Author Topic: The power of math...for y'all also going into ACA/Obamacare  (Read 1768 times)


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The power of math...for y'all also going into ACA/Obamacare
« on: November 05, 2013, 03:21:29 PM »
So there I was assuming we'd stick with a "bronze" level plan.  Ran the numbers (slightly gnarly spreadsheet - health insurance math is mildly convoluted at times). 

Guess what?  At our current level of healthcare usage (see below) the best fit for us  turns out to be a bells-and-whistles platinum plan.  The worst choice?  One of the other platinum plans.  Lesson: do the numbers!!

Obviously everyone's numbers are likely different (state, health care usage, county within state, small business or individual tax status).  I'm not saying go with a platinum plan.  I'm saying take time to do the numbers on a wider range of plans than I did at first. 

There are enough details that you'll want to have your recent health services bills handy to check plan by plan, even from the same insurer in the same coverage (metal) category.  For us, it is still going to cost a bunch more than pre-ACA/Obamacare, but thankfully we're already FI and this won't change that.

(more details)
Basically the premiums-plus-out-of-pocket-max ('total max') of almost $15,000 is lowest by far for one of the platinum plans (beware, the other platinum plan has the highest 'total max' of the 8 plans I ran #s for-over $27,000).  At lower levels of health service usage, the bronze plans do have lower out of pocket costs.  The expected out-of-pocket costs for us (premiums, routine physicals & labs, one "I'm sick" Dr/urgent care visit/person/year, I threw in an x-ray because that seems to pop up every so often) are surprisingly close (all 8 plans within $3,500, or $3,800 after rough tax adjustments). 

The platinum plan that we plan to go for is in the middle of the pack for expected out-of-pocket costs at almost $15,000 (we would actually reach the cap) and we "lock in" a cap that a single hospital visit (or even an extended illness or branded full-time med) would make *very* helpful vs. other plans.  I realize not everyone would make the same decision, but we're thinking the roughly $2,000 "extra" expense vs. the best bronze fit is worth the $5,600 lower cap.

Note that our expected spending of almost $15,000 is a *LOT* higher than our pre-ACA/Obamacare plan (total annual costs including premium of about $8,432 under the same list of services).  Out of pocket with no insurance would be roughly $9,600 (including penalty, and paying 'rack rates' instead of negotiated rates for services) - but there is unlimited expense exposure if something scary happens.  Even if "they" grandfather pre-ACA plans (we have received a plan cancellation notice), we still have to switch, as our carrier is dropping our state from coverage (separate cancellation notice).