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You are here: Home / Anderson On Health Insurance / What’s my deal?

What’s my deal?

by David Anderson|  March 16, 20156:03 pm| 15 Comments

This post is in: Anderson On Health Insurance

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Valued commenter,  Violet,   asked a really good question earlier today:

I was also wondering if there is something available that helps people assess their current plan if it’s employer-based. I mean to figure out what level it is–gold, silver, bronze, whatever. In most workplaces you get what you get or maybe you have a couple of choices. But I haven’t seen them branded “Gold plan,” “Silver plan” so it’s kind of hard to do an apples-to-apples comparison.

The Center for Medicare and Medicaid Services has a really nifty little macro enabled Excel file at this link.

It allows for you to play around with your plan’s schedule of benefits to determine roughly what the actuarial value of the plan is.  I’ll give some of the simplest thresholds for the metal bands.  There is a near infinite way that an insurance company can assemble deductibles, co-insurance, co-pays, and benefit tiers to build a plan that hits an expected actuarial value plus or minus two percentage points.  All of these examples are for single coverage only.

Platinum 90% Actuarial Value: $750 deductible only OR $500 deductible with a 25% co-insurance to $1,000 total.

Gold 80% Actuarial Value: $1,850 deductible only OR $1,250 deductible with a 25% co-insurance to $2,000 total.

Silver 70% Actuarial Value: $3,300 deductible only OR $2,000 deductible with a 25% co-insurance to $4,000 total.

Bronze 60% Actuarial Value: $5,600 deductible only OR $4,000 deductible with 25 % co-insurance to $6,300 total.

A couple of points here.

  • Co-pays for common things (Primary Care, specialists etc) can be treated almost like deductibles
  • To drop 10% Actuarial Value is is always more than doubling of the deductible
  • Costs are concentrated in a very narrow segment of the population.
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Reader Interactions

15Comments

  1. 1.

    Baud

    March 16, 2015 at 6:11 pm

    In before single payer.

  2. 2.

    Another Holocene Human

    March 16, 2015 at 6:20 pm

    A lot of working poor people are getting hit with penalties this year because they didn’t know they needed a code from healthcare.gov to certify that no, they can’t afford health insurance.

    These are people who would have been on Medicaid yesterday if that had been available to them.

    Fuck you, John Roberts. Not like you care but … fuck you.

  3. 3.

    Richard Mayhew

    March 16, 2015 at 6:28 pm

    Just as a reminder, Medicare (Part A, B and D) combined is roughly an 80% Actuarial Value plan, so Medicare for All would be roughly a Gold plan.

  4. 4.

    Seanly

    March 16, 2015 at 6:49 pm

    Hmmm, I’m very surprised. We’ve gone with the high deductible plan from my company after they dropped the PPO plan we previously had. According to the spreadsheet, it’s got an actuarial value of 79% so pretty much Gold Tier. We have an individual deductible of $1500 with OOP max of $4500 w/ 80% co-pay. Company does put in $400 to HSA for taking that plan.
    I do have to be fair to the insurance company. My wife has been very ill for the last 15 months (so 2 years of max payout for us), but the insurance company hasn’t fought or denied anything. Other than a few items here & there, we’ve been able to get her the care she needs.

  5. 5.

    Litlebritdifrnt

    March 16, 2015 at 6:54 pm

    OT but the three legged cat problem has been solved. She belongs to my neighbor and is normally an indoors cat but will occasionally escape to have some adventures. She is named Eileen (geddit?) and is as sweet as can be. She is now happily back indoors next door.

  6. 6.

    Litlebritdifrnt

    March 16, 2015 at 7:04 pm

    Another OT a national food company in Canada is going to be selling ugly fruits and vegetables at discount prices.

    http://www.treehugger.com/green-food/canadian-grocer-will-sell-ugly-fruits-and-vegetables-discount.html?utm_source=dlvr.it&utm_medium=twitter

    Great news for everybody, farmers, consumers, grocery stores, landfills. You name it.

    I have often said this. My local store advertises “grade A fancy” strawberries or whatever at such and such a price. Why can’t I have the option to buy “grade B not so fancy” strawberries at a lower price? In fact why don’t I have the option to buy “grade D down right bloody ugly” strawberries at a rock bottom price because they are going to end up in a pie anyway?

  7. 7.

    Don K

    March 16, 2015 at 7:18 pm

    Thanks, Richard. My former employer offers one really basic BC/BS-administered PPO (fine if you’re 30 and healthy – it will keep you out of bankruptcy if you get hit by a bus), two PPO upgrades, and one HMO, and I’ve wondered how they line up against the ACA bands.

  8. 8.

    Villago Delenda Est

    March 16, 2015 at 7:25 pm

    I get the feeling that the insurance companies do not want a simple to understand pricing/benefits regime out of old habits of doing anything they could to avoid actually paying claims. ACA has addressed some of that, to be sure, but old habits die hard.

  9. 9.

    Mnemosyne (iPhone)

    March 16, 2015 at 7:26 pm

    @Another Holocene Human:

    They should probably appeal to the IRS — contrary to their reputation, the IRS has been trying NOT to penalize poor people this year because they didn’t understand the new system. They may be able to get a retroactive code from HHS and get that money refunded.

  10. 10.

    Violet

    March 16, 2015 at 7:33 pm

    Thank you, Richard! I’ll give that a try. I’m curious where my plan falls. Changed to high deductible a few years ago because after using the calculator the company provided, unless you had a very expensive year–at least one hospitalization and ongoing treatment–the plans were pretty much a wash in terms of out of pocket based on a typical year and any drug costs.

  11. 11.

    Villago Delenda Est

    March 16, 2015 at 7:34 pm

    @Mnemosyne (iPhone): The GOP is doing everything it can with sequestration to prevent the IRS from doing that.

  12. 12.

    Violet

    March 16, 2015 at 7:37 pm

    @Litlebritdifrnt: Supposedly the former president of Trader Joe’s is starting a similar store, the Daily Table. Here’s a link to an article from 2013. Can’t see that it’s up and running yet, though.

  13. 13.

    Kropadope

    March 16, 2015 at 7:48 pm

    @Villago Delenda Est:

    The GOP is doing everything it can with sequestration to prevent the IRS any part of the government from doing that anything helpful.

  14. 14.

    NotMax

    March 16, 2015 at 8:21 pm

    Except on Tuesdays.

    Unless it’s night.

    It’s Fizzbin, I tells ya, Fizzbin!

  15. 15.

    NotMax

    March 16, 2015 at 8:32 pm

    @Litlebritdifrnt

    Remember well what was printed in big, bold block letters on a stark white background on the label of the #10 cans of peas used in the kitchen at summer camp:

       ”Product does not meet minimum FDA standards.
     
       Above legend mandatory. Peas actually high quality.”

    Bright green in the can, they were more of a brownish-gray once cooked and served, all the bright green having leached out to the cooking water.

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