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View Diary: More evidence Obamacare is working to provide the health care people need (38 comments)

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  •  ...our family's saga continued... (0+ / 0-)

    Here in our part of Arizona (probably partly/mostly because it’s Arizona… snark added), there were very wide differences in plans, both in coverage and cost (can somebody explain why there are some plans with less coverage but substantially higher premiums?).  

    My wife was losing her employer insurance coverage (not related to O-care, but poorly managed company finances), and she was the only one covered in our family.  Our family budget is tight, so we were trying to get coverage for all of us, but stay within the amount they were “crediting” her for not continuing coverage (the subsidy seemed like it might make it possible).  I was trying to balance monthly premium cost against likely medical costs (I have a prescription medicine I take, and we each have a couple of doctor visits a year for followups on non-serious but chronic conditions). Between the premium credit from the company, and money we would have because we lost our HSA access, we had about $400/mo to work with.

    Our choices came down to this… a Bronze plan for about $330/mo, with a $5,500/$11,000 deductible and generally 50% co-insurance for both medical and prescriptions (**after deductible for both medical and prescriptions), or a Silver plan for about $480/mo, with a $2,500/$5,000 deductible and then 20% co-insurance for doctor visits, and fairly high co-pays for prescriptions, especially the Tier 3 migraine medicine.  Both plans had about the same max OOP of about $12,500.

    I did an extensive spreadsheet to test different medical scenarios, plugging in my $100/mo medicine and our general assortment of doctor visits and requisite lab tests, and then various possible minor “disasters”.  Perhaps not surprisingly, it was about a wash, annually (damn those accurate actuaries!).  And, yes, I did deduct our once-a-year free “physicals”…

    What I found was that paying essentially cash, under the Bronze plan, for the few remaining the doctor visits, the migraine medicine, and an urgent-care visit or two (we have a 10-yr-old), was just about the same as the extra $150/month premium, for the Silver plan, plus what we would have still paid for co-insurance and drug co-pays — especially since the deductible would have to be met in many cases before the co-insurance would kick-in.

    All of us are relatively healthy at the moment, and my wife and I are managing our conditions well with exercise and lifestyle.  So, ultimately, we decided to go with the cheaper Bronze plan (for this remaining 9 months of 2014) and see if we come out ahead by not needing the doctor visits as much.  But, we know we are covered if something catastrophic happened (an accident or newly discovered major illness…).  

    It’s better than we were doing before, with my wife’s crummy employer “catastrophic” insurance (even when she had it…) and no coverage for anyone else.  At least the whole family is covered and the worst that could happen financially is a $12,500 hit in costs, which we felt we could cover between savings and available revolving credit.

    Next year (2015), we’re hoping to be making a bit more as a family, and would like to move up to a lower deductible, more-copay based Silver (or, hey, maybe even Gold…) plan.  We can dream, right?

    Sheesh… Can’t wait for the day of “single-payer”!

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