• Menu
  • Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar

Before Header

  • About Us
  • Lexicon
  • Contact Us
  • Our Store
  • ↑
  • ↓
  • ←
  • →

Balloon Juice

Come for the politics, stay for the snark.

Today’s GOP: why go just far enough when too far is right there?

And now I have baud making fun of me. this day can’t get worse.

Proof that we need a blogger ethics panel.

Black Jesus loves a paper trail.

Balloon Juice has never been a refuge for the linguistically delicate.

Fuck these fucking interesting times.

fuckem (in honor of the late great efgoldman)

Roe isn’t about choice, it’s about freedom.

The truth is, these are not very bright guys, and things got out of hand.

Too often we hand the biggest microphones to the cynics and the critics who delight in declaring failure.

Whatever happens next week, the fight doesn’t end.

Republicans are the party of chaos and catastrophe.

You don’t get to peddle hatred on saturday and offer condolences on sunday.

White supremacy is terrorism.

Since when do we limit our critiques to things we could do better ourselves?

Make the republican party small enough to drown in a bathtub.

Never entrust democracy to any process that requires republicans to act in good faith.

Despite his magical powers, I don’t think Trump is thinking this through, to be honest.

Not so fun when the rabbit gets the gun, is it?

They love authoritarianism, but only when they get to be the authoritarians.

The cruelty is the point; the law be damned.

He really is that stupid.

The revolution will be supervised.

Take your GOP plan out of the witness protection program.

Mobile Menu

  • Winnable House Races
  • Donate with Venmo, Zelle & PayPal
  • Site Feedback
  • War in Ukraine
  • Submit Photos to On the Road
  • Politics
  • On The Road
  • Open Threads
  • Topics
  • Balloon Juice 2023 Pet Calendar (coming soon)
  • COVID-19 Coronavirus
  • Authors
  • About Us
  • Contact Us
  • Lexicon
  • Our Store
  • Politics
  • Open Threads
  • War in Ukraine
  • Garden Chats
  • On The Road
  • 2021-22 Fundraising!
You are here: Home / Anderson On Health Insurance / Going through my choice structure

Going through my choice structure

by David Anderson|  October 18, 201810:17 am| 17 Comments

This post is in: Anderson On Health Insurance

FacebookTweetEmail

Between the Medicare open enrollment period and the Exchanges opening up for enrollment in a few weeks, a lot of people will be making a lot of tough, and hard to fully describe choices for their health insurance.  I, personally, have a much easier choice set but I want to go through my decision process on how I chose the insurance for 2019 for my family last night.

    1. Grab a beer (I recommend 21st Amendment Blood Orange)
    2. List probable future medical utilization
      1. Flu shots
      2. 2 Pediatric well child (docs @ Duke)
        1. Several PCP visits for school age crud
      3. 1 or 2 adult wellness visits  (my doc is @ Duke)
        1. 1 or 2 urgent care visits for random stuff
      4. 1 OB-Gyn well visit (no relationship established)
      5. Possible surgery to clean up a broken ankle if it does not heal right
    3.  Expected Pharmacy Utilization
      1. Asthma crisis medications (generic nebulizer and brand name blue inhaler)
      2. Asthma maintenance medications (brand name orange inhaler)
    4. Confirm Pharmacy benefit is the same across all plans
    5. Eliminate the nationwide PPO and the North Carolina wide HMO network plans as they are too expensive.  The less expensive narrow network choices are built around Duke owned facilities.  If one of us has something weird, we’re likely going to Duke anyways as  Duke handles a good chunk of the complex/weird cases.
    6. Choices are now restricted to a no deductible/co-pay only Plan A.  It has a higher premium coming out of my paycheck compared to Plan B which has a $600 deductible/$2,000 individual  maximum out of pocket or $1,800 family deductible/$6,000 family maximum out of pocket plan.

Before I go further, I just want to state that this is damn good insurance.  The low AV plan is low platinum level coverage and the no deductible plan is high platinum coverage.  This is damn good coverage.

I had to figure out which would cost the family the least.  My son’s asthma medications are a constant cost, so they are analytically irrelevant.  My wife has a broken ankle.  So far she is healing well.  The orthopedic surgeon has told her that in similar cases, he frequently will need to go in and install screws/plates if everything does not heal up right after several months of light activity and supportive stabilization.  This is our big question mark.

Assuming that she needs surgery, we figure it is at at least a $5,000 operation with at least a dozen physical therapy sessions afterwards.  Under Plan A we would pay a $600 hospital admission co-pay and then $240 in PT co-pays.  Under Plan B, she would max out her deductible of $600 and run up most of her out of pocket limit through PT co-pays and coinsurance for the surgery.

If she needs surgery, Plan A is the better choice as the higher monthly premiums buy out the deductible and it has much lower co-pays.  Conditional on my wife needing ankle surgery, Plan A has us coming out ahead by about $1,000 for the year.  If she does not need surgery, Plan B is a better value by $1,500 or so for the year.

