Kelly in comments on Wednesday laid out his family’s insurance options.
Window shopping healthcare.gov I see we’re down to 3 insurance companies here in Marion County, Oregon. Best I can recall we had 8 or 10 a couple years ago. Kaiser has increased it’s price advantages. I can get a Kaiser Gold plan w/$2000 deductible for $17 less than Moda silver w/$7000 deduct and $27 less than Providence w/$5000 deductible. That would be a compelling bargain but my wife does not like Kaiser and the clinic is 30 to 45 minutes away vs our local docs that are 10 minutes away. Much to think about.
I agree, there is a lot to think about.
In some regions where there is only a single insurer that offers a single network and a variety of flavors of the same HMO or PPO, the choice is simple. If Gold is cheaper than Silver and the same premium as Bronze then buy Gold instead of Silver or Bronze. That is the easiest decision case and it is highly dependent on your income and the county that you live in.
Kelly’s case is more complex. He sent me some more details and him and his wife are more likely to be grandparents than expecting an infant. They qualify for subsidies. The least expensive Bronze plan has a post-subsidy premium of $30 a month and a $13,100 combined deductible/maximum out of pocket cap. The total cost of care for the year between premiums and deductible would be a maximum of $13,500.
The Gold plan that he references has $6,800 in premiums per year and a maximum out of pocket of $14,000. The Moda Silver plan has annual premiums of $7,000 premiums for the year and a maximum out of pocket of $14,700. The big difference between the two plans is the deductible. The out of pocket maximums are roughly the same but the Gold plan is set up so that the first $5,000 in expenses for Kelly would cost him $1,000 of deductible and $1,267 in co-insurance for a total of $2,267. The Moda Silver would make Kelly pay $2,500 in deductible and $875 in additional co-insurance so that first $5,000 bill would mean a $3,375 check out of his pocket. If he was hit by a meteor, Gold and Silver are roughly the same annual cost and Bronze would be cheaper if he knows that he is getting hit by a meteor.
But he is considering other other very relevant factors. A happy wife going and nearby doctors are very valuable things that might be worth an extra $17 a month.
These are tough choices to make and they require a lot of thought as to what you value and what hard constraints you face.
Right now, take your time and window shop. See what is out there. See what you qualify for. Identify what you must have given your life circumstances and probable health. Finally, get help and take your time working through this. There are seven weeks to looks and six weeks to buy, a decision is not needed on the first day.