ACA 2019 - same coverage but one policy cheaper!

[Frankies Girl]

I am currently slogging through the summary of benefits for two plans. Both offered by the same insurance, both silver, same doctor network, etc...

Our current 2018 plan (silver plan A) is going up about $100/month. It also is changing a few things in their favor like the OOP is going up about $500, the ER/outpatient fee is moving from a flat $300 to a percentage (20%), and a few other very minor things that don't bother me (the two I mentioned do bother me, but I keep telling myself that it is unlikely I'll need to worry about either one of them).

I noticed the insurance company offers silver plan B as well. It has the exact same coverage - I went over the summary of benefits for plan A & B side by side, line per line, and there was not one thing different other than one line in the drugs column: "Pharmacy deductible does not apply." But plan B is $60/month cheaper than plan A... and for the life of me I can't figure out why. Generic drugs are 100% covered with no deductible needed and we're not currently on anything that could count towards a deductible anyway.

Coverage is for two adults, mid 40s. No health issues, I am on a low maintenance dose of a thyroid med that is so generic, I don't even bother running it through insurance because it costs me like $10 for 90 day supply. We go to the doctor one time a year for our preventive screenings (I go twice for a well woman/general health checkup) and we get flu shots and boosters and such at the pharmacy each year. We're surprisingly healthy.

I also am debating currently with the idea of stepping down to a bronze level due to the lack of health issues, but we get great subsidies and cost sharing so the silver plan is a REALLY good deal and we only pay like $180-190/month... but I could drop to bronze and get coverage for zero a month (literally pay nothing and have bronze level coverage due to the subsidy) and it would come with a $15K OOP. Which we can easily cover ourselves. Just wondering if it's a smart idea since we're gambling on whether we'll save money or not considering it's kind of random if one of us gets injured or sick enough to blow through that OOP. We may be in great health now, but just a few years ago we both had major health issues, so wondering if that's penny wise/pound foolish to go down to bronze?

Tried talking through all of this with the husband but he's not good with stuff like this and gets a deer in the headlights look. Sigh.

[Bucksandreds]

If your expected health care costs are below several thousand dollars then bronze plan makes the most sense. It’s possible that in any given year you could spend more by selecting the bronze plan but as an average, you would save money.

[geekette]

We have an oddity for our plans as well.  One has a $100/year lower deductible, but costs $100/month more.  Seriously?  It might have something to do with the Cost Sharing stuff, though.

If sometime during the year you need a non-generic antibiotic or whatever, it looks like you'd have to pay for that OOP, but eh.  Only you can decide if you want to roll the dice, though, on the chance of something more major.

[Mtngrl]

We moved from a silver to a bronze plan this year. The bronze plan had a deductible of $5000 (compared to $5300 for silver), a $40 primary care copay (vs $35 for Silver) and $20 drug copay (vs $10 for silver). We don't have a lot of prescriptions (my husband takes nothing and I have a generic allergy pill and generic thyroid that, as you say, are so cheap through the pharmacy's plan I don't have to go through insurance.) I saw the doctor twice last year, he saw the doctor once. The premium (with subsidy) for the silver plan was $497 a month and for the bronze plan was $57 a month -- so it was a no-brainer for us.

Two years ago we had a bad health year -- I had my thyroid removed and he had an accident that required amputation of his thumb. We both met our deductibles (that plan was $6600 each). I was grateful for the insurance, but it made me see that for most big medical problems, the bronze and silver plans offered identical coverage -- everything  outside of primary care goes to the deductible, so all those specialist visits, surgery and lab work had identical coverage under the two plans. I'm thrilled not to be paying triple digits for a premium this year.

[Frankies Girl]

I revisited the plans with a fine toothed comb and discover the difference... geekette got it right. :D

I'm controlling our taxable income so well, we're getting SUPER discounts for the cost sharing in the silver plans. So Plan A is the regular silver and Plan B is supposed to be their "lean" silver (meaning they are technically higher deductible, higher OOP than the regular silver and cost less)... but due to the cost sharing based off my poor-as-a-churchmouse income, it's dropped BOTH of these plans to go so low that they hit the same bottom pricing/percentages for things like their OOP, deductibles, and all the rest - and the lean silver ended up costing less for the same coverage as the regular silver because it started out costing less.

In any case, it looks like Plan B lean silver is the best deal with minor increases across the board on things I mentioned (OOP max/$20 for labs and diagnostics and now a 20% copay for ER/inpatient) and a total monthly premium increase of $14 more per month than what we currently pay.

I realized that as attractive as the no insurance cost would be for the bronze, knowing my luck, we'd have something terrible happen to blow that coverage savings. I just have a giant cosmic "kick me" sign on my back apparently, so I'm not feeling confident enough to take the risk/gamble despite the logic of it all. :(

I did also confirm that our insurance company is offering us a 10% discount (based on the total monthly premium BEFORE subsidy!) for taking a 10 question health assessment survey - good for the whole year. I have no idea why they do this, as they're not even intrusive questions, but hey, I'm always down to save money with little effort and no risks.