Twelve counties in Oklahoma have an extraordinarily odd pricing arrangement. Anyone who qualifies for premium subsidies on the individual market can get a $0 Gold plan***. Below is the relevant part of the pricing table for one of the counties.
| State | County | Metal Level | Issuer Name | Plan ID – Standard Component | HIOS ID | Premium Adult Individual Age 40 |
|---|---|---|---|---|---|---|
| OK | Alfalfa | Bronze | Blue Cross Blue Shield of Oklahoma | 87571OK0320097 | 87571 | $433.00 |
| OK | Alfalfa | Gold | Blue Cross Blue Shield of Oklahoma | 87571OK0320092 | 87571 | $608.00 |
| OK | Alfalfa | Silver | Blue Cross Blue Shield of Oklahoma | 87571OK0320083 | 87571 | $669.00 |
| OK | Alfalfa | Bronze | Medica Insurance Company | 21333OK0020005 | 21333 | $761.00 |
| OK | Alfalfa | Bronze | Medica Insurance Company | 21333OK0020011 | 21333 | $788.00 |
| OK | Alfalfa | Expanded Bronze | Medica Insurance Company | 21333OK0020023 | 21333 | $840.00 |
| OK | Alfalfa | Gold | Medica Insurance Company | 21333OK0020025 | 21333 | $1,002.00 |
| OK | Alfalfa | Silver | Medica Insurance Company | 21333OK0020003 | 21333 | $1,159.00 |
Gold plans will be effectively free for anyone who qualifies for subsidies. The Blue Cross Silver plans with CSR are better financial protection for anyone making under 250% Federal Poverty Level and Bronze is cleanly dominated. What is happening is that BCBSOK is running a Silver Load/Gold Gap game on their plan offerings with a price order of Bronze-Gold-Silver. If they were the only insurer, Gold would have a decent discount on Silver and Bronze would be dirt cheap for subsidized buyers. However, Medica also entered the county. They are also running a Silver Load/Gold Gap game of Bronze-Bronze-Bronze-Gold-Silver. If Medica was the only insurer in the county, there would be huge discounts on all Bronze plans and a large discount on the Gold plan.
However, they are both in the county. Medica’s general price level in the twelve counties are much higher than the BCBS-OK so instead large but not incredibly massive gapping, BCBS-OK will be running some ridiculous gaps where all of their plans are effectively free for the subsidized population. The Gold plan may not be the optimal plan for everyone. It is clearly beaten by the BCBSOK CSR Silver plans for anyone earning under 200% FPL. There is a fuzzy space between 201-250% FPL between Gold and CSR Silver.
But there is free gold lying on the sidewalk just waiting for people to sign up. I am very curious if people will sign up for $0 premium Gold plans in these counties as this will inform us as to how much price really matters versus other non-financial factors.
*** I’ve tested this for the adult purchaser’s stingiest scenario (a single 19 year old non-smoker making $48,560 (precisely 400% FPL)) in Alfalfa County but the pricing holds everywhere else and the spreads get bigger for any other scenario. Any scenario where a buyer group consists of either older individuals or multiple individuals at 400% FPL will see even larger Silver to Gold spreads.
low-tech cyclist
All those rows beginning with “OK Alfalfa” made me wonder if it was a new album by CB-Radiohead.
Amir Khalid
@low-tech cyclist:
I think we all realised something was going on when Mayhew started talking about metal bands.
Michael Cain
The generous retiree health plan that had covered my wife and I for several years was terminated at the end of 2017. We were both turning 65 in 2018 and would transition to Medicare, so needed an exchange policy to tide us over. The eventual factor that decided our choices for the year were not the money, but changing doctors. In my wife’s case, she was looking at changing two of her three regular docs, then six months later changing some number of them again when she went on Medicare. We decided on a strategy that made us change all our docs, but only once, w/o really paying attention to the price of the exchange policy.