Adventures In Obamacare 3: Electric Pricingaloo

As I hinted at my previous Adventures In Obamacare post, healthcare.gov, the government one stop shopping center for insurance quotes still sucks.  My current insurance company’s web site (BCBSIL) sucks less.  I have always HATED their website.  It’s designed well for people shopping for insurance but incredibly poorly for actual members.  For instance, it’s nigh impossible to figure out how to make a payment online.  Also, instead of giving you a list of doctors in your plan, they send you to another site where you have to enter in your plan information all over again which is confusing because the name of your plan can be different from the list of plans you can choose.

Since I can’t compare plans on the government site, I will compare my options with Blue Cross which is who I’ll likely go through in the end.  I am assuming that various other insurance companies’ offerings will be similar.

Blue Cross offers 18 different plans in Illinois.  The prices listed below are for me, a 40 year old male.  They range in cost from their bare bones Bronze plan which would cost me $152.24/month to a Gold plan that costs $383.14/month.  Due to the weird pricings that go into deductibles and coinsurance and copays, the one Platinum plan that they offer comes in at $357.13/month.

I will compare only three plans for the sake of brevity.  They will be the three that I briefly mentioned in my previous blog post.  They are: the cheapest plan (Blue Choice Bronze PPO 006) at $152.24/month, the one closest to what I pay now (Blue PPO Bronze 006) at $225.40/month, and the one closest to my current benefits (Blue PPO Bronze 005) at $227.69.  A chart of the comparisons will follow at the end of the post.  But to begin, Blue Cross screwed up when they sent my letter.  I currently pay $303/month which is not close at all to the one they say is closest to what I pay now.  The issue there was I just switched to a higher deductible plan ($5,000) and I paid less than the $303 for the first cycle because of the pricing differences when switching plans.  Somehow, Blue Cross quoted me that lower price per month instead of my actual price per month.

As far as coverage is concerned, all three plans are exactly the same.  The cheapest one is a Blue Choice PPO plan and the other two are Blue PPO plans.  As far as I can tell, the Blue Choice PPO plans offer a smaller network of doctors to choose from than the Blue PPO plans.  For that added ability to choose, they charge $73.16/month.  That’s a 48% premium.  It’s funny that the Blue Choice plans actually have less choice.  They are obviously steering people towards those plans based on that name.  I’m sure they’re somewhat more profitable than the others.

Besides the added ability to choose, the Blue Choice Bronze PPO 006 and the Blue PPO 006 plans are exactly the same.  They all have a $6000 deductile which is $1000 more than my current deductible and require no copay.  Despite the fact that they both state a 100% coinsurance, they both have an out-of-pocket maximum of $6000 so coinsurance shouldn’t ever actually come in to the equation.  So really, the coinsurance should read “not applicable” but I guess programming wise it may be easier to just say 100%.  The Blue PPO Bronze 005 plan costs just $2 more than the similarly named 006 plan but coinsurance actually comes into play here with only a $5000 deductible and a $6250 maximum out-of-pocket cost with a coinsurance rate of 80%.

The bottom line is I can get similar coverage under the Obamacare plan for 33% less than what I currently pay.  If I am willing to accept a $1000 larger deductible and a smaller network, I can cut my insurance premium in half.  Not bad.  Not bad at all. As an added bonus, with the savings, I will likely add dental insurance which I have not had in the past.

My next Adventures In Obamacare post will be when I can actually get on the exchange and compare other companies.

Blue Choice Bronze PPO 006
Blue PPO Bronze 006
Blue PPO Bronze 005
$152.24
$225.40
$227.69
Quote Profile
Effective Date 01/01/2014 01/01/2014 01/01/2014
Zip Code xxxxx xxxxx xxxxx
Applicants 1 1 1
Plan Features
Individual Out-of-Pocket Maximum $6000.00 $6000.00 $6250.00
Plan Features
Benefit Level Bronze Bronze Bronze
Individual Deductible $6000.00 $6000.00 $5000.00
Family Deductible $12700.00 $12700.00 $12700.00
Coinsurance 100% 100% 80%
Lifetime Benefit No Limit No Limit No Limit
Well-Adult Care 100% 100% 100%
Well-Child Care 100% 100% 100%
Medical Coverage Details
Preventive Care 100% 100% 100%
Maternity Coverage 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Outpatient Physician Medical Services 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Outpatient Physician Surgical Services 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Inpatient Physician Medical/Surgical Services 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Outpatient Hospital Services including Surgery 100% Coinsurance after Deductible 100% Coinsurance after Deductible 100% Coinsurance after Deductible
Outpatient Hospital Diagnostic Testing 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Inpatient Hospital Services Medical/Surgical Services 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Outpatient Emergency Care (Physician and Hospital) 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Mental Illness Treatment and Substance Abuse Rehab – Outpatient Hospital/Physician Care 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Mental Illness Treatment and Substance Abuse Rehab – Inpatient Hospital Care 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Mental Illness Treatment and Substance Abuse Rehab – Inpatient Physician Care 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Outpatient Prescription Drug Details
Preferred Generics 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Non Preferred Generics 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Preferred Formulary 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Non Preferred Formulary 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Specialty 100% Coinsurance after Deductible 100% Coinsurance after Deductible 80% Coinsurance after Deductible
Cost Reductions
Tax Credit Eligible Yes Yes Yes
Cost Sharing Eligible No No No
Health Savings Account Eligible (HSA) Yes Yes Yes

2 thoughts on “Adventures In Obamacare 3: Electric Pricingaloo

  1. Mr Mike

    Si, in your opinion, which is better Blue PPO Bronze 005 0r 006? Probably not a huge difference but a bit of a gamble. If you get hit with a big bill of $11, 250 or more, you get hit with an extra $250 on the 005 vs the 006. But if it turns out to be $5000 – $10,000 you save yourself up to $1000. So, the potential upside of saving up to $1000 vs the downside of paying a maximum of $250 more?

    Reply
    1. Jean-Paul Post author

      For a perfectly healthy person, which you should be to even consider a bronze plan, they are fairly equal. It is very unusual to make it above $5,000 a year for a healthy person. Given the similar monthly costs of the two, you can bet a billion dollars that you will, on average, end up paying the same out of pocket for both plans if you end up going above $5,000. I think this is more of a reflection of the outrageous costs of healthcare than anything else. If the costs of healthcare do go down, which they should, the coinsurance option would be more valuable as the chance of hitting that $5,000-$10,000 sweet spot would become more likely. But then again, the insurance costs will change to reflect that. So in the end, it comes down to how you would like to pay as opposed to which will likely save you money. With the coinsurance option, your out of pocket costs have a decent chance of coming out of your pocket a little more slowly than the $6,000 deductible even if the final costs to you end up being the same. Personally, I like the higher deductible option, more because it is much easier to keep track of how much you are supposed to be paying and who wants the extra stress of keeping track of bills when you’re dealing with an illness.

      Reply

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