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California Obamacare plans


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So I have a question about these -- either I don't understand what the words "maximum out of pocket" means or something doesn't add up.

 

I used their cost calculator at coveredca.com.  Age 47 adult and age 40 adult.  2 dependent children under 18.

 

Premiums:

Bronze 60:  $791 monthly  ($9,492 annually)

Platinum 90:  $1,378 monthly ($16,536)

 

Maximum out of pocket for family:

Bronze 60:    $12,700

Platinum 90:  $8,000

 

Total maximum cost for family:

Bronze 60:  $12,700 + $9492 = $22,192

Platinum 90:  $8,000 + $16,536 = $24,536

 

Here is the question:

Why are BOTH the minimum possible annual cost AND the maximum possible cost lower for bronze60 versus the platinum90 plan?

 

Minimum annual expense:  $9,492 annually if you go with Bronze60 plan

Maximum annual expense:  $24,536 annually if you go with Platinum90 plan

 

www.coveredca.com/shopandcompare/#healthplans

 

 

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(thinking out load)

 

I think the Platinum90 is something you choose if your family has pre-existing conditions.  No deductible (vs $5,000 for Bronze) and the cheapest co-pays, hospital stays and lab tests.

 

I guess that's why the maximum cost is a bit higher -- to price in the fact that these policies are more likely to blow the ceiling out due to the tendency of it to attract the sickest people.

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I suspect its what is covered under the two plans.  The platinum plan from my understanding is suppose to cover everything under the sun.  If that is the case, the bronze coverage would probably be leaving something out which if it occurs it's out of pocket.

 

 

 

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Pulled this out of the paper a couple of minutes ago.  This is for NC.  They still haven't released pricing data which kinda has me wondering why it's so secretive.  Will probably wait a month or so before trying to compare everything for myself.

 

 

Charlotte Observer

 

Bronze plans will have the lowest premiums but cover only 60 percent of medical costs on average, so policy holders will have the most out-of-pocket expense for deductibles and copays. Platinum plans will have the highest premiums but cover 90 percent of the cost of care.

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I suspect its what is covered under the two plans.  The platinum plan from my understanding is suppose to cover everything under the sun.  If that is the case, the bronze coverage would probably be leaving something out which if it occurs it's out of pocket.

 

The strange thing though is that in California the bronze plan costs the least overall if the shit really hits the fan. 

 

This is what I wrote:

Total maximum cost for family:

Bronze 60:  $12,700 + $9492 = $22,192

Platinum 90:  $8,000 + $16,536 = $24,536

 

 

So it's like you play this game where you are better with Platinum than Bronze if things are really bad, but if things go from really bad to extremely bad, then you'd have been better off with the Bronze rather than the Platinum.

 

So that's what I find really weird.  Anyways, if you choose Bronze you cost yourself (worst case) $5,656 too much over the course of the year (over the optimal play).  But you save $7,044 annually if no sickness occurs.  So I feel that Bronze is the optimal play if you don't have preexisting conditions.

 

Honestly, what a bizarre system.

 

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i think hsa's have been priced this way pre-obamacare.

 

I remember doing a similar analysis to evaluate our company plan options a couple years ago.  It worked out that the HSA was the best if you used very little...or if you used a lot and hit the max out of pocket.  Anywhere in between, and you'd be better off with the PPO.  For example people with chronic conditions such as diabetes who know they will use some, but hope to not use a lot.

 

I think this is the way the bronze will be...good if you don't use it at all, or good if you have a catastrophe.

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Boy that's expensive.  Here is in Michigan I am paying 440/mo for a policy for 2 mid 40 adults and 1 teenager.  It is an HSA plan with 8000 deductible. 

 

So min is 5280 and max is 13280.  Move to Michigan, Ericopoly :)

 

Supposedly about 15% of Californians are uninsured.  Does anyone believe they have an extra $9,492 in their annual family budget with which to purchase one of these bronze plans?

 

I'm curious to see how many people actually sign up versus pay the $500 penalty.  The penalty of course is only 5% of the actual cost of insurance.  Not much of a penalty really.

