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Um, no one is doubting that lowcost insurance can be accessed b/c of ACA.
But the premiums are only one part of the equation. What do the policies COVER? When there is a high deductible, only partial coverage for pharmaceuticals . . . that equates to high out of pocket coverage.
I CHOOSE catastrophic insurance and know I will be paying for nearly all of my healthcare costs every year, out of pocket. However, I think most folks ASSUME that having healthcare insurance means low co-pays, 80% to full payment on hospital bills, Imaging, etc.
That is not the case with these plans. Folks need to read the fine print carefully when choosing a plan. Just b/c the premium is low, that doesn't mean the COST of healthcare for that individual throughout the year is going to add up to be low.
Bronze only pays 60 percent of cost with the insured paying the balance. As you note folks need to look at the big picture cost.
Ex. Son/dil - 46/43 - max out of pocket on silver plan is $12,600. Bronze would be higher because premium is 30% less. Son/dil said their deductibles/copays were plenty high on her employer coverage. Diff in mo. premium Bronze/Silver about $100 per Kaiser. So, they'll have to pick their poison. Don't have exact figures for WI yet. Can't get anything off healthcare.gov. Won't even let me "apply."
Ex. Son/dil - 46/43 - max out of pocket on silver plan is $12,600. Bronze would be higher because premium is 30% less. Son/dil said their deductibles/copays were plenty high on her employer coverage. Diff in mo. premium Bronze/Silver about $100 per Kaiser. So, they'll have to pick their poison. Don't have exact figures for WI yet. Can't get anything off healthcare.gov. Won't even let me "apply."
The sites have been flooded all day. Give it a week to settle down.
ACA has a limit on out of pocket costs (not including premiums) of $12,700....just because the premium is less doesn't mean the out of pocket costs are more. The Bronze plan is a 60/40 plan where you pay 60% of the billed charges until you meet the out of pocket max. The other plans are 70/30 or 80/20 or something like that. You will reach your out of pocket max faster with the bronze but that doesn't mean you pay more.
Also, just because the out of pocket max is $12,700 that doesn't mean you will SPEND that much every year. You really need a major medical event, surgery, etc. to reach that. Keep in mind that your annual physical, well baby checks, cancer screenings, etc. are covered at 100% so you won't pay anything for those. Some medications are covered at 100% as well.
We have always had a high deductible so the $12,700 out of pocket is not that much of a sticker shock to us. I might guess it will be to those who have little savings. I also discovered on the health.gov sight that they are using 2013 and guestimates of income for 2014 which helps us a lot. Our 2012 income was basically peanuts in a bag due to the economy hitting our industry so hard. Things are picking up, slowly, but they are moving up. I think the health care program will take a few months to shake the bugs out. We can then decide.
Just ran some estimated numbers for a friend in NY covering her and her teenage daughter Their site is not cooperating so these are based on their cost estimator. She wanted a catastrophic plan because it was "less" expensive. I didn't even run numbers on that plan because for her, a high user, it's going to be very expensive. Based on premium and estimated costs over the year, probably maxing out her deductible but not quite reaching her OOP Max--real plan costs for her--40K AGI:
These do not include any medications because the ones she takes is on the $4/plan at Walmart. The co-pays for meds Bronze-Gold are identical on the NY plans, a bit less on the Platinum.
These are middle of the road numbers, some plans are less, some are more but this was the plan with her current carrier.
These costs are NOT JUST PREMIUMS--they include likely out of pocket costs given her health history. Under her current plan, her real costs are about $600/year less then the Platinum plan is, except that she continues to pay her co-pays even after meeting deductible and out of pocket costs and doesn't include the costs for her daughter, $30/month for her plan and she never goes to the dr outside of annual physicals really. So, she is looking at a $20/month, max, increase over last year's costs, premium and out of pocket costs. If she goes to the doctor even ONE more time this year, her costs will be about the same.
wrong info. FL does not have its own exchange. Go the healthcare.gov if you live in florida.
It's not the exchange - it's an insurance agent for "Florida Blue" (with a gateway to Florida Blue policy options). OTOH - it's a very good website from a large prominent health insurer in the State of Florida. So - if I were looking in Florida - I'd certainty look into the website/company. It might not be the cheapest outfit around - but it seems to have its act together. Robyn
P.S. The premiums are kind of scary - at least for older people (like $750 ---> $1400/month) - but I didn't dig into the details of the various plans.
Now that I think about - there aren't that many companies offering coverage in Florida - and only 4 that seem to be offering PPO (as opposed to HMO coverage):
So why wouldn't someone just use an experienced insurance agent who represents all or most of these companies to help them navigate through this - as opposed to some "navigator" who's only been on the job for 2 weeks? We used an agent to help us sort through our Medigap policy options - and he was . Robyn
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)? Robyn
Using An Insurance Agent
. Robyn
