Author Topic: ACA Gold plans now more attractive option for moderate income?  (Read 717 times)

lhamo

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Tinkering around a bit with the ACA plan estimator (Washington health plan finder in my case) this morning to see what impact increasing on-paper income would have on my health costs.  In past years I have always just used Molina Cascade Silver as my default, because at moderate income levels (25-30k for a single person, 50-60k for a 2 person household) that has been the most reasonable option.  But now it looks like due to shifts in the deductible/co-pay/OOP limit structures the Cascade GOLD plans are now the much better option -- slightly higher premiums, but much better on the other fronts.

For example, for a one person household with 30k in income, the plans look like this:

Silver: 

$127 monthly premium after credits, $2500 deductible, $30 PCP copay, $20 generic prescription copay, and $7250 OOP max

Gold:

$151 monthly premium after credits, $600 deductible ($0 prescription deductible), $15 PCP copay, $10 generic prescription copay, and $5900 OOP max

For many people, the savings on copays/prescriptions alone would make up for the slightly higher monthly premium, not to mention the big savings on deductibles and the lower OOP max.

Just curious if people in other states are seeing similar things and what might be behind the move to make gold plans a more attractive option than silver these days. 

PS:  Answered my own question -- looks like this is largely a function of the new state subsidies for affordable healthcare in Washington state that kicked in this year. 

https://www.wahealthplanfinder.org/content/wahbe/global/en/about-the-exchange/what-is-the-exchange/cascade-care/cascade-care-savings.html

Lots more geeky info about ACA health insurance in Washington state here:

https://www.healthinsurance.org/health-insurance-marketplaces/washington/

Interesting to see how this is working locally -- and perhaps a heads up for those in other states that might pursue similar programs
« Last Edit: April 23, 2023, 01:20:03 PM by lhamo »

lifeisshort123

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Re: ACA Gold plans now more attractive option for moderate income?
« Reply #1 on: April 24, 2023, 07:25:06 PM »
Where we live basically the bronze and platinum plans make the most sense.  Everything in the middle offers limited financial benefit.  Bronze lowest monthly premium, so if youíre healthy/have the savings, etc. are a great plan.  Platinums cover everything - know people who had 100k medical bills and didnít even hit the out of pocket maximum because so much was covered.

The ones in between are less than ideal.

seattlecyclone

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Re: ACA Gold plans now more attractive option for moderate income?
« Reply #2 on: April 24, 2023, 08:24:11 PM »
In most states you should go on a silver plan if and only if you qualify for the cost sharing subsidies. During the Trump administration, the Republicans in charge decided to stop reimbursing insurance companies for the cost of these subsidies, and so the cost needs to be made up out of premiums. Most states have settled on a practice called "silver loading" where the cost sharing subsidies are paid only out of the silver plan premiums. If you're on bronze or gold or platinum you don't need to pay extra to help lower-income people, while on silver you do, so the sliver will probably look like a worse deal. Gold will look better if you're a relatively high utilizer of health care services, while bronze might look better if you're generally healthier.