 

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Boy that's expensive.  Here is in Michigan I am paying 440/mo for a policy for 2 mid 40 adults and 1 teenager.  It is an HSA plan with 8000 deductible. 

 

So min is 5280 and max is 13280.  Move to Michigan, Ericopoly :)

 

Supposedly about 15% of Californians are uninsured.  Does anyone believe they have an extra $9,492 in their annual family budget with which to purchase one of these bronze plans?

 

I'm curious to see how many people actually sign up versus pay the $500 penalty.  The penalty of course is only 5% of the actual cost of insurance.  Not much of a penalty really.

 

 

 

I believe you still have to factor tax credit based on income level, which considering median or avg income of 55K for household in CA  , would be about 6000 to 7000 dollars.

 

Please check how much will tax credit help me from below link.  Let me know what you think.

 

www.coveredca.com/frequently_asked_questions.html

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Boy that's expensive.  Here is in Michigan I am paying 440/mo for a policy for 2 mid 40 adults and 1 teenager.  It is an HSA plan with 8000 deductible. 

 

So min is 5280 and max is 13280.  Move to Michigan, Ericopoly :)

 

Supposedly about 15% of Californians are uninsured.  Does anyone believe they have an extra $9,492 in their annual family budget with which to purchase one of these bronze plans?

 

I'm curious to see how many people actually sign up versus pay the $500 penalty.  The penalty of course is only 5% of the actual cost of insurance.  Not much of a penalty really.

 

 

 

I believe you still have to factor tax credit based on income level, which considering median or avg income of 55K for household in CA  , would be about 6000 to 7000 dollars.

 

Please check how much will tax credit help me from below link.  Let me know what you think.

 

www.coveredca.com/frequently_asked_questions.html

 

I see.  Once I've got my portfolio entirely in MKL and Berkshire shares (no dividend income), the rest of you working Americans will subsidize my insurance.  Thanks!

 

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Is there a low cost Health Savings Account (HSA)?  Something preferably with a self-directed brokerage option where we can pick individual stocks/bonds/options?

 

I see Wells Fargo has an HSA, but the investments are limited to Wells Fargo mutual funds.  Their bond funds charge between 70 and 80 basis points for expenses.  That's roughly 15% of the income!

 

For comparison, Vanguard charges only 59 basis points for a comparable bond fund inside a variable annuity (and variable annuities have a reputation for being expensive).

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I use HSA Bank.  HSA Bank acts as trustee, and you can link it to an Ameritrade account. 

 

Fees for HSA Bank are something like $2.50 a month base + $3.00 a month for investment account add-on.  Fees are Ameritrade are standard fees.  You can do options in the Ameritrade account the same way an IRA can do options (no margin).  Not as cheap as IB, but best option I've see for an HSA. 

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I use HSA Bank.  HSA Bank acts as trustee, and you can link it to an Ameritrade account. 

 

Fees for HSA Bank are something like $2.50 a month base + $3.00 a month for investment account add-on.  Fees are Ameritrade are standard fees.  You can do options in the Ameritrade account the same way an IRA can do options (no margin).  Not as cheap as IB, but best option I've see for an HSA.

 

 

Awesome!  Thanks.

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I use HSA Bank.  HSA Bank acts as trustee, and you can link it to an Ameritrade account. 

 

Fees for HSA Bank are something like $2.50 a month base + $3.00 a month for investment account add-on.  Fees are Ameritrade are standard fees.  You can do options in the Ameritrade account the same way an IRA can do options (no margin).  Not as cheap as IB, but best option I've see for an HSA.

 

I'm also using HSA Bank with Ameritrade. I researched the topic a couple of years ago and HSA Bank was the only HSA account option I could find where you could manage the investments yourself. Everything else was in mutual funds.

 

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  • 3 weeks later...

$791 monthly????? :o

I thought Obama said the plan will be very affordable and will cost about $50-70 per month, right? ::)

 

Don't temp me to switch my money into Berkshire shares that don't pay a dividend.

 

I would have no income at all.  Then I could qualify for a subsidy.  I think it would perhaps (I haven't checked) then only cost me the $50-$70 that you quoted.  I thought it might be more like $100 a month, but perhaps your $50-$70 figure is accurate.  I don't know.