We don’t know if she needs surgery yet. We don’t have a good way to estimate our probabilities beyond the vague information from her orthopedist that he “frequently” needs to go in.  I don’t know what “frequently” means.  Is  it 20% of the time, or  50% of the time or does he slice and dice  85% of the time?  I don’t know.

At this point in the analysis, it was no longer analytical.  It had to become a discussion about tolerances and values.  I grabbed a beer for my wife, and she turned on The Good Place before we talked about our risk tolerances and our ability to take a hit on bad outcomes arrived through a good process.  This is mostly a values questions.  It reflects our risk tolerance at this point in our lives is not a perfectly rational loss/reward frontier.  We decided that we would stick with Plan B as we can afford an incremental $1,000 hit if she needs surgery although we’ll grumble about it.  But we would regret the extra $1,500 in spending if she does not need surgery.

This is how we made our insurance decision for next year. And this was a very easy set of choices.  We started with four choices with significant elements constant across all possibilities (the prescription drug benefit).  We eliminated from consideration the two expensive broad network options. We then primarily focused on one possibility. We excluded from consideration unusual and very high cost events as both plans will be good enough for a cancer diagnosis or similar events.   And even with that simplification, we’re gambling on imperfect information on what we need.  I think we will have satisfied minimal criteria but I know we are not optimizing our decision making.

This is the easy case. 

Some Medicare Advantage buyers will look at forty or more plans in 2019.  Some ACA Exchange buyers will see over 100 plans offered in their county in 2018. The language used to described the same element will vary wildly between insurers and the prescription drug benefits will also have significant confusion introduced by variation.  This is a tough choice.  And it is a choice where I think most people need to go into the decision matrix knowing that they won’t get the optimal choice but if they lay out a series of minimally acceptable criteria, that they can get a good enough choice.

FacebookTweetEmail
Previous Post: « Thursday Morning Open Thread: Excellent Arguments
Next Post: The Bullying Swagger »

Reader Interactions

17Comments

  1. 1.

    WaterGirl

    October 18, 2018 at 10:25 am

    This is very helpful! Kind of calming to hear you lay out your steps in a methodical way.

  2. 2.

    grubert

    October 18, 2018 at 10:50 am

    Nice kick in the pants to start thinking about these things.

  3. 3.

    Scott

    October 18, 2018 at 10:58 am

    This is a good methodological analysis. I could certainly go through something similar; however, I know my wife (also well educated but not analytical) could not. I always wonder how the average overworked middle class citizen can do any of this with any approximation of precision. What a horrible system.

  4. 4.

    Ceci n est pas mon nym

    October 18, 2018 at 10:59 am

    For the last 16 months I’ve been on the government’s version of COBRA, which they call Temporary Continuation of Coverage (TCC). Expensive as hell of course as any COBRA plan is, but I liked the plan and my wife’s coverage was at the time uncertain. I’m about to switch to her plan, which is stable for at least another year and hopefully longer (the issue is that she teaches at a university that wants to do annual contracts rather than permanent hires). Then I’ll be 62 and eligible to take my deferred federal retirement and see how good that plan is. Also (knock wood) by then maybe we’ll have Democratic hands back on funding for the ACA and it will actually be a functioning national health plan.

  5. 5.

    Raven

    October 18, 2018 at 11:07 am

    Our situation is weird. My bride retired this year at 60 and she’s on my BCBS HMO. I’m going to work until next September and, when I do, my organization gives us a set amount to buy insurance through AON. The strange thing is that, even after I retire, she stays on the BCBS until she reaches medicare age.

  6. 6.

    dr. bloor

    October 18, 2018 at 11:27 am

    You’d better enjoy that insurance for as long as you can keep it, however big a chunk of the premium they’re making you pick up. The only place I see policies like that anymore are from people employed at universities and C-suite plans.

  7. 7.

    Thomas Levenson

    October 18, 2018 at 12:27 pm

    We’ve got the one-partner-is-eligible-for-Medicare shoals to navigate.

  8. 8.

    dr. bloor

    October 18, 2018 at 12:40 pm

    @Thomas Levenson: On the good ship Self-Employed, we call that a “harbor.”

  9. 9.

    Mayken

    October 18, 2018 at 1:46 pm

    I’m curious about the open enrollment for ACA. Covered California’s started October 15th and goes through January 15th. On Healthcare.gov they have Nov 1st – Dec 15th. How is California able to have different dates from the federal exchange and other states?

    My husband’s job is offering a HSA and he’s actually considering it. Scares the crap out of me frankly. As a person with a few chronic issues including asthma and a ridiculous number of meds plus a child under 10 at home, I can’t see how it can be good for us. So I think your method will be very helpful to us both.

  10. 10.

    David Anderson

    October 18, 2018 at 3:35 pm

    @Mayken: California runs their own state based exchange. They can do (pretty much) whatever they want. Healthcare.gov is run by CMS and that is the federal exchange so that 39 (IIRC) states are running on the same schedule.

    Regarding HSA — depending on premiums, deductible, your 100% certain to incur healthcare costs and your tax bracket, they can be a really good deal for people with repeated high cost years. But you have to work through the math to make it all make sense.

