Private Insurance Transition
Sep. 1st, 2013 03:51 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
livingdebAs you may know, I got private insurance after I quit my job.
The present
My only real goal for insurance is to cap my out-of pocket expenses so I don't have to spend all my savings if I get really sick or injured. I prefer low premiums in return for paying out of pocket for lots of stuff. That's because premiums are guaranteed. I have to pay those no matter what. Additional costs may or may not be high and for me I like those odds. And once you have the whole deductible saved up (which may, admittedly, take more than one year), it's not even scary to have to pay that.
The risk of this approach is that apparently most people put off getting check-ups and medical care when they have to pay for it themselves, and this allows conditions to go unchecked longer, which can make them much more expensive to treat once the person finally gives up and goes in. (Not to mention more painful and less likely to work.) But I have ways of countering that tendency.
My experience has been that I get much better prices than I would have gotten if I were uninsured, plus I get the Affordable Care Act benefits that apply to all insurance plans. So, it's basically a good deal for me.
The future
Learning about the Affordable Care Act been more exciting for me than it would have been if I still had my full-time job where I would just be keeping my same plan which is fully paid for by my employer. In my current state, things are going to change. I'm not exactly sure how yet; all I know is:
* Rates will be based on age, location, plan level, and tobacco use--nothing else matters (gender, non-tobacco-related behavior, pre-existing conditions, etc.).
* There will be four plan types: bronze, silver, gold, and platinum. The bronze has the lowest premiums and should be designed to cover 60% of an insured person's costs on average. The gold has the highest premiums and should be designed to cover 90% of an insured person's costs on average. Silver and gold are between, covering 70% and 80% of costs on average.
* Theoretically, premiums should be lower on average because all people, even healthy people, have to get insurance. In reality, Republicans are sure it's going to cost more. I'm not sure why. Maybe it's because the plans for California that are already out cost more (do they?). Maybe it's because some (many?) employers are cutting worker hours or cutting workers so they don't have to provide insurance, so those workers will have to pay more. Maybe it's because of the subsidies (it's costing more in taxes). Actually, I think it's because insurance now has to cover more things in most states (especially Republican-majority ones).
* There will be government subsidies for families making below 400% of the poverty level wages to ensure that they don't pay more than 9.5% of their income for silver-level insurance. That includes a majority of Americans, though most of my readers are high-earning adults with no kids, so it probably doesn't include most of y'all.
* There is a maximum out-of pocket expense ($6,350 per person for most plans, $4,000 for platinum).
There is still a lot of room for how to design plans at each level so long as with the given co-pays, deductible, co-insurance, and maximum out-of-pocket expenses, it comes out to the appropriate percentage on average. I don't know if I will still have a choice between high-deductible, low-rate plans and low-deductible high-rate plans. Who knows how the different levels will differ? I don't even know if companies (or states) are allowed to have more than one kind of plan at each level.
So I looked at California's Health Insurance Marketplace. I clicked their Shop and Compare button, entering my old full-time income, my current age, and an affordable-looking zip code. It looks like there is one plan available at each level. The lower levels have higher deductibles, co-pays, and co-insurance. So they don't have the choices I want and would require me to buy more insurance than I have now. So it's likely I'd just pick the cheapest one, the bronze.
The one weird thing is that since my income was below 400% of the poverty-level for a one-person family, I'd qualify for the "Enhanced Silver" plan. The part that's relevant to me is that the maximum out-of-pocket expense is $5,200 instead of $6,350. I don't know why the government wants to make silver plans extra affordable for lower-income people, but it does affect things oddly.
Then I looked at the premiums to see how they compare to what I'm paying now ($199/month, will probably be more like $205 next year). Of course the ones I looked up are higher because a) it's for more coverage and b) it's in California. Even the bronze is $325 - 373/month (depending which company you choose and whether you choose a PPO or an HMO). Even with the government assistance (tax credit) of $92/month that still comes out to $233 - 282. The enhanced silver (after tax credit price) is substantially higher ($288 - 382). Gold is $337 - 501 and plantinum is $392 - 496.
