Blue Shield has added the University of California to its plans.
http://insuremekevin.com/calhabg/blue-shield-to-drop-stanford-health-care-from-ifp-network/
YES! That’s my point. Go to Covered California. Pick a zip code in Silicon Valley-- for example, pretend you live in the lobby of Apple Computer, 95014. Look at the prices for Blue Shield plans. Pretend you’re near Medicare age. Ask yourself why you’d ever buy the Platinum when you could have bought the Silver.
Both dstark and arabrab say that self-employed people can deduct their entire insurance premium, but not their entire health care costs, from their taxes. OK. So the hypothetical person who buys Silver deducts their premium, and the person who buys Platinum deducts theirs. The difference is $6600 in deductibility. For both these buyers, that whopping $16,800 that the Platinum would have cost is less than 10% of gross income, or we’re not having this discussion because both of them could have deducted their health costs from their taxes.
So Platinum Card’s after-tax cost just for health care premiums is about $4000 more than Silver Fox’s cost, before either of them has as much as a sniffle. The most Silver Fox can spend, counting all costs, is $6250, because that’s Silver Fox’s maximum out of pocket. And if Silver Fox spends less than $4000, it doesn’t matter what Platinum Card spends; Silver Fox wins. What is the scenario where Silver Fox spends more than Platinum Card, for the same health care?
BS of California is making positive changes to it’s individual plan provider networks. They were the ones with the EPO option during the first ACA signup which caused a patient uproar.
I looked at their IFP options several weeks ago and stumbled over some interesting wording…I’m going by memory but the gist was ‘Our EPO clients now have access to the larger PPO network’. I’d called for clarification but was told this applied to the next year (2016) and since I did not have a qualifying circumstance for changing insurance at that time, they could not provide any further info. My question was…they why not just call it a PPO plan?
The reason I would jump to Kaiser is because I’ve watched that organization ‘grow up’ over the past 15 years. I’ve managed most of my elderly parents healthcare for the past decade and they have been with Kaiser. The quality of care is great (true, sometimes a bit of pushy intervention is needed). And you KNOW your anesthesiologist and ER triage doc will be ‘in network’. I’ve also found Kaiser physicians to be very willing to spend time discussing issues via email or phone. My guess is they are able to do this since they don’t need to spend 20 minutes of each hour dealing with paperwork.
We have our doctors and we don’t want to change, but we thought seriously about going to Kaiser. We had Fang Jr on our plan, but we switched him over to Kaiser. I think highly of Kaiser. We might switch over for 2017.
Check out the difference in hospital stay costs between the plans. There is a 2250 deductible with silver plans. After you pay the deductible, you pay 20 percent of the costs.
With a platinum plan, you pay 10 percent of the costs.
I am not saying you can save a lot of money by choosing a blue shield platinum plan over a blue shield silver plan. You can’t. Is it more likely that almost everybody will save money by choosing a blue shield silver plan over a blue shield platinum plan. Yes it is.
Kaiser prices its platinum plans differently.
So…anyone have suggestions for AZ…not CA?
Doesn’t the out of pocket maximum include everything? Hospitals, doctor visits, prescription drugs, everything? Including the deductible?
Not exactly. They’re still in negotiations, and probably they’ll come to terms somewhere around February, I’ve been told. They did the same thing last year. That’s one reason I like Kaiser-- no annoying brinkmanship every year. This is our first year with individual insurance, and it may be our last year before we make the jump to Kaiser.
Ancient and doddering, dstark. Ancient and doddering.
Let’s just stay in network. Yes.
Out of pocket spending does not rise similarly with each plan.
What are the out of network spending limits under each plan?
I shouldn’t have gotten into this discussion. 
If somebody is in a 45 percent combined federal and state tax bracket, under rare circumstances, he may be able to save a few hundred bucks choosing a bs platinum plan over a bs silver plan. (In network).
I just objected to the word nobody benefits…almost nobody benefits…
I thought it was published how many people buy platinum plans.
Kaiser prices its platinum plans so much better.
I don"t like Blue Shield.
I don’t think you should buy the bs platinum plan. I know you aren’ going to buy that plan.
My wife and I would save a combined $6,000 a year pre tax by choosing a Kaiser platinum plan over a BS platinum plan.
Retirees who can’t deduct these premiums really get screwed.
