Deciding Which HealthCare.Gov Plan to Choose - Which of these 4 Plans?

[jeff2017]

Anyone else going through this process at the moment? 28 Year old, healthy male here checking in for some MMM opinions. I lead a healthy life, non smoker, social drinker, and good diet. Looking back at the last few years, I have got sick, on average (and thankfully), once per year (0 in 2017 thus far) and have a doctor I have been going to since I was a kid that doesn't take insurance anyways (anti-Govt. old timer doc that charges a flat $40!).

I have 10 Options to choose from... 3 Bronze Plans with an average premium of $283, 5 Silver Plans with an average premium of $384 per month, and 2 Gold Plans with an average premium of $526 per month...

There are 2 providers that each offer 5 plans and my doctor belongs to only one, so that lowers it to 5 Plans to Choose from, 2 Bronze, 2 Silver, and 1 Gold.

5 Choices total.

I paid $300 per month last year and they claim my comparable plan this year would be one of the Silver plans which is:

Silver Option #1 = Monthly Premium = $345, Deductible = $4,500, Out of Pocket Max = $7,350, Estimated total yearly cost = $4,325... COPAYS/COINSURANCE = Emergency room care: $500 Copay after deductible, Generic drugs: $10, Primary doctor: $25, Specialist doctor: 30% Coinsurance after deductible.

Silver Option #2 = Monthly Premium = $381, Deductible = $3,700, Out of Pocket Max = $7,350, Estimated total yearly cost = $4,749... COPAYS/COINSURANCE = Emergency room care: 20%, Coinsurance after deductible, Generic drugs: $10, Primary doctor: $20, Specialist doctor: 20% Coinsurance after deductible

Bronze Option #1 = Monthly Premium = $230, Deductible = $7,000, Out of Pocket Max = $7,350, Estimated total yearly cost = $3,020 ... COPAYS/COINSURANCE = Emergency room care: 50% Coinsurance after deductible, Generic drugs: 50% Coinsurance after deductible, Primary doctor: 50% Coinsurance after deductible, Specialist doctor: 50% Coinsurance after deductible

Bronze Option #2 = Monthly Premium = $256, Deductible = $7,350, Out of Pocket Max = $7,350, Estimated total yearly cost = $3,316 ... COPAYS/COINSURANCE = Emergency room care: 50% Coinsurance after deductible, Generic drugs: $10, Primary doctor: $25/50% Coinsurance after deductible, Specialist doctor: 50% Coinsurance after deductible

Gold Option #1 = Monthly Premium = $530, Deductible = $1,000, Out of Pocket Max = $7,000, Estimated total yearly cost = $6,507 ... COPAYS/COINSURANCE = Emergency room care: $500 Copay after deductible, Generic drugs: $8, Primary doctor: $15, Specialist doctor: $60

I'm ruling out the Gold plan right off the bat, deciding which of the other 4 to go with is my next decision.

[LeRainDrop]

Anyone else going through this process at the moment?

I'm going through this at the moment.  I left my job last year, so have been using an AHA plan until I return to the workforce, which likely will be sometime next year.

I think I'm going to select the cheapest plan possible because I don't plan on actually using it other than for incidental prescription benefits or in case of catastrophe.  None of the plans in my state consider any of my doctors to be in network.  I am loyal to most of those doctors and would not consider changing providers (unless I could not afford to stay with them).  My doctors also give significant discounts to their patients who are self-pay.  As such, it actually works out better for me to not use the AHA plan at all and go see my doctors out of pocket.  Of course, I'd rather I not have to buy any insurance other than catastrophic, but that is not allowed by the law, so I get stuck paying premiums for a next-to-worthless plan.

[Paul der Krake]

Are there no options that are HSA-eligible?

That's by far the best thing you can do as a healthy person.

[jeff2017]

Are there no options that are HSA-eligible?

That's by far the best thing you can do as a healthy person.

Unfortunately not

[jeff2017]

I'd go with Silver Option #1, because if you have a ER visit with a bill of $10k (for a broken bone or something similar) your $500 copay after deductible is going to be way cheaper than a 20% copay.   Also lower rates for primary and specialist visits.

Thanks for your feedback. My initial reaction was Silver Option #1 as well, but the frugal/cheapness inside me likes the idea of the cheapest $230 per month plan... The more I think about it though, it is a marginal $115 per month decision...

Will sleep on it, look forward to perhaps more responses by the AM as well. Have to pull the trigger by Friday and preferably tomorrow or Thursday night.

[jeff2017]

Whoops, sorry for the double post here.

[nurseart]

Hey Jeff,

First off, those are pretty good plans! In my area it was going to be $1400 for my husband and I PER MONTH FOR A BRONZE PLAN. The very small company where I work had a couple other folks in the same position so we are setting up a plan through the company thank goodness.

Are any of these bronze plans HSA eligible? Given your demographics, I would be very interested in the opportunity to have an HSA if possible.

Otherwise, it depends on you and your risk tolerance. We are young healthy non-smokers with minimal health care use. For example, our last ACA plan (ending at the end of this month) cost us 550ish a month in premiums and in the 6 months we had it our only use so far has two flu shots. Not very cost effective. I'd rather pay a lower monthly cost and am happy to have a higher deductible because I have those funds available if something happened. If I had no savings and was struggling paycheck to paycheck and a several thousand dollar medical bill would ruin me financially and result in an inability to pay rent it would be different.

[jeff2017]

Thanks! I guess it is a matter of perspective. I was initially pretty ticked off my rates for a similar plan increases 15%, but it could be much worse.

I wish there were HSA options, but there are literally ZERO offered in my state.

[LeRainDrop]

Thanks! I guess it is a matter of perspective. I was initially pretty ticked off my rates for a similar plan increases 15%, but it could be much worse.

I wish there were HSA options, but there are literally ZERO offered in my state.

I hear ya, bud.  If I were to stick with the same ACA plan in 2018 that I had in 2017, the monthly premium was going up by 50%!!!  The options are pretty crappy for young, healthy people.

[MaaS]

I just went through this same scenario.  27, perfect health.

Your state is a bit more favorable than mine (which is very LCOL).  If I were you, I'd go Bronze 2, followed up Bronze 1.

I paid $323 a month for a plan pretty close to Bronze 1, the premiums rose 58% over last year. No HSA options. Essentially covers nothing until I pay $7350.  There's one provider in my state left... I love the concept of the ACA, but the reality is very different than what the news tells you.  Paid for on the back of middle class entrepreneurs trying to build dreams.

Rant over :D

[Laserjet3051]

These decisions are very person/family specific, that also includes risk tolerance. I've got 2 kids, and while we dont have any chronic diseases/disorders, we do use healthcare (mostly kids and wife), but I really like the GOLD plan with its $0 deductible. And due to the 25% penalty on silver tier plans, in my state Gold and silver are about the same price, so for the 4th year in a row I'll stick with GOLD and pay the extortion-level price.