Of course I might not be making 42K next year. If I'm making only 25K next year, the tax credit goes up to $280/month, which is crazy high! That could bring my rates down to $40/month at tax payer expense.
The transition
My current health insurance policy was originally set to end in May. However, I just got a letter that says that the expiration date has been moved up to November 30, 2013. Then I can renew the same policy for a full year if I want to and basically be grandfathered to be able to keep it for 11 months into the new era. By November 30, the details of the new plans will be out (they are supposed to be ready by October 1, 2013), so I can make an informed decision.
Brilliant. I love that news!
But I'm learning to ask myself another question: what's in it for them? One bad thing is that they are going to receive A LOT of calls all at the same time with everyone's policies all ending at the same time. (Job opportunity for me?) I wonder if they think the new plans will be less profitable for them. Or maybe they are just afraid because there hasn't been any experience with the new plans, so they don't know how good they'll be at guessing the appropriate rates. If a lot of people are in the tried-and-true plans during the experimental phase, there's only so much trouble they can get into. Or maybe they'll think if we are changing our insurance, the chances are higher that we'll switch to a different company.
Hopefully this will all be moot for me by then because I'll have a full-time job at UT again. If not, I'd have to make a guess at what my income would be before I would be able to compare my final costs. And if my income were low, well, I don't think taxpayers should have to pay for more insurance for me than I even want; that's pretty rude. Though totally legal and tempting.
Article of the Day - Sarah Goodyear's One Simple Tip That Could Save a Cyclist's Life - 'The saddest thing about these cases is that dooring is perhaps the most preventable conflict between drivers and cyclists. For the person on the bike, staying out of the "door zone" by riding farther from the line of parked cars is the best solution.
'But the onus should really be on the person exiting the car. . . . Using your mirrors and also turning to look over your shoulder are the best way to do it – just the way you avoid crashing when changing lanes in traffic.
'But I’ve recently seen a few mentions of what seems to be the simplest and most elegant fix of all: train drivers to open their doors with their right hands when they’re exiting the car, forcing them to turn their bodies so that they are automatically looking over their shoulders."
Sounds like a good new habit to try for.
The present
My only real goal for insurance is to cap my out-of pocket expenses so I don't have to spend all my savings if I get really sick or injured. I prefer low premiums in return for paying out of pocket for lots of stuff. That's because premiums are guaranteed. I have to pay those no matter what. Additional costs may or may not be high and for me I like those odds. And once you have the whole deductible saved up (which may, admittedly, take more than one year), it's not even scary to have to pay that.
The risk of this approach is that apparently most people put off getting check-ups and medical care when they have to pay for it themselves, and this allows conditions to go unchecked longer, which can make them much more expensive to treat once the person finally gives up and goes in. (Not to mention more painful and less likely to work.) But I have ways of countering that tendency.
My experience has been that I get much better prices than I would have gotten if I were uninsured, plus I get the Affordable Care Act benefits that apply to all insurance plans. So, it's basically a good deal for me.
The future
Learning about the Affordable Care Act been more exciting for me than it would have been if I still had my full-time job where I would just be keeping my same plan which is fully paid for by my employer. In my current state, things are going to change. I'm not exactly sure how yet; all I know is:
* Rates will be based on age, location, plan level, and tobacco use--nothing else matters (gender, non-tobacco-related behavior, pre-existing conditions, etc.).
* There will be four plan types: bronze, silver, gold, and platinum. The bronze has the lowest premiums and should be designed to cover 60% of an insured person's costs on average. The gold has the highest premiums and should be designed to cover 90% of an insured person's costs on average. Silver and gold are between, covering 70% and 80% of costs on average.
* Theoretically, premiums should be lower on average because all people, even healthy people, have to get insurance. In reality, Republicans are sure it's going to cost more. I'm not sure why. Maybe it's because the plans for California that are already out cost more (do they?). Maybe it's because some (many?) employers are cutting worker hours or cutting workers so they don't have to provide insurance, so those workers will have to pay more. Maybe it's because of the subsidies (it's costing more in taxes). Actually, I think it's because insurance now has to cover more things in most states (especially Republican-majority ones).
