Michael

It's money burns a hole in your pocket concept. Some people say they need a Platinum plan because they can't afford to pay a large medical bill if one occurs but in reality what they are really saying is that they don't have the financial self discipline to save money if they have it but can make larger monthly payments if they have to.

For example, a bronze plan for a single person may possibly cost $300 per month for a $6,5000 deductible with a $6,500 maximum out of pocket expense so therefore in the worst case situation, their total cost will be $10,100 in any year. On the other hand, a Platinum plan may possibly cost $600 per month with no deductible and a $2,000 maximum out of pocket expense so therefore in the worst case situation, their cost will be $9,200. Therefore purchasing a Platinum plan is usually only financially beneficial if their out of pocket expenses approach the maximum out of pocket expenses.

However if their annual medical expenses are only $2,000, the bronze plan will normally save the person money compared to a Platinum plan.

It's the same concept that some people need a $250 deductible for collusion insurance for their car instead of $1,000 deductible since they can't save an extra $750 during the year to pay for a possible accident but can afford to pay an extra $20 per month for car insurance premiums. A lower deductible is usually only an advantage if they have a car accident about every two years and even then, it often isn't an advantage if the accident only causes $1,000 worth of damage since insurance rates will rise if the accident is reported to the insurance company.

scrubbedexpat099

Where I am a Platinum plan for a couple aged 60 is 1400 more pm than a Bronze.

Interesting article in the NY Times today.

nun

The level of co-pays and co-insurance is important too as that will govern how quickly you get to your out of pocket max.

My current plan has a $400/month premium, buy only a $250 deductible, no co-insurance and low copays...eg if I have to be admitted to hospital it costs me a co-pay of $250, that's my deductible right there and I pay nothing more for that visit.

I'm now wrestling with the relatively high premiums of my ex-employer's plan vs a very low premium and low co-pays of the ACA option I could get. The thing that keeps me with the more expensive plan is that it avoids any political issues with the ACA and that in 18 months it's premium will go down to $100/month.

Michael

$1,400 per moth * 12 = $16,800 per year which is over $4,000 per year more than the maximum allowed out of pocket expense for a family for a Bronze plan ($12,569). In that case, there can never be any financial advantage to having a Platinum plan.

scrubbedexpat091

Maybe it could be like what we have in BC although our system is still costly but still feasible.

Monthly premiums which range from $0 to $72 per month for a single.

Monthly premiums up to roughly up to $150 or so per month for a couple and above, the only folks paying the max are families of 4 or more and over a certain income threshold.

For a single person if they make under 30,000 per year they get anywhere from a full subsidy to partial subsidy those making under 22,000 for example pay nothing, where someone making 29,999 gets I think a 10% subsidy.

Basic medical care such as GP and specialist visits, most lab procedures, hospital stays and such are still free of charge at point of service.

Prescriptions however are not free of charge at point of service for most, although we do have programs in place to ensure folks with certain ailments who can't afford their medication to ensure they get it, again mostly based on income, although certain medications for certain illnesses are covered regardless of income, however most medications are not covered and if not low income have 2 choices:

1) Prescription insurance either from work or self pay.

2) Take the risk and take no insurance and pay out of pocket.

However there is again program in place income based where once you hit your deductible you can receive up to 70% coverage.

It's not perfect, but it ensures everyone has access to basic medical care.

Some provinces have no monthly premiums and try and fund solely via taxes but those provinces seem to have more issues and more cuts backs in their system, so I think BC has found a good mix to provide the service without bankrupting everyone and the government.

I wanted to add most medical services in BC are not government run, the government is simply acting as the payer or insurance.

GP's, pharmacies, most labs and such are private companies or self employed and they bill the government for eligible services based on the negotiated rate.

Bnet36

I actually would not mind paying a small fee when I return to the UK. After living through the 'American hustle' insurance world, a small co-pay sounds reasonable. I imagine this would not go down well with those that have not gone through the US experience though.

A small concern is that the UK introducing co-pays would start the ball rolling toward a more US type of healthcare system.

scrubbedexpat099

Exactly. The way it has been structured.. The only logic I could think of is if the premiums are deductible.

Michael

Cobra is different in that the premiums are based on employer's health costs for the company. Cobra can only charge costs plus a maximum of 5% administrative handling and if the employees are healthy, the cost for a good plan can be low but if a few people have large medical bills, premiums can skyrocket.

nun

It's not COBRA, I'm a deferred retiree and so can buy the insurance at full premium up to the age of 55 when I go back to what an employee would pay; the company picks up 75% of the premium leaving me to pay $100/month.

Michael

Is it really a concern? Just about every other developed country except the UK has copays. And even if that was the case, the Swiss have a similar system as ACA (except premiums are not age dependent) for everyone and it works very well. No one would copy the US system but they might copy the Swiss system and that may not be the worst thing that could happen. In the 1990s, the Swiss system was almost identical to the US system but since then, it is the only medical system in the developed world that has reduced costs as a percentage of GDP.

Michael

OK so that is a highly subsidized plan and probably beneficial to keep.

nun

Yes it's a highly subsidized plan, but I have to justify keeping it for the next 18 months and paying $7.2k in premiums vs maybe $1.8k on an ACA plan.

Hotscot

Tell me again why Republicans are against the Individual Mandate? Seems so topsy turvy and a little bit silly.

nun

If I knew their alternative I might be able to give you a sensible answer other than they oppose it because it is Obama implementing an mainstream Republican plan.

Michael

They are against the whole concept of government regulations/involvement in health care and making the "mandate" illegal is just one way to make sure that ACA fails. Another way to make ACA fail is to eliminate the subsidies. A final way would be to eliminate the regulations for the insurance companies.

In my opinion, the republicans purposely tried to bankrupt Medicare quickly by passing Medicare reform to get to their ultimate goal of privatizing Medicare. It made absolutely no sense to make Medicare insolvent 10 years early with minimal benefits to the retiree except for the purpose to privatize Medicare. Luckily ACA has undone some of the damage and the life expectancy of Medicare has been extended by about 12 years.