Health insurance + free care?
December 9, 2018 7:51 AM Subscribe
I'm currently eligible for a 100% discount at the hospital that I get all of my medical care from. I'm trying to pick a plan from the health insurance marketplace, but my premium will go up significantly from this years' if I choose any plan that covers my regular doctors, who are all at this hospital. If I'm getting free care anyway, should I just choose a catastrophic plan with a low deductible?
I'm eligible for a 100% discount the next 6 months, at which point I will reapply, but I don't expect anything to have changed in the next 6 months, so I will likely get this again (this is the second time I have been approved for it). I would make sure to select a plan that covers my current prescriptions. The discount applies to hospital and physician services, including emergency room.
I basically have three options:
1) A silver plan that covers my doctors and prescriptions and has a low deductible, but costs 50% more than my current premium.
2) A silver plan that covers my prescriptions but NOT my doctors and has a low deductible, but costs 60% LESS than my current premium.
3) A bronze plan that covers my prescriptions and NOT my doctors and has an extremely high deductible but costs almost nothing.
Please assume I am at a point where an extra $50 a month means a lot. Is there any reason I shouldn't just choose the bronze plan? My paranoia/play-everything-safe is making me lean towards option 2 because I know catastrophic plans are Bad News, but if I get all my care through this hospital (which is large and has many locations and different kinds of specialists) is it worth the extra money? You are not my financial advisor, etc.
I'm eligible for a 100% discount the next 6 months, at which point I will reapply, but I don't expect anything to have changed in the next 6 months, so I will likely get this again (this is the second time I have been approved for it). I would make sure to select a plan that covers my current prescriptions. The discount applies to hospital and physician services, including emergency room.
I basically have three options:
1) A silver plan that covers my doctors and prescriptions and has a low deductible, but costs 50% more than my current premium.
2) A silver plan that covers my prescriptions but NOT my doctors and has a low deductible, but costs 60% LESS than my current premium.
3) A bronze plan that covers my prescriptions and NOT my doctors and has an extremely high deductible but costs almost nothing.
Please assume I am at a point where an extra $50 a month means a lot. Is there any reason I shouldn't just choose the bronze plan? My paranoia/play-everything-safe is making me lean towards option 2 because I know catastrophic plans are Bad News, but if I get all my care through this hospital (which is large and has many locations and different kinds of specialists) is it worth the extra money? You are not my financial advisor, etc.
For me it would depend on the fact that you don't have a guarantee after six months. While your circumstances might not change, the hospital's financial situation might change, or the program your care is through might be discontinued. If I knew more about the program you got your free health care through, I might feel differently, but with just the info here, I would not feel totally stable on a plan that had to be renewed every six months. I'd go with #2.
The other thing to take into account is whether you ever travel. If there is any conceivable reason you might need health care in a situation where you can't get it at your preferred provider, that deductible is going to make a difference.
posted by gideonfrog at 10:42 AM on December 9, 2018 [1 favorite]
The other thing to take into account is whether you ever travel. If there is any conceivable reason you might need health care in a situation where you can't get it at your preferred provider, that deductible is going to make a difference.
posted by gideonfrog at 10:42 AM on December 9, 2018 [1 favorite]
I think a big factor is what happens if you get it wrong - you take the bronze and then you lose your deal with the hospital. I know it wouldn't be good but what are your contingency plans? Eating cat food for the next decade? Declaring bankruptcy? Maxing out credit cards? Working out a payment plan with the hospital? Using up your savings? If your backup plan is reasonably survivable then you can look at the math in more detail.