* There will be government subsidies for families making below 400% of the poverty level wages to ensure that they don't pay more than 9.5% of their income for silver-level insurance. That includes a majority of Americans, though most of my readers are high-earning adults with no kids, so it probably doesn't include most of y'all.
* There is a maximum out-of pocket expense ($6,350 per person for most plans, $4,000 for platinum).
There is still a lot of room for how to design plans at each level so long as with the given co-pays, deductible, co-insurance, and maximum out-of-pocket expenses, it comes out to the appropriate percentage on average. I don't know if I will still have a choice between high-deductible, low-rate plans and low-deductible high-rate plans. Who knows how the different levels will differ? I don't even know if companies (or states) are allowed to have more than one kind of plan at each level.
So I looked at California's Health Insurance Marketplace. I clicked their Shop and Compare button, entering my old full-time income, my current age, and an affordable-looking zip code. It looks like there is one plan available at each level. The lower levels have higher deductibles, co-pays, and co-insurance. So they don't have the choices I want and would require me to buy more insurance than I have now. So it's likely I'd just pick the cheapest one, the bronze.
The one weird thing is that since my income was below 400% of the poverty-level for a one-person family, I'd qualify for the "Enhanced Silver" plan. The part that's relevant to me is that the maximum out-of-pocket expense is $5,200 instead of $6,350. I don't know why the government wants to make silver plans extra affordable for lower-income people, but it does affect things oddly.
Then I looked at the premiums to see how they compare to what I'm paying now ($199/month, will probably be more like $205 next year). Of course the ones I looked up are higher because a) it's for more coverage and b) it's in California. Even the bronze is $325 - 373/month (depending which company you choose and whether you choose a PPO or an HMO). Even with the government assistance (tax credit) of $92/month that still comes out to $233 - 282. The enhanced silver (after tax credit price) is substantially higher ($288 - 382). Gold is $337 - 501 and plantinum is $392 - 496.
Of course I might not be making 42K next year. If I'm making only 25K next year, the tax credit goes up to $280/month, which is crazy high! That could bring my rates down to $40/month at tax payer expense.
The transition
My current health insurance policy was originally set to end in May. However, I just got a letter that says that the expiration date has been moved up to November 30, 2013. Then I can renew the same policy for a full year if I want to and basically be grandfathered to be able to keep it for 11 months into the new era. By November 30, the details of the new plans will be out (they are supposed to be ready by October 1, 2013), so I can make an informed decision.
Brilliant. I love that news!
But I'm learning to ask myself another question: what's in it for them? One bad thing is that they are going to receive A LOT of calls all at the same time with everyone's policies all ending at the same time. (Job opportunity for me?) I wonder if they think the new plans will be less profitable for them. Or maybe they are just afraid because there hasn't been any experience with the new plans, so they don't know how good they'll be at guessing the appropriate rates. If a lot of people are in the tried-and-true plans during the experimental phase, there's only so much trouble they can get into. Or maybe they'll think if we are changing our insurance, the chances are higher that we'll switch to a different company.
Hopefully this will all be moot for me by then because I'll have a full-time job at UT again. If not, I'd have to make a guess at what my income would be before I would be able to compare my final costs. And if my income were low, well, I don't think taxpayers should have to pay for more insurance for me than I even want; that's pretty rude. Though totally legal and tempting.
Article of the Day - Sarah Goodyear's One Simple Tip That Could Save a Cyclist's Life - 'The saddest thing about these cases is that dooring is perhaps the most preventable conflict between drivers and cyclists. For the person on the bike, staying out of the "door zone" by riding farther from the line of parked cars is the best solution.
'But the onus should really be on the person exiting the car. . . . Using your mirrors and also turning to look over your shoulder are the best way to do it – just the way you avoid crashing when changing lanes in traffic.
'But I’ve recently seen a few mentions of what seems to be the simplest and most elegant fix of all: train drivers to open their doors with their right hands when they’re exiting the car, forcing them to turn their bodies so that they are automatically looking over their shoulders."
Sounds like a good new habit to try for.