Kid one has a medical condition that requires two medications per month…and two tests per year (eye). He needs good RX coverage which we have not ever seen with a bronze plan.
Yes…his annual physical is covered…and oddly, his eye doc visits were covered too beginning in March of this year…he would like to keep that coverage. (Well…he on,y had to pay $50 instead of $250).
For office visits for general illness or whatever…he is a big fan of the minute clinic.
I take it you/he compared bronze + out-of-pocket costs of the medications to the cost of a plan that covers the medications?
For my own insurance plan choices, I made a spreadsheet to compare different plans. I added up premiums plus expected costs for the different choices.
@ucbalumnus the meds are $100 EACH out of pocket…per month…actually a tad more. So self paying for them is not cost effective. I mean…that’s $200 a month for RX refills.
In California, all exchange silver plans have a surcharge added to cover the CSR’s, but that surcharge is not required to be included for plans bought off-exchange. Covered California is openly encouraging full-payers who want silver plans to buy off exchange – basically if a policy premium is $500 off-exchange, it will be about $565 for the same policy on exchange – and all companties which sell on-exchange also sell off-exchange.
I qualify for subsidies but am borderline, upper end. To be sure to qualify, I need to be able to fund and deduct an HSA, because the HSA deduction reduces AGI by a little over $4K. In California, the only exchange plans with HSA eligibility are bronze level. My base premium has gone up a trivial amount – only about 5%, and when I factor in the fact that I am a year older, that might not be any true increase. But because of the CSR surcharge, my subsdidy is calculated off of the cost of the second-lower cost Silver, and that has skyrocketed.
I am with Blue Shield (most expensive insurer in my area) - and last year the Blue Shield Bronze PPO actually cost slightly more than the SLCSP (an HMO) – but this year there is a big gap, so my monthly premium is dropping by more than $200. At this point, age 63, I’ll have a premium of roughly $150 a month – so this illustrates the cascade effect of the change in the silver pricing. That is, I will now get a federal subsidy, funded by taxpayers, to cover services that don’t get or qualify for, because the subsidy dollars now go to everyone who qualifies for subsidies on any plan, whether or not they opt for a silver plan or have low enough income to qualify for CSR’s.
I’d note that in my area, at my age, there is now at least one gold HMO plan with premiums equal or ower than the lowest cost Silver – (I believe with Kaiser) – so good deal for some subsidized Kaiser users who will essentially be able to increase their coverage level and cut down on out-of-pocket costs by choosing Gold over Silver.
This is my last full year on the market; I’ll turn 65 early in 2019, so I guess next year at this time I’ll be trying to figure out Medicare options. All that complicated stuff about Medicare Advantage and Medicare supplemental insurance and Medicare prescription drug coverage, and what the )#& does my current medical group take…
@thumper1 - still might be worth spreadsheeting it out. For myself I’ve found that the increase in premium isn’t worth it. What I save in premium covers the medication costs. Though I don’t get a subsidy so maybe with his subsidy the different in premium isn’t as great as in my case.
I will probably go with the bronze. Ive been looking at the covered Ca site and trying to figure out if I should take my youngest off our plan and buy her one using her northern Ca zip. The Bronze Blue Shield plan in my area is pretty useless but the only insurance offered so we have no choice. My Dr is out of network for Anthem and will still be out of network for Blue Shield.
Kid who is 30 also buys her insurance on the individual market and lives in our city. Last year she bought bronze and will probably buy it again. She has asthma and they don’t cover much of her inhaler costs. It is basically in case of an emergency coverage with I think a deductible for next year of over $7000. She will have to find a new Dr and that is going to be difficult with so few providers. No subsidy for her so health care costs are a big chunk of her income.
Youngest D is still a dependent but lives in another part of the state. Her primary Dr is in the UCDavis system but she isn’t attached to keeping her. Her options if I buy for her separately she can go with Health Net, Blue Shield, Kaiser or Western Health Advantage. It looks like Western Health starting in 2018 is not going to be able to see UCDavis medical group so I don’t see why she would go with that.
Any views on Kaiser in Northern Ca?
Calmom’s good news illustrates what I’m saying. In states where the CSR surcharge is on Silver plans only, people who are subsidized are getting great deals. The Silver plans are expensive, and that makes subsidies high. Subsidized people can use those big subsidies either to buy very cheap Bronze plans, or to buy valuable Gold plans at a huge discount. Subsidized people are better off with these CSR surcharges.
In states where the CSR surcharge is on Silver only, unsubsidized people are not worse off, unless they had their hearts set on Silver and their state allowed the CSR surcharge on off exchange Silvers too.
Unfortunately some states (Colorado is one of them) have put CSR surcharges on all metals. Unsubsidized people in those states will pay higher prices because the White House stopped paying CSRs.
This isn’t to anyone in particular, but I always try to give this warning especially to the “young invincibles” (and their parents).
Remember that health insurance isn’t just for what is currently wrong but for what may go wrong.
I’ve always had relatively minor (cheap) health problems- depression, acid reflux- that kind of thing. I took omeprazole and sertraline for years as my only meds. Both of which are very cheap.