 

But hell yes I need a subsidy!  I mean "no income" is "no income", right?  You are poor if you have no income, right?

 

 

http://www.pbs.org/newshour/rundown/2013/09/will-you-qualify-for-an-obamacare-subsidy.html

 

The law bases eligibility on household income. What does that include?

It is income, not assets. The value of a house, stocks or bank accounts is not taken into consideration. Household income starts with adjusted gross income -- a number people can find on their tax returns.

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I use HSA Bank.  HSA Bank acts as trustee, and you can link it to an Ameritrade account. 

 

Fees for HSA Bank are something like $2.50 a month base + $3.00 a month for investment account add-on.  Fees are Ameritrade are standard fees.  You can do options in the Ameritrade account the same way an IRA can do options (no margin).  Not as cheap as IB, but best option I've see for an HSA.

 

I'm also using HSA Bank with Ameritrade. I researched the topic a couple of years ago and HSA Bank was the only HSA account option I could find where you could manage the investments yourself. Everything else was in mutual funds.

 

I use HSA Bank + TD Ameritrade as well. When I researched it a few years ago I found the same thing you did, they offer the only HSA account with standard brokerage features. I was really excited when I found out my employer was using HSA bank :) 36 percent gain so far this year on my HSA investments. 

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  • 5 months later...

We live in Indiana, but our daughter lives in the LA area. She turns 26 in May and her employer does not provide health insurance, so she is looking to purchase health coverage. We researched to find her two excellent doctors. They both told her they will not except any covered CA plans. We especially will keep one of them because he has been wonderful. Can any Californians lend insight in what is happening with health insurance and doctors in California and what we should do? Any recommendations for private insurance plans?

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We live in Indiana, but our daughter lives in the LA area. She turns 26 in May and her employer does not provide health insurance, so she is looking to purchase health coverage. We researched to find her two excellent doctors. They both told her they will not except any covered CA plans. We especially will keep one of them because he has been wonderful. Can any Californians lend insight in what is happening with health insurance and doctors in California and what we should do? Any recommendations for private insurance plans?

 

Does she qualify for premium subsidies? If not, then it might make sense for her to  go off exchange and purchase HSA compatible plan directly from an insurance company.

 

 

If available, she can check out Kaiser Permanente. My g/f uses them and she loves it. It's an one stop shop for her. She also like their online portal for scheduling doctor appointments and prescriptions.

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We live in Indiana, but our daughter lives in the LA area. She turns 26 in May and her employer does not provide health insurance, so she is looking to purchase health coverage. We researched to find her two excellent doctors. They both told her they will not except any covered CA plans. We especially will keep one of them because he has been wonderful. Can any Californians lend insight in what is happening with health insurance and doctors in California and what we should do? Any recommendations for private insurance plans?

 

Does she qualify for premium subsidies? If not, then it might make sense for her to  go off exchange and purchase HSA compatible plan directly from an insurance company.

 

 

If available, she can check out Kaiser Permanente. My g/f uses them and she loves it. It's an one stop shop for her. She also like their online portal for scheduling doctor appointments and prescriptions.

 

She does not qualify for a subsidy.

 

The issue is we researched to find her top doctors and these top doctors will not accept Obamacare. There is a huge spread in competency of physicians. You know what they call the medical student that finishes last in his/her class? Doctor.

 

Also top hospitals, where you would want to go with some life-threatening situations, are opting out of Obamacare,

 

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

 

Or they are like Cedars-Sinai Medical Center and have only one company in their respective networks

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We live in Indiana, but our daughter lives in the LA area. She turns 26 in May and her employer does not provide health insurance, so she is looking to purchase health coverage. We researched to find her two excellent doctors. They both told her they will not except any covered CA plans. We especially will keep one of them because he has been wonderful. Can any Californians lend insight in what is happening with health insurance and doctors in California and what we should do? Any recommendations for private insurance plans?

 

Does she qualify for premium subsidies? If not, then it might make sense for her to  go off exchange and purchase HSA compatible plan directly from an insurance company.

 

 

If available, she can check out Kaiser Permanente. My g/f uses them and she loves it. It's an one stop shop for her. She also like their online portal for scheduling doctor appointments and prescriptions.

