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What sense does this make?

MaggieD

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Okay, here's a link to a "shopping trip" for Obamacare: https://retailweb.hcsc.net/retailshoppingcart/IL/plans?plantype=majormedical&b=0

I put in my cousin's age (58) and wanted to help her shop. Blue Cross Blue Shield comes up with a variety of plans -- and the premiums don't make sense to me. What am I doing wrong?

Example: The first choice shows a policy available for $302.40 a month (Bronze Plan). $6,000 deductible. $6,000 maximum out-of-pocket. Co-insurance 100% (IOW, after the $6,000, you pay nothing...I think)

The second choice shows a policy available for $302.60 a month (Bronze Plan). $5,000 deductible. $6,250 maximum out-of-pocket. Co-insurance at 80%. Why would anyone buy THAT policy?

WTF is going on? Look at the rest of them. They don't make sense...
 

davidtaylorjr

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Okay, here's a link to a "shopping trip" for Obamacare: https://retailweb.hcsc.net/retailshoppingcart/IL/plans?plantype=majormedical&b=0

I put in my cousin's age (58) and wanted to help her shop. Blue Cross Blue Shield comes up with a variety of plans -- and the premiums don't make sense to me. What am I doing wrong?

Example: The first choice shows a policy available for $302.40 a month (Bronze Plan). $6,000 deductible. $6,000 maximum out-of-pocket. Co-insurance 100% (IOW, after the $6,000, you pay nothing...I think)

The second choice shows a policy available for $302.60 a month (Bronze Plan). $5,000 deductible. $6,250 maximum out-of-pocket. Co-insurance at 80%. Why would anyone buy THAT policy?

WTF is going on? Look at the rest of them. They don't make sense...

I just looked on Blue Cross for SC and NONE of the plans even offer coverage outside the state of SC! What!!! Stupid.
 

MaggieD

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I just looked on Blue Cross for SC and NONE of the plans even offer coverage outside the state of SC! What!!! Stupid.

Either the website's screwed up or you're doing something wrong. The above website is Blue Cross and I entered an Illinois zipcode.
 

davidtaylorjr

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Either the website's screwed up or you're doing something wrong. The above website is Blue Cross and I entered an Illinois zipcode.

No, I know. I was curious what it was for my state. :)
 

RabidAlpaca

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Okay, here's a link to a "shopping trip" for Obamacare: https://retailweb.hcsc.net/retailshoppingcart/IL/plans?plantype=majormedical&b=0

I put in my cousin's age (58) and wanted to help her shop. Blue Cross Blue Shield comes up with a variety of plans -- and the premiums don't make sense to me. What am I doing wrong?

Example: The first choice shows a policy available for $302.40 a month (Bronze Plan). $6,000 deductible. $6,000 maximum out-of-pocket. Co-insurance 100% (IOW, after the $6,000, you pay nothing...I think)

The second choice shows a policy available for $302.60 a month (Bronze Plan). $5,000 deductible. $6,250 maximum out-of-pocket. Co-insurance at 80%. Why would anyone buy THAT policy?

WTF is going on? Look at the rest of them. They don't make sense...

Let me put on my surprised face.

fresh_prince_amazed.gif


OMG! This isn't the affordable healthcare that everyone thought it would be? If only somebody had known ahead of time!
 

Ray410

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Those sound like catastrophic umbrella plans and people just pay for their own healthcare.
 

CanadaJohn

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Okay, here's a link to a "shopping trip" for Obamacare: https://retailweb.hcsc.net/retailshoppingcart/IL/plans?plantype=majormedical&b=0

I put in my cousin's age (58) and wanted to help her shop. Blue Cross Blue Shield comes up with a variety of plans -- and the premiums don't make sense to me. What am I doing wrong?

Example: The first choice shows a policy available for $302.40 a month (Bronze Plan). $6,000 deductible. $6,000 maximum out-of-pocket. Co-insurance 100% (IOW, after the $6,000, you pay nothing...I think)

The second choice shows a policy available for $302.60 a month (Bronze Plan). $5,000 deductible. $6,250 maximum out-of-pocket. Co-insurance at 80%. Why would anyone buy THAT policy?

WTF is going on? Look at the rest of them. They don't make sense...

Firstly, Maggie, I'll say you live an interesting life.

Secondly, I'm inclined to think you should look at this like you would car insurance. Is your cousin in pretty good health (good driver) and isn't involved in risky activities (doesn't drive fast or gets in lots of fender benders) and has no family history of serious medical issues (didn't have lousy driver relatives teach her how to drive)? If so, then the plan with the highest deductibles and the lowest monthly premium would be the best bet because she's not looking to access a lot of medical/health services in the course of this year and so she wants/needs to have the coverage for catastrophic illness/accidents, just in case, but she's not worried about having to pay a lot of out-of-pocket health care expenses because she's healthy and lives a healthy lifestyle.

