Silver vs. Bronze plan for healthy Type II diabetic?

[Fru-Gal]

We are blessedly all very healthy, but one of us does have Type II diabetes (no complications, it runs in the family) and must take Metformin daily and use a glucose meter (with the test strips, which must cost something). They also take a statin but that's optional given particular health situation.

I've read about insulin being crazy expensive, wondering is Metformin as well? Currently have very good insurance through my job, so we're used to paying little or nothing for meds. In preparation for me quitting we have all gotten our preventative care and screening tests done this year.

Bronze plan is cheaper but you pay more for care... does this apply to the meds (Metformin + test strips) as well?

Silver you pay more monthly but care costs less.

[Fru-Gal]

Hmm, based on quick Google search it appears Metformin is not that expensive a drug.

[Frankies Girl]

I have a silver ACA plan and I have yet to get any meds run through my actual insurance. I take generic drugs (but not for diabetes) and try to get my doctor to write the script for 90 days. I've heard some docs do a split pill script (most won't now, but may be open to the idea if cost is higher on scripts).

It's been cheaper for me to just use GoodRx and go to whatever pharmacy fills my script at the lowest price. I get one generic script filled at Walmart and another is cheaper at a local grocery. Go figure.

Metformin is pretty cheap in my area using GoodRx: I'm seeing a 90 day script, 500mg tablets coming in at $7.57 at the local grocery pharmacy. I'm not sure what brand of test strips you'd need, but I'd start looking around to see if they are available through that discount program, or ask at the pharmacy you currently use and see what the non-insurance pricing is, and if they have any recommendations for cheaper testing units/strips if you find the current one is very pricey.

If you're good with bronze, and the meds are cheap outside of insurance the bronze is likely good enough as long as you're comfortable with the OOP max. Otherwise, the other benefit of silver is cost sharing subsidies, and potentially lower out of pocket and deductibles. I have a zero cost deductible, and my total out of pocket for the year (family) is around $5K total. I use an insurance company that also pays me to take short quizzes and watch/read health/lifestyle tips and earn $500 each (2 adults so total of 1k each year) off my insurance premiums too.

[Fru-Gal]

Thanks for the insights!

[Greystache]

If you can find a bronze plan with an HSA, you can put around $7000 per year as a married couple into an HSA. If you are over age 55 you can contribute even more. The amount you contribute is deducted from your MAGI and if your income is small enough, will increase your premium subsidy. On the down side, only high deductable plans are eligible for HSA. So you would be looking at around $7K out of pocket before insurance kicks in.

[Fru-Gal]

Thank you, @Greystache!

[ltt]

We are blessedly all very healthy, but one of us does have Type II diabetes (no complications, it runs in the family) and must take Metformin daily and use a glucose meter (with the test strips, which must cost something). They also take a statin but that's optional given particular health situation.

I've read about insulin being crazy expensive, wondering is Metformin as well? Currently have very good insurance through my job, so we're used to paying little or nothing for meds. In preparation for me quitting we have all gotten our preventative care and screening tests done this year.

Bronze plan is cheaper but you pay more for care... does this apply to the meds (Metformin + test strips) as well?

Silver you pay more monthly but care costs less.

Yes, you will pay more for prescription medications on a bronze plan.  I did not know that when we signed up for a plan earlier this year (we are currently on a gold plan, but switching to a bronze plan).  Metformin is fairly inexpensive, and I know one of the statin prescriptions my husband takes is also inexpensive. We ordered test strips off of Amazon, and I believe we could run them through our HSA or FSA account at the time.

Husband's insulin charges are capped at $25 a month under the plan we chose.  Prior to choosing a plan, you have the option of inputting the prescriptions you are on and if you look into the particular plan a little more, it will tell you how much the co-pays are per prescription.

[seattlecyclone]

You should consider cost-sharing reductions and whether you qualify for them. If your income is below 250% of the poverty line this will modify the silver plans (and only the silver plans) to offer lower out-of-pocket costs than the standard version offered to higher-income folks. The subsidies are especially valuable below 200% of the poverty line, much less significant discount in the 200-250% range.

About to get into the weeds here...

When the ACA was new, the federal government would reimburse insurers for the cost of these extra subsidies. When the Republicans took over Congress they decided they didn't want to pay for that anymore and they cut it out of the budget. The cost must therefore be paid from premium dollars. Many (most?) states settled on a practice called "silver loading" where this cost is only baked into the premiums charged to people who select silver plans. That inflates the premium for silver plans relative to the other levels, which means that if your income is too high for the cost sharing reductions you may find a bronze or gold plan to be a better overall value than silver.

The funny thing is that not paying the cost-sharing subsidies is probably a net negative for the federal budget. The premium subsidies that everyone gets are based on the cost of—you guessed it—silver plans. The net premium that someone with a low to moderate income will pay to be on one of these silver plans depends only on their income. If you tack a bunch of extra cost onto the unsubsidized premium for these plans, all you do is increase the subsidy that everyone gets for any type of plan.

[darknight]

If you can find a bronze plan with an HSA, you can put around $7000 per year as a married couple into an HSA. If you are over age 55 you can contribute even more. The amount you contribute is deducted from your MAGI and if your income is small enough, will increase your premium subsidy. On the down side, only high deductable plans are eligible for HSA. So you would be looking at around $7K out of pocket before insurance kicks in.

100%
I worked in Health insurance - Buy a bronze HSA plan, contribute to it and use a good Rx card to save at the pharmacy. No guarantee you'll need the lower deductible with silver, guaranteed you'll have to pay your monthly premium. Lower what you can. I would lay out for a consumer 12 months of premium + worst case scenario (utilizing insurance all the way up to your "max out of pocket"). Both silver and bronze plans have similar max out of pocket amounts across most states and carriers. The savings for a bronze plan are usually substantial AND you get tax protection.

Unless you qualify for "silver alt" plans due to lower than average income.. Most Americans who purchase through healthcare. gov qualify for assistance and some qualify for "alt" plans that reduce your deductible etc. Check that

[geekette]

Metformin is dirt cheap.  Test strips range from about .50 to over $1 each without insurance, from what I've seen.

If you're quitting and can adjust your income, you really need to wade through the plans available to you on Healthcare.gov.  If your income is less than 200% of the FPL ($34,840 for a family of 2), the silver plans with the cost sharing reductions are quite good, at least in our area.  The plan we picked offers 3 free primary care visits free, and copays of $4-20/month for meds (even for one of mine that's $700/month on GoodRx).  We don't even need to pay any deductible unless we have something done, like surgery, or an ER visit. 

BTW, preventive care is covered free under the ACA.  Even with a bronze plan, your annual physical, mammograms, screening colonoscopy, and flu shot should be free.  They may bill you for some blood/urine tests, though. 

[Khaetra]

As a T2, insurance can be confusing.  For right now, my advice would be to make sure that vision/specialists are covered (eyes and feet are two areas we cannot compromise on and must be checked yearly, sometimes more often).  Metformin is cheap (check around...some stores offer it for free), buy a meter and strips off Amazon and pay OOP for those.