 

She does not qualify for a subsidy.

 

The issue is we researched to find her top doctors and these top doctors will not accept Obamacare. There is a huge spread in competency of physicians. You know what they call the medical student that finishes last in his/her class? Doctor.

 

Also top hospitals, where you would want to go with some life-threatening situations, are opting out of Obamacare,

 

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

 

Or they are like Cedars-Sinai Medical Center and have only one company in their respective networks

 

LA is a crazy market because there is a huge spread in quality between top and bottom.  There's a lot of garbage health care in LA, even at big hospitals.  Where I am in the Sacramento region, there are only a few big health systems and the level of care is much more consistent across the area.  Sure, there's some low quality but not at the scale of LA.  We have top quality but probably don't match SF or LA for the very elite care in some areas. 

 

If you want your daughter to have access to the very best doctors and hospitals, you are going to have to pay for it.  Blame Obamacare if you want but it was like that when I lived in LA from 99-07.

 

I'm completely biased, because my wife is a Kaiser physician, but check out Kaiser.  When she was at med school (in LA), I got to know a lot of students.  Of the ones I would trust my life or my family's life with, a great number of them went to Kaiser.  They want to practice medicine and don't want to deal with the business/regulatory BS.

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We live in Indiana, but our daughter lives in the LA area. She turns 26 in May and her employer does not provide health insurance, so she is looking to purchase health coverage. We researched to find her two excellent doctors. They both told her they will not except any covered CA plans. We especially will keep one of them because he has been wonderful. Can any Californians lend insight in what is happening with health insurance and doctors in California and what we should do? Any recommendations for private insurance plans?

 

Does she qualify for premium subsidies? If not, then it might make sense for her to  go off exchange and purchase HSA compatible plan directly from an insurance company.

 

 

If available, she can check out Kaiser Permanente. My g/f uses them and she loves it. It's an one stop shop for her. She also like their online portal for scheduling doctor appointments and prescriptions.

 

She does not qualify for a subsidy.

 

The issue is we researched to find her top doctors and these top doctors will not accept Obamacare. There is a huge spread in competency of physicians. You know what they call the medical student that finishes last in his/her class? Doctor.

 

Also top hospitals, where you would want to go with some life-threatening situations, are opting out of Obamacare,

 

http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2013/10/30/top-hospitals-opt-out-of-obamacare

 

Or they are like Cedars-Sinai Medical Center and have only one company in their respective networks

 

LA is a crazy market because there is a huge spread in quality between top and bottom.  There's a lot of garbage health care in LA, even at big hospitals.  Where I am in the Sacramento region, there are only a few big health systems and the level of care is much more consistent across the area.  Sure, there's some low quality but not at the scale of LA.  We have top quality but probably don't match SF or LA for the very elite care in some areas. 

 

If you want your daughter to have access to the very best doctors and hospitals, you are going to have to pay for it.  Blame Obamacare if you want but it was like that when I lived in LA from 99-07.

 

I'm completely biased, because my wife is a Kaiser physician, but check out Kaiser.  When she was at med school (in LA), I got to know a lot of students.  Of the ones I would trust my life or my family's life with, a great number of them went to Kaiser.  They want to practice medicine and don't want to deal with the business/regulatory BS.

 

 

We don’t mind paying so that we get to choose her doctors.

 

I think we will go with a Healthnet plan. One of her two doctors accepts this plan. The other only accepts United Health and you cannot get an individual policy from United Health in California. But he solved a problem that many other doctors were not able to, so I am willing to pay him directly.

 

We have noticed that spread in quality in health care in the LA market.

 

My daughter needed her wisdom teeth out. We waited too long and two of them were close to nerves. She went to see an oral surgeon who someone at work had used. Fortunately my wife was out in LA and went with her. The surgeon wanted to schedule the surgery for the next day. My wife got her out of there.

 

I have a friend in Malibu who used to be CFO of a dental supply company. He called a few dentists he knew in LA to find out who were the best oral surgeons in the LA area. We used the one most recommended. My daughter was back to 100% in about a day with no after effects.

 

 

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