This can change from year to year and she can adjust her deductibles downward and her monthly premium upwards if she finds that's more cost effective. But for the average healthy person, regardless of age, the lowest monthly premium cost is the best bet. In effect, she's gambling she'll stay healthy rather than gambling she'll get sick - always best to take the optimistist approach in any endeavor, I always say.
 

MaggieD

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Firstly, Maggie, I'll say you live an interesting life.

Secondly, I'm inclined to think you should look at this like you would car insurance. Is your cousin in pretty good health (good driver) and isn't involved in risky activities (doesn't drive fast or gets in lots of fender benders) and has no family history of serious medical issues (did have lousy driver relatives teach him how to drive)? If so, then the plan with the highest deductibles and the lowest monthly premium would be the best bet because she's not looking to access a lot of medical/health services in the course of this year and so she wants/needs to have the coverage for catastrophic illness/accidents, just in case, but she's not worried about having to pay a lot of out-of-pocket health care expenses because she's healthy and lives a healthy lifestyle.

This can change from year to year and she can adjust her deductibles downward and her monthly premium upwards if she finds that's more cost effective. But for the average healthy person, regardless of age, the lowest monthly premium cost is the best bet. In effect, she's gambling she'll stay healthy rather than gambling she'll get sick - always best to take the optimistist approach in any endeavor, I always say.

I think you missed the point. Why would anyone pay 60-cents more a month for just a slightly lower deductible and, instead of 100% covered after deductible, only 80% covered after deductible?

As to my interesting life? That would make the giant assumption that I actually have one.
 

CanadaJohn

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I think you missed the point. Why would anyone pay 60-cents more a month for just a slightly lower deductible and, instead of 100% covered after deductible, only 80% covered after deductible?

As to my interesting life? That would make the giant assumption that I actually have one.

Sorry, I didn't miss your point but I had no intention of getting stuck in the quagmire that is the Obamacare roll-out. I just wanted to offer some general, always free, worth the price, DP friendly advice.
 

MaggieD

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Sorry, I didn't miss your point but I had no intention of getting stuck in the quagmire that is the Obamacare roll-out. I just wanted to offer some general, always free, worth the price, DP friendly advice.

Always knew you were smart...
 

CanadaJohn

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Always knew you were smart...

I have to tell you though, just from a Canadian perspective with what liberal Americans call "free" healthcare, it would cost me about $380.00 per month to buy supplemental healthcare coverage and I'm 57, so your $300 and change monthly doesn't appear all that bad.

It would cover the things that our "free" healthcare doesn't cover, like drugs, optometrists, dental, etc., all with 10 or 20% deductibles. But at this point in my life, pretty healthy, seldom visit the doctor and haven't paid out of pocket for much other then twice yearly cleanings at the dentist and every two year visits to the optometrist, I don't bother with the extra coverage. And if and when I reach 65 a lot of those extras will be mostly covered.
 

Tucker Case

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Okay, here's a link to a "shopping trip" for Obamacare: https://retailweb.hcsc.net/retailshoppingcart/IL/plans?plantype=majormedical&b=0

I put in my cousin's age (58) and wanted to help her shop. Blue Cross Blue Shield comes up with a variety of plans -- and the premiums don't make sense to me. What am I doing wrong?

Example: The first choice shows a policy available for $302.40 a month (Bronze Plan). $6,000 deductible. $6,000 maximum out-of-pocket. Co-insurance 100% (IOW, after the $6,000, you pay nothing...I think)

The second choice shows a policy available for $302.60 a month (Bronze Plan). $5,000 deductible. $6,250 maximum out-of-pocket. Co-insurance at 80%. Why would anyone buy THAT policy?

WTF is going on? Look at the rest of them. They don't make sense...

You're not doing anything wrong that I can see, the difference between the deductible and the out of pocket maximum is the reason why the second pan is more expensive.

Remember, once the mac out of pocket is reached, all insurance covers 100%. The coverage doesn't kick in until the deductible is reached, though.


So when you compare these plans, look at it like this. Plan 2 covers 0% until $5,000, ~80% of the costs after $5,000 until you end up spending $6,250 out of pocket, and 100% after you've spent $6,250.

Plan 1 covers 0% until $6,000 and 100% after $6,000.

So let's break this down so that it makes sense.

If a person's medical expenses usually fall between $5,000 and $9,999 (actual cost, not after insurance cost) annually, Then the second plan will cost them either significantly to slightly less in the long run.

With both plans, they've got to shell out the first $5K before the insurance kicks in. From there, plan two kicks in and covers 80% of the medical costs, while plan 1 is still $1,000 away from kicking in.

