible and the coinsurance (rather than co-pay) set up. The problem is that the larger your family, the greater the likelihood that at least one person is going to incur significant medical costs during the year. On the other hand, if the family does have significant assets to fall back on – I can see the attraction of banking the money, knowing that the maximum out of pocket is limited to roughly $13000, assuming you are happy with the network. Plus of course if the family goes for an HSA, you have the added tax benefits, as well as banked funds to help pay the medical bills. </p>
<p>It is showing a subsidy of $1403 so that would be $1408 premium before the subsidy. The subsidy should be around $1000. This is definitely incorrect. </p>
<p>Yes its a bronze plan.</p>
<p>I have no idea what our income next year is going to be, so I played around with numbers. At a difference of only $2,000 in income, our monthly subsidy went from $600+ to $0! So I guess there’s a cliff? Why wouldn’t there be a gradual reduction in subsidy as your income goes up?</p>
<p>MaineLonghorn, there is a cliff. It’s at 400% of the poverty level- around $78K for a family of three, $94K for a family of four. The cliff sucks.</p>
<p>3younguns, why do you think the subsidy should be around $1000? As you probably know the subsidy is the difference between how much you are deemed able to pay and the cost of the second-cheapest Silver plan. If you have a family of 5, and your income is $100K, you are going to be deemed to be able to pay around $9000/year, or $750/month (I don’t have a chart for the exact numbers at hand right now, but it’s something around 9% of income).</p>
<p>How much does your second-cheapest Silver plan cost? </p>
<p>I plugged in your numbers ($100K income, ages of 55, 55, 24, 23, 22) for my area. The second-lowest Silver costs about $2000 a month, and the cost to my hypothetical family would be $617/month, because that’s how much my hypothetical family would be deemed able to pay.</p>
<p>I think the numbers you’re seeing for the Bronze plan are correct.</p>
<p>We’ve talked about this before, but I’m going to put in a quick reminder about Cost Sharing Reductions, because it can be relevant for our low-income kids buying insurance. </p>
<p>People between 100% and 400% of poverty level are eligible for premium subsidies. But in addition, people below around 250% of poverty level can also be eligible for subsidies for their copays and deductible- the Cost Sharing Reduction. But subscribers can only get a Cost Sharing Reduction if they buy a Silver plan.</p>
<p>So for someone with a low income and moderate to large expected healthcare needs, buying a Silver plan could end up cheaper. They’d have to pay more upfront, for their premium, but less when they got medical care and faced lower copays and deductible.</p>
<p>@Cal mom @ Cardinal Fang. I understand everything you guys are saying. This is our second year on Covered California so I understand it. Cardinal, The second lowest silver plan is $408 with the subsidy or $1887 without. You are correct, it should be around $750, the same as it was last year. Per the covered CA website prior to today and the Kaiser Foundation website our subsidy should be $1123. Today Covered CA is showing $1480 subsidy which is the $350 difference between $750 and $408. I’m telling you the website is incorrect TODAY. It is showing $350 more than it should. Maybe its just my area that is incorrect but I tried 3 zipcodes with the same results. 94526,94904,and 94803. 58, 57, 20,20,20 (yes triplets all in college)</p>
<p>We choose the bronze plan because the annual cost is $4000 less than the silver plan. Basically I am the only one who has prescriptions and specialist visits but they don’t come anyway near $4000 per year. We prefer to roll the dice which has paid off for us.</p>
<p>I tried 94526, and the numbers you gave, and I’m seeing a subsidy of $1127. Maybe they just fixed the website right now?</p>
<p>That is really bizarre. I was using " preview plans". When I rebooted and pulled up the website again it was a totally different website It was not what I had on there this morning. I’m not a computer person but could it have been the old website because I was looking at it last night and not turned computer off? Weird!
So NEVERMIND!</p>
<p>They could have fixed it in between this morning and now.</p>
<p>My wife went online to see her cataract bills. I have trashed Anthem quite a bit in the past.</p>
<p>The actual operation for each eye (excluding the anesthesiologist) looks to be about $4,500 for a total of $9,000. This does not include the multi focal lenses. The negotiated rate for both eyes was under $3,500. </p>
<p>Of course, the anesthesiologist looks to be out of network. </p>
<p>Right now…the savings using Anthem compared to going uninsured is approximately $5,500. </p>
<p>We were told the cost was going to be close to $14,000 for cataract surgery using the muli focal lenses. </p>
<p>We are not going to be close to that. From the web site, it looks like the costs are closer to $9,000. </p>
<p>The opthamologists can do these operations like deli workers make deli sandwiches. The opthamologists can turn out quite a few an hour. Even though the negotiated rate was a lot lower than the billed rate, I think the opthamologists will be ok. </p>
<p>The general doctor that does the ekg and the checkup before the cataract surgery makes crap. </p>