  11. 11.

    Zelma

    October 18, 2018 at 3:49 pm

    The complexity of our health “insurance” system is bizarre. I’m on Medicare with a United Health Care supplemental policy. It’s top of the line and very expensive. No co-pays, complete provider choice, etc. I chose it originally because I had doctors in two states and it’s completely portable. Also, I had just had a bout with cancer

    But now I’m in one state and 11 years past cancer and thought maybe I could find something cheaper. But when I started investigating my options, I became more and more confused. As far as I can tell, I remain in complete control of my senses and am pretty smart. But I’m having a hard time figuring this out.

    I’ll probably just keep on paying the high premiums because at least I know exactly what my medical care is going to cost me. It shouldn’t be this hard!

  12. 12.

    Mayken

    October 18, 2018 at 4:11 pm

    @David Anderson: Thanks I didn’t realize the state exchanges had that kind of flexibility. Good to know!
    And thanks for the reassuring note on HSAs. I feel a bit better.

  13. 13.

    lahke

    October 18, 2018 at 7:18 pm

    You can simplify a little by also considering quality rankings–both CMS (for Medicare) and NCQA (for commercial plans, the non-Medicare, non-Medicaid ones) have a 5-star rating system. If you have come down to just a few plans to decide amongst, look for the star ratings and go for the highest.

Comments are closed.

Trackbacks

  1. My company offers free health insurance — here’s why I decided to spend $1,000 more on a better plan – CapitolZero says:
    November 1, 2018 at 8:24 am

    […] who used to work at a health insurance company, to take a look at my options. (He also wrote up a blog post on how he picks his own family’s insurance—I found it really helpful, and it inspired […]

  2. My company offers free health insurance — here’s why I decided to spend $1,000 more on a better plan | Andre Eger says:
    November 1, 2018 at 8:33 am

    […] who used to work at a health insurance company, to take a look at my options. (He also wrote up a blog post on how he picks his own family’s insurance—I found it really helpful, and it inspired […]

  3. My company offers free health insurance — here’s why I decided to spend $1,000 more on a better plan – Andre Eger – Consulting und Business Development says:
    November 1, 2018 at 8:48 am

    […] who used to work at a health insurance company, to take a look at my options. (He also wrote up a blog post on how he picks his own family’s insurance—I found it really helpful, and it inspired the […]

  4. My company offers free health insurance — here’s why I decided to spend $1,000 more on a better plan – Factsa And News says:
    November 1, 2018 at 9:05 am

    […] who used to work at a health insurance company, to take a look at my options. (He also wrote up a blog post on how he picks his own family’s insurance—I found it really helpful, and it inspired […]

Primary Sidebar

Recent Comments

  • dm on War for Ukraine Day 400: Russia Takes a Hostage (Mar 30, 2023 @ 8:55pm)
  • Sister Golden Bear on Open Thread: Red Staters for Moloch (Mar 30, 2023 @ 8:55pm)
  • Mr. Bemused Senior on War for Ukraine Day 400: Russia Takes a Hostage (Mar 30, 2023 @ 8:55pm)
  • karen marie on HEY DID YOU GUYS HEAR (Mar 30, 2023 @ 8:54pm)
  • Jim, Foolish Literalist on HEY DID YOU GUYS HEAR (Mar 30, 2023 @ 8:54pm)

Balloon Juice Meetups!

All Meetups
Seattle Meetup coming up on April 4!

🎈Keep Balloon Juice Ad Free

Become a Balloon Juice Patreon
Donate with Venmo, Zelle or PayPal

Fundraising 2023-24

Wis*Dems Supreme Court + SD-8

Balloon Juice Posts

View by Topic
View by Author
View by Month & Year
View by Past Author

Featuring

Medium Cool
Artists in Our Midst
Authors in Our Midst
We All Need A Little Kindness
Classified Documents: A Primer
State & Local Elections Discussion

Calling All Jackals

Site Feedback
Nominate a Rotating Tag
Submit Photos to On the Road
Balloon Juice Mailing List Signup
Balloon Juice Anniversary (All Links)
Balloon Juice Anniversary (All Posts)

Twitter / Spoutible

Balloon Juice (Spoutible)
WaterGirl (Spoutible)
TaMara (Spoutible)
John Cole
DougJ (aka NYT Pitchbot)
Betty Cracker
Tom Levenson
TaMara
David Anderson
Major Major Major Major
ActualCitizensUnited

Join the Fight!

Join the Fight Signup Form
All Join the Fight Posts

Balloon Juice Events

5/14  The Apocalypse
5/20  Home Away from Home
5/29  We’re Back, Baby
7/21  Merging!

Balloon Juice for Ukraine

Donate

Site Footer

Come for the politics, stay for the snark.

  • Facebook
  • RSS
  • Twitter
  • YouTube
  • Comment Policy
  • Our Authors
  • Blogroll
  • Our Artists
  • Privacy Policy

Copyright © 2023 Dev Balloon Juice · All Rights Reserved · Powered by BizBudding Inc

Share this ArticleLike this article? Email it to a friend!

Email sent!