Then at 24, I got really sick. Literally overnight I went from taking two pills a day to over a dozen very expensive meds. I now take nearly 2 dozen a day. The year I got dx’ed with lupus (& a bunch of related things), my medical expenses skyrocketed to over 200k. I was fortunate to have very, very good insurance for the first time in my life and I don’t know what I would’ve done if I had a bare bones plan.
I hope beyond hope that no one else ever experiences this but it is worth remembering as you never know what will happen. Even healthy young people can develop severe, expensive health problems out of nowhere.
^Excellent reminder. We have friends whose healthy 24-year-old son was in a bad car accident and almost didn’t survive. He has no health insurance and his hospital bills are astronomical. Not sure what the family is going to do. I’m puzzled as to why he wasn’t on his parents’ policy since he wasn’t 26 yet. 
@MaineLonghorn We are in a similar boat as far as group insurance. We’ve fallen into a lucky crack in that BS still underwrites small H and W group plans in their off exchange offerings.
We’ve had to add back our 23 year old S and 25 year old D. Our monthly premium well exceeds our California mortgage. And the first 3.5 K pp is still out of pocket.
I’m hoping the association plan option will restart the small group market. With any luck Costco will get into that business. They used to offer Healthnet plans for small family businesses but of course the ACA required them to drop that offering.
I will,have my kid one in AZ check the costs of gold plans with his subsidy. He only has ONE provider choice…so it won’t take long!
Health insurance is expensive no matter where you get it. The average cost of an employer insurance plan last year for a family was $19K. That’s a lot.
Thank you, CF, for this very helpful thread.
Our D in LA just left her UC job with terrific benefits to try freelance work. She is freaked out about health insurance, though the university continued coverage for one month, and we have offered to pay her (pricey) COBRA coverage until she selects an individual plan. I have two questions that you may be able to answer:
How will her income/potential subsidy be determined for this enrollment period? Will it be based on last year’s 1040? This year’s earnings to date (combination of nice university salary and skimpy freelance earnings)? Current skimpy freelance earnings?
Assuming subsidies are based on current, skimpy freelance earnings, which would put her in the highest subsidy group, what plan makes most sense for her?
Thanks so much for any help you can provide!
Your daughter’s subsidy will be determined by what she expects to earn in 2018. If she mis-estimates her income, then when she files her taxes in 2019 the difference will be reconciled.
If she is in the lowest subsidy-eligible group, she should buy a Silver plan. She will pay a smallish percentage of her income, and she will get great subsidies for deductible and copay.
If her income is less than 138% of the federal poverty level-- so if it’s less than $15,800 a year-- she is not eligible for premium subsidies or cost sharing subsidies. Instead, she is eligible for Medi-Cal (California’s Medicaid), which is free. Don’t knock it. People on Medi-Cal love it.
She can window shop right now on coveredcalifornia.com.
All those subsidized people who might enjoy a new larger subsidy also need to pay close attention to their income, if they predict an income that qualifies for subsidies and then earn more, they will be paying back the excess subsidy they received. This would especially apply to someone near the eligibility cliff who is at risk of receiving no subsidy at all.
Very good point, @somemom.
People who think they are near, but just under, 400% of the poverty level should make sure they remain under 400% of the poverty line. For some families, slipping over the subsidy level could cost thousands of dollars.
People who are near the line should shelter some of their income by making it tax-exempt, for example by putting it in a tax exempt retirement account.
Here is 400% of poverty level for 2018. If you/your child/your family are below that level, you are eligible for premium subsidies.
One person: $48240
Family of two: $64960
Family of three: $81680
Family of four: $98400
While I have four providers to choose from, I’m pretty sure which one I’ll pick. For me, though, and perhaps also for @thumper1’s son, that doesn’t mean the choice of plan is simple. I have to figure out which plan is the best bargain for me. This involves a spreadsheet.
Yes…every year, we crunch those numbers…look at monthly premium, costs of RX drugs, costs of tests needed annually, etc. then we figure it out.
For example…we self insure dental for our kid who buys direct,y from the company…no subsidy. The premium cost FAR exceeds what she spends on her check ups. Now…if she breaks a tooth or something…oh well.
The ACA kid cant get dental…so he self insured for that also.
We are thinking now…
Kid one with the need for good RX will look at all the different color metal plans…and will look for what meets his needs at the most reasonable cost. He earns less than $45,000 a year. So…I’m thinking he should look for coverage value.
Kid two…it will be all about premium cost. Her options aren’t very good…so…the goal will be to keep her premiums under $400 a month. Isn’t that ridiculous for a healthy 30 year old?
“Isn’t that ridiculous for a healthy 30 year old?”
Given healthcare costs these days, although expensive, I wouldn’t call it ridiculous. It is an age when many have children and one healthy pregnancy would cost much more to the insurance company than what they would collect in premiums at $400/month (not even mentioning all the other non-pregnancy stuff). Granted, I’m not saying that your adult child has that in mind but it does drive up costs for healthcare providers at that age.
This is from 2013. I imagine it has only gone up:
“The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.”
What’s really driving up premiums for 30-year-olds is 60-year-olds.