$1,000 is 20% of $5,000, so it takes $5,000 of medical costs in order for the person to spend as with Plan 2 as they would with only $1,000 of medical costs on Plan 1.

With only $250 difference in the max out of pocket between the plans, plan 2 is actually the more cost effective plan for someone who is likely to have medical costs in excess of $5,000 annually (This is the case for many people who are on a lot of meds.)

If that is unlikely, then plan 1 is the better option for that person.
 

Tucker Case

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I think you missed the point. Why would anyone pay 60-cents more a month for just a slightly lower deductible and, instead of 100% covered after deductible, only 80% covered after deductible?

As to my interesting life? That would make the giant assumption that I actually have one.

The max out of pocket difference is minimal, so both plans cover 100% after $6,250, one just covers everything $250 earlier, while the other starts covering 80% $1,000 earlier than that.
 

Tucker Case

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BTW, this has nothing to do with Obamacare, really. It's just standard health insurance stuff.
 

Tucker Case

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Let me break this down a little bit simpler. Let's say we have two people: Bill and John.

Bill has plan 1, John has plan 2. They both have to have a procedure that costs $6,000 done and have not spent any money on healthcare so far that year.

Bill will end up paying $6,000 out of pocket for that procedure.

John will end up paying $5,200 out of pocket for that procedure.
 

Rainman05

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Okay, here's a link to a "shopping trip" for Obamacare: https://retailweb.hcsc.net/retailshoppingcart/IL/plans?plantype=majormedical&b=0

I put in my cousin's age (58) and wanted to help her shop. Blue Cross Blue Shield comes up with a variety of plans -- and the premiums don't make sense to me. What am I doing wrong?

Example: The first choice shows a policy available for $302.40 a month (Bronze Plan). $6,000 deductible. $6,000 maximum out-of-pocket. Co-insurance 100% (IOW, after the $6,000, you pay nothing...I think)

The second choice shows a policy available for $302.60 a month (Bronze Plan). $5,000 deductible. $6,250 maximum out-of-pocket. Co-insurance at 80%. Why would anyone buy THAT policy?

WTF is going on? Look at the rest of them. They don't make sense...

Uhm... there are warning signs all over the internet that there are false websites put online that look official but aren't and they'll steal your private info.
 

Tucker Case

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Uhm... there are warning signs all over the internet that there are false websites put online that look official but aren't and they'll steal your private info.

That's the real Blue Cross Blue Shield of Illinois site, though.
 

tech30528

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I wonder what would happen if we told all the members of Congress that there is going to be a change in clothing choices for them. There will be 3 different choices of which style of suit they would like to wear. They are all unisex and one size fits all. Think they would go for it?
 

tech30528

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That's the real Blue Cross Blue Shield of Illinois site, though.

Yeah, we had BCBS of Illinois when we lived there and it was really good. Then we moved to Georgia, BCBS in Georgia sucked balls. IIRC it wasn't even listed as an INsurance company, it was an ASsurance company. Presumably to slide under insurance regulations.
 

lizzie

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Okay, here's a link to a "shopping trip" for Obamacare: https://retailweb.hcsc.net/retailshoppingcart/IL/plans?plantype=majormedical&b=0

I put in my cousin's age (58) and wanted to help her shop. Blue Cross Blue Shield comes up with a variety of plans -- and the premiums don't make sense to me. What am I doing wrong?

Example: The first choice shows a policy available for $302.40 a month (Bronze Plan). $6,000 deductible. $6,000 maximum out-of-pocket. Co-insurance 100% (IOW, after the $6,000, you pay nothing...I think)

The second choice shows a policy available for $302.60 a month (Bronze Plan). $5,000 deductible. $6,250 maximum out-of-pocket. Co-insurance at 80%. Why would anyone buy THAT policy?

WTF is going on? Look at the rest of them. They don't make sense...

It's government, Maggie. What else needs saying?
 

Tucker Case

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People blaming this on obamacare and the government are way off the rails, here. The things that they aren't understanding are the standard practices of health insurance companies. It has nothing to do with obamacare. Obamacare isn't what is making the difference between those two plans confusing to people. Their lack of understanding of how health insurance works is what is making them confusing.

And it's understandable that so many people don't know how it works. Very few people have ever had to shop around for their own insurance before now. They usually just pick between a few selected options from their employer or went uncovered.

They don't know how to operate in a free market for health insurance (comparing a large array of plans in order to decide which one works best for them). They are used to a few limited options with just one company. That's the thing that I find most surprising about Obamacare. It's opening up the possibility of a free market approach to healthcare.

I wish that this kind of thing existed when I was still self-employed and single. I'd have saved a ton of money.
 
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