This is a follow-up from yesterday’s post on how systems need to change to address the weirdness of Silver Loading and Gold Gapping in the individual market. Today’ we’ll talk about what you should do. This only applies if you buy your insurance in the individual market.
First, let’s establish some basic guidelines for everyone:
- Health insurance is complicated and your situation is your own
- SHOP, SHOP, SHOP
- Ask for help from brokers/agents and navigators as needed
- SHOP, SHOP, SHOP
The Kaiser Family Foundation has a great set of FAQs for everybody to peruse. That should be your first stop.
The second thing to do is check to see if you are Medicaid eligible. The exchange should send you towards Medicaid if your income qualifies you. This is under $16,600 for a single person or $33,900 for a family of four.
If you are not Medicaid eligible and earn between 100% and 150% FPL ($12,060 to $18,090) go Silver. You still qualify for the reduced out of pocket expenses. The insurer has to give that to you. The entire CSR fight is a behind the scenes fight on how these costs are reimbursed to the insurer.
No Load States (North Dakota, Vermont, Washington DC)
Nothing has changed, do what you did last year.
Broad Load States (Delaware, West Virginia, Kentucky, Indiana, Oklahoma, Colorado)
All plans are more expensive. Bronze plans will be comparatively cheaper for subsidized buyers and Gold/Platinum plans will be comparatively more expensive. The benchmark Silver will cost the same for subsidized buyers and the least expensive Silver will be slightly cheaper as the gap is bigger. Off-Exchange, you’re paying more. Look around and determine what is the minimal network you need and be ready to switch insurers and plans to save some money.
Silver Load and Silver Switch States
This is where it gets confusing. In some regions of the state, the price order will be Bronze-Silver-Gold-Platinum. In those areas, follow the rules of Broad Load.
In other regions, the price order will be Bronze-Gold-Silver-Platinum. Here is where you need to pay attention.
If you make between 150% and 200% FPL ($24,120) you have some choices to make. You still qualify for good CSR but the monthly premiums will be higher than some Gold plans. Gold plans for people who qualify for mid-range CSR have higher deductibles but may have lower premiums. If you see a Silver plan and a Gold plan with an insurer and network that you like, you have to make a choice. Do you trade a bigger monthly payment for a smaller out of pocket maximum. For people who think that they are likely to be healthy and have some assets to absorb a financial hit, this trade for Gold may make sense. For people who know that they will hit the out of pocket max no matter what, staying with Silver is probably a good idea.
In the Silver Load and Silver Switch states, the complexity really starts to happen. We’ll work through Pennsylvania’s Silver Switch loading below the fold: