Exactly so, but I couldn’t figure out how the Platinum Plan would result in a lower overall cost for anyone in any circumstance, since it costs $6600 more per year than the Silver, and still has a max out of pocket of $4000. Dstark says that the self-employed can deduct their entire insurance premium (but not their out of pocket health costs) from their taxes, which might be the explanation.
If Canadians can buy drugs that aren’t tainted, I don’t particularly see why I can’t buy drugs from a real Canadian pharmacy the same way. I assume that when Medco sends me drugs by mail order, they’re legit. If drug importation from Canada and Europe was legalized, it could work the same way.
Right now there are some shady operators in part because importation is not legal. Fix the legality, and the problem greatly diminishes.
I don’t want price caps. I just don’t think that American consumers ought to be paying for the bulk of pharmaceutical profits worldwide. Arbitrage would fix this rather nicely.
I think you would need to look at what each plan covers, and how much you pay out of pocket for different things. In theory, if the Platinum plan costs $6600 more than the Silver plan, then the average Platinum subscriber would see something like $6000 less in copays than the Silver subscriber. They both have the same out of pocket, but the richer plan covers so much more that it takes a lot longer to reach that level.
Again, this is in theory - I have glanced only cursorily at these plans.
The maximum out of pocket for any plan is $6850 for 2016. That’s set by law.
So it’s difficult to understand how a Platinum plan that is $6600 more than a Silver plan could be a better deal. If the person gets the Silver plan and pays the max out of pocket, they’ve only paid $250 more than just the premiums for the Platinum-- and if that sick person had bought Platinum instead, they would have had at least $250 in copays or coinsurance.
Maybe dstark’s tax savings would make the difference, but that’s a hard case to make. The subscriber would only get the benefit of the tax savings on the $6600 premium difference. If the Platinum turned out to be better, it would only be a small bit better.
Busdriver, none of this is as simple as stupid companies vs savvy. If one company brings in 1500 or 5000 employees and another is representing 30k+, the negotiating power is different. Then, if there’s a strong union involved, which demands a further discount by the employer, the net price to the individual/family can be even lower. And all that is off the exchange, not an exchange product.
Back to Fang. On the Silvers in dstark’s link, the max OOP is $6350, not $6850. YMMV.
Out of idle curiosity, I did run numbers, using the Kaiser link. Say someone knows they need a 30k hip replacement in 2016, with 3 days in hospital. They might think a Platinum is worth it, as it covers more or better. But.
In short, the Silver max OOP of $6350 does seem to trump the $6600 extra Platinum premium. I ran that hip operation with the deductibles, co-ins %, per diem in-patient cost differences and was surprised. Even considered any differences in x-ray costs, whatever. If there’s a magic bullet in there, I don’t see it. (Maybe someone does get a tax break, but that’s too individual for me to consider.)
What might make a difference is is someone were purchasing on the exchange, where prices are income dependent, where it doesn’t net to $6600 more.
My understanding is that this is the maximum any plan is allowed to levy, higher-level plans can have lower maximums. The idea is that the higher-level plans have higher up front costs but lower variable costs, meaning lower co-pays, deductibles, and maximums.
Has anyone tried to get a platinum plan and seen the maximum out of pocket?
I was looking at my Kaiser choices. The difference in plan costs between platinum and silver plans is much lower tha CF’s numbers. About $230 a month. $2760 a year. Then there are tax deductions. If the combined federal and state tax rate is 40 percent, the after tax cost is $1656. The oop max difference is 2250. Also, the siver plan has a 2250 deductible while tye platinm plan has a zero deductible. The platinum plan can be better under certain circumstances.
But cosmicfish, I actually ran it, from the Kaiser link. I was thinking like you and surprised. There may be some obscure value, but Fang hasn’t said there’s an obscure need. I considered the 30k surgery and 50k of something. Obviously, we’re all considering if no services are used, either.
What I think is happening in this example, is they have an offering that does not make sense unless one purchases through the exchange. (Or if there is a difference in doctor/hosp accessibility, which she said there isn’t.) I do know that, in my state, there are Gold plans like that. This is why I advocate running your numbers, projecting possible scenarios.
A mental health visit on Plat costs $20 versus $20 after deductible of $1500 on the Silver HSA or a flat $40-45 on the Silver HMO. But, so what, if you are paying $550 more per person, per month, to save that difference? You could hit that 1500 ded on the silver HSA and be down to $20 per visit- versus paying 550 more, every month, all year.
CF,
Is this really correct?
You’re right, dstark, I’m only seeing Kaiser and she quoted BS. Still, I find value in trying numbers.
CF’s numbers look like a bronze plan compared to a platinum plan to me…except lookng at those premiums…I didn’t think CF was so old! 
Most large companies self insure. I know myH’s does. I also know that as a salaried employee, our costs have gone up but the union employees their costs have remained the same as they are working under their last contract. I expect that at their new contract talks the company will be asking the union to bear more of their health care costs as we are already doing.
I am currently receiving two drugs from Canada. My US physician sent the prescription to the Canadian pharmacy in the same way they would have sent it to Costco. The physical suggested going thru Canada. One particular medication would have been almost $900/month at Costco! I specifically requested the name brand because of known (and FDA published) problems with the generics. The other med was not available in generic form in the US and the name brand version was 4X more than the Canadian price.
The name brand version were labeled as manufactured in Turkey or Israel.
So, I’m not clear on why some posters are saying it’s illegal to have prescriptions filled by Canadian pharmacies. I’m very sure this particular physician would not risk her practice by engaging in illegal activity.
I think I know a rationale for the CF Platinum Plan: If you own your own business, you can either take a full deduction for the cost of your health insurance or take an above-the-line adjustment to income for 1/2 the cost of your health insurance, depending on how your business is organized. Since very few taxpayers with incomes above $100K can itemize medical expenses, and most small businesses don’t offer 125 cafeteria savings plans, shifting expenses from non-deductible oop expenses to deductible premiums makes sense. Because it is an above-the-line adjustment, it reduces your Adjusted Gross Income, which might also make you eligible for other tax benefits/credits like the American Opportunity Tax Credit.
@dietz199 - I’m afraid the FDA disagrees with you, other than in very limited circumstances: http://www.fda.gov/AboutFDA/Transparency/Basics/ucm194904.htm
My issue is not with bronze vs silver vs any other metal color…it is that in Arizona all of the individual plans on the exchange are now HMO plans with a VERY narrow doctor list. Many doctors are not participating with these HMO set up plans. They just aren’t. The cost isn’t an issue…they are reasonable enough. But it’s insurance with little chance of being able to actually use it except for prescriptions…because the doctors won’t take these plans.
@arabrab My drugs fall under 3 of the conditions under which the FDA really doesn’t care about importation. Frankly, the exceptions are very vague and can be interpreted in a broad manner. Also, both drugs ARE approved in the US and have been for many years.
. This issue was a concern and discussed early on on another thread. The majority considered it to be either an over reaction or irrelevant. Have you checked off-exchange plans? These may offer non-HMO options. Of course, there are no subsidies for the off-exchange plans.
The ACA as it stands is simply not financially viable. (hence the ‘you get what you can pay for’ HMO only plans) However, since it’s implementation is piecemeal over several years the problems are showing up in bits and pieces. The next part of the Jenga tower most lily to crumble is the Medicaid expansion. States will be faced with spiraling costs and Medicaid patients will WISH they could get the limited HMO network.
For my situation, Blue Shield Platinum Plans are $250 a month more expensive than Kaiser Platinum Plans. Platinum plans are about $500 a month more than silver plans.
Blue Shield has also dropped Stanford from its individual PPO plans.
Yes, BS has dropped Kaiser. A substantial rumor now says Kaiser is coming to my area. H and I will jump ship from BS to Kaiser about 10 nanoseconds after it becomes available.
Lots of insurance companies no longer have PPO plans…at all. Many have converted to POS, and HSA plans.
As I said, I am happy my kids can get insurance. And yes, I advised the AZ kid to look off the exchange for a high deductible plan.