Growing up, my dad would look at me and with his best imitation of W.C. Fields say, “Close but no cigar kid!” when I’d almost get the point but be just a little off on what I was saying. I was reminded of his doing that with my ongoing search for affordable health insurance through the federal exchange. I’m closer to the answers I’ve been seeking but I haven’t been awarded a cigar yet.
The biggest hurdle to completing my search has been the federal exchange web site. It’s not operational. I went on-line Wednesday and chatted with one of the support personnel who confirmed the site isn’t operational and there’s no way to create an account. The only way to review and price plans is to create an account, so until that’s operational, anybody in one of the 37 states who doesn’t have a participating State exchange is out of luck.
I then turned to Blue Cross Blue Shield (BCBS) of Texas with who I’ve had an individual health insurance policy for the last two years. Most of the BCBS websites, regardless of State, have the ability to compare the plans available through them. This at least has been helpful, although until the www.healthcare.gov is operational, I’m unable to compare pricing of non-BCBS plans.
What I’ve found in talking with BCBS of Texas is the following:
- BCBS in Texas (this may vary by State) will not offer a Platinum level plan
- That leaves only Bronze, Silver, and Gold plans from which to choose
- There are a bunch of non-HSA compatible plans in all three plan levels
- The only HSA compatible plans are available for a Bronze level plan
- The deductible options on the Bronze plans is either $5,000 or $6,000 a year, that’s the individual deductible (the family deductible is higher)
- Total out of pocket for the plan with the $5,000 deductible is $6,250, and $6,000 for the plan with a $6,000 deductible
- If I go with the plan that has the $5,000 deductible, then there’s a 20% copay until I hit the total out of pocket limit for the year
- If we qualify for the tax credit, I’ll save about $135 a month over what I’m paying now (I’ll throw that extra amount into the HSA account to hopefully offset the plans deductible being over twice what I have now which is $2,500)
- If I were going to match a plan that has a deductible close to my current policy deductible, it would be a silver or gold plan and that premium runs $500 to $750 a month
- All the plans, including the Bronze level options provide for preventative care (annual physical, colonoscopy, prostate screening, mammograms, etc.)
There was some discrepancy between what the BCBS agent told me and what I saw on their website. The agent stated that both the HMO and PPO versions of their Bronze plan are HSA compatible, but on their web site only the PPO plan is HSA compatible. That’s something I hope to confirm in the next couple of weeks.
Now that I have an idea of what the plans costs are, I’ll begin to frame my decision around the following two criteria:
- HSA compatibility
- PPO versus HMO
I prefer having an HSA oriented policy because it is a built in savings account that grows from year if it’s not completely used that year. In addition, as a self-employed person, there are tax advantages for having a HSA (at least for now).
The decision of PPO versus HMO plan will be easily made if the HMO plan has an option that’s HSA friendly. If not, then my preference for the HSA option will force the decision to a PPO Bronze plan.
There are some interesting things we all need to be aware of that are beginning to become apparent as more information becomes available.
- Not all hospitals will accept all plans nor all plans accept all hospitals. As a resident of Dallas, the BCBS PPO plan allows me to pick from Baylor Medical Center, Presbyterian, Medical City, and Doctors Hospitals. The HMO plan limits me to Doctors and Medical City Hospitals.
- The HMO plan requires the primary care physician be the gatekeeper to all other physicians, meaning they will need to refer you to a specialist. The PPO plan means getting around the gatekeeper whenever you feel it’s warranted.
I’m not terribly concerned that the federal exchange is not up and running yet. We do have until December 15th to enroll in a plan with an effective date of January 1. At least I know what some of my answers are, but I’d really like to compare all the plans and nail down that cigar!
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