Anyone on a state Co-op plan? I’m considering due to the HUGE jump in my premiums. Net research varies. Sounds like they had a rocky start in 2013, but some have been doing better now. One major concern is what happens if they default? Is the insured left responsible for the medical bills, or are insurance companies insured
Thumper, during the original mega thread, when a similar question came up, I did ask my insurer, what if the right doc (call it that) were needed and is not in-plan? They talked about concessions, when the case can be made.
Coverage of out of network providers vary by plan. Some will cover at a reduced rate and some won’t cover at all. You will need to contact insurer for more direct information.
Customs has made the decision to not go after people who import prescription drugs for individual use as long the supply is no more than 3 months and they aren’t controlled medications. Research has shown a good number of imported medications via the internet are adulterated/fake. With online pharmacies, you don’t know if they are telling the truth or not. Many so-called Canadian pharmacies are actually based in India or China. If you are going to an actual physical pharmacy in Canada, you are fine; but online, who knows.
FWIW, my MIL had several packages of migraine medication impounded by US customs even though it was less than a 90 day supply.
She was also told that the expense associated with imported drugs wasn’t allowable as a tax deduction since they were considered illegal drugs.
Perhaps the rules have changed.
I am trying to help my 26 year old pick a health plan from his work. They offer 9 plans, basically BC/BS and HMO types, with different premiums/deductibles/copay/coinsurance, including prescriptions.
With HMO from his work, he will lose the optometrist, where he goes every 2 year for eye exam and new prescription, he can find another one near home. (Current one is in another town where we used to live, he has been going to him since 10th grade).
HMO premium is cheaper, he pays about 25% of premium costs, with typical BC/BC at $11k a year for single, cheapest HMO $9k, so the difference with his 25% will be around $500 a year.
Copay for BC/BS type plan is $10, HMO is $20, with prescription for the former at 10% while higher for HMO.
I am leaning to have him pick the less expensive HMO plan. Any cons?
If he doesn’t have any particular health issues that push him to get a PPO type plan, the HMO sounds reasonable.
It might be good to make sure he finds out now what Urgent Cares and hospitals are in his network, and the advantage of using an in-network Urgent Care instead of a hospital ER in case he needs care out-of-hours. In our plan, the Urgent Care has a $75 copay, the ER has a $750 copay. Worse, there are now “freestanding” ERs in our state that look like Urgent Care centers, but they’re operated by hospitals and billed at hospital ER rates. Buyer beware.
The premiums for our Anthem/Blue Cross will increase almost $200/month next year. Insurance companies have had no interest in controlling costs. For the flu shots, BC paid our “in network” the full cost of $52/shot. We asked them if we could get the full reimbursements of $14.95/shot at Costco. BC said no since Costco was not “in network”. We could only get 1/2 of the cost back.
This is manifestly untrue. In my area, Blue Shield has had well-publicized disputed negotiations both with megacorp Sutter Health, which has been buying up hospitals and medical groups and jacking prices, and with Stanford Hospital. These disputes are entirely over costs. Sutter Health and Stanford want to charge a lot of money, and Blue Shield doesn’t want to pay it.
hopeful820- my S had a similar choice a few months back. He ended up with the HMO. It wouldn’t have been my choice but he is saving quite a bit.
My older D works for a small business that doesn’t provide group insurance. She bought a Anthem Bronze plan last year but is facing a pretty large increase in premium. She is considering going with the cheapest minimum plan. It would save her $600 in premium cost for the year. Her feeling is that her present plan doesn’t cover much anyway and is wasting her money. She is healthy aside from asthma and aside from her annual exam rarely sees a Dr. What risks is she taking going with minimum coverage? She doesn’t qualify for a subsidy.
H and I have always purchased private insurance. Our network locally has shrunk to the point where if I don’t want to go to the large clinic practice I’m almost always out of network. Every single Dr I have a LNG term relationship is now out of network. The Dr’s in network are booking months out. Frustrating.
People in this thread and elsewhere often talk about how when HMOs first started, they were hailed as cost-saving miracles, but in large part they failed. They did fail, not because they didn’t contain costs but because people didn’t like the ways they contained cost. In particular, people didn’t like having to see only the HMO’s doctors, and not other doctors.
Fast-forward to today. Insurers are doing the same thing HMOs are doing: restricting the choice of doctors and hospitals in order to contain costs. HMOs don’t look so bad now, do they? Kaiser may restrict one’s choice of doctors, but unlike some of these individual insurance plans, Kaiser has plenty of local doctors to choose from. If I choose Kaiser, I’ll have to change doctors, but I’ll have no trouble finding new doctors to handle my and my husband’s health issues.