The next question is to this about what the chances are that you might have to resort to using the hospital plan. I find an x out of y statement is more intuitive than assigning a percentage. So, is this a one in twenty chance? one in one hundred? Then you can look at how much you are saving versus the expected value of a major medical expense where you have to use your plan. Let's say the chances of a disaster are 1 in 20. That is 5%. If you have a $10,000 cost difference then the saving from the bronze plan would have to be significantly more than $500 to be worth it. However, I think the percentage of the costs that you pay on bronze is higher than silver. So, in that case, you would not only have to pay the higher deductible but also a higher percentage of all of the rest of the expenses as well. So, there is an additional small chance that you might face a hospital bill of hundreds of thousands of dollars. Not very likely, but still a real chance of it happening.
I have people in my family who had major, unexpected medical expenses when they were young and healthy, so I tend to weigh the chances of something big happening higher than most. But the fact that you are already have a team of regular doctors suggests that your odds might be higher than these healthy young folks that I've know.
posted by metahawk at 5:23 PM on December 9, 2018
The next question is to this about what the chances are that you might have to resort to using the hospital plan. I find an x out of y statement is more intuitive than assigning a percentage. So, is this a one in twenty chance? one in one hundred? Then you can look at how much you are saving versus the expected value of a major medical expense where you have to use your plan. Let's say the chances of a disaster are 1 in 20. That is 5%. If you have a $10,000 cost difference then the saving from the bronze plan would have to be significantly more than $500 to be worth it. However, I think the percentage of the costs that you pay on bronze is higher than silver. So, in that case, you would not only have to pay the higher deductible but also a higher percentage of all of the rest of the expenses as well. So, there is an additional small chance that you might face a hospital bill of hundreds of thousands of dollars. Not very likely, but still a real chance of it happening.
I have people in my family who had major, unexpected medical expenses when they were young and healthy, so I tend to weigh the chances of something big happening higher than most. But the fact that you are already have a team of regular doctors suggests that your odds might be higher than these healthy young folks that I've know.
posted by metahawk at 5:23 PM on December 9, 2018
Response by poster: Thanks for all the good points. I know that I tend to be a bit paranoid and overestimate risk, so it's good to know other people feel like there is some risk here.
That said, I realized I forgot to factor in drug prices--on the bronze plan I pay full price for my meds up to the deductible vs a $10 co-pay on the silver plan. (And yes, I am young but not at all healthy, so I have a lot of prescriptions.) Combining med prices and the premium, the silver plan ends up actually only being $5 more expensive per month. $5 a month is probably worth it for the peace of mind.
I'll double check with the hospital in the morning, but assuming going with a plan the hospital isn't covered under doesn't invalidate my financial assistance, it probably makes the most sense to go with option 2. So for anyone else looking at this in the future: check your drug prices before deciding on a plan!
But because I always second guess myself... there's definitely no reason to go with option 1, right? As long as it doesn't interfere with my financial assistance?
posted by brook horse at 6:43 PM on December 9, 2018
That said, I realized I forgot to factor in drug prices--on the bronze plan I pay full price for my meds up to the deductible vs a $10 co-pay on the silver plan. (And yes, I am young but not at all healthy, so I have a lot of prescriptions.) Combining med prices and the premium, the silver plan ends up actually only being $5 more expensive per month. $5 a month is probably worth it for the peace of mind.
I'll double check with the hospital in the morning, but assuming going with a plan the hospital isn't covered under doesn't invalidate my financial assistance, it probably makes the most sense to go with option 2. So for anyone else looking at this in the future: check your drug prices before deciding on a plan!
But because I always second guess myself... there's definitely no reason to go with option 1, right? As long as it doesn't interfere with my financial assistance?
posted by brook horse at 6:43 PM on December 9, 2018
In the worst-case scenario where your financial assistance plan isn't renewed, are you willing to change doctors?
That's the only downside of picking option 2 over option 1, that I can see.
posted by serelliya at 4:52 PM on December 14, 2018
That's the only downside of picking option 2 over option 1, that I can see.
posted by serelliya at 4:52 PM on December 14, 2018
This thread is closed to new comments.
posted by AlexiaSky at 10:01 AM on December 9, 2018 [4 favorites]