As I indicated in my last article, I am attempting to use the Washington State Health Insurance Marketplace (called the Exchange) to get a new insurance policy for 2014 under the Affordable Care Act. And detailing my adventures, here. As I also indicated, the Exchange crashed soon after I started using it October 1, the first day, because of all the other people logging on. But before it went down I had managed to make a first run through the website’s sorting program, inputting my expected annual income, my age, my location, and my current doctor (who I want to keep). This resulted in a list of 27 different medical insurance plans from three different insurance companies. The list indicated each plan’s deductible, the out-of-pocket maximum you’d have to pay before the plan took over making all payments, and co-pay levels along with links to full plan details. I printed this list out (fortunately before the site stopped working). And spent a few days looking through the list while waiting for things to calm down so I could get back on the Exchange and start doing some paring down of the list. Over the weekend I checked and the Exchange was back up and functional; so I got to work.
Once you’ve given it basics like income, location, and doctor, the Washington State Exchange itself tries to make it easier for you to figure out the plan you want by asking you some general questions and matching them against the qualities of the plans it has. Like did you expect to see your doctor and have medical procedures and tests often during the year or were you planning on just a few visits? Would you be satisfied letting your doctor decide if you needed to see other doctors and specialists, or are those decisions you want to make yourself? How important was limiting your out of pocket expenses? Answering these questions eliminated some of the plans, which was helpful; but it is unwise to let a computer programmed by others make decisions for you. And besides, I had some ideas of my own. The website allowed me to change the search criteria at will, so I started making some changes.
During the time between site visits I’d continued researching Obamacare, and reached a few conclusions based on what I’d found out. To start with, my health is good. But I have several pre-existing conditions and my doctor likes me to come in every two-three months for examination and tests to make sure my health STAYS good, with occasional trips to specialists for anomalies – of which I seem to have a lot – in the test results. This means I get a fair amount of medical bills. Most of which I have to pay myself, as my current plan has a high deductible AND out of pocket cap (it’s the pre-existing conditions, right now they sock it to you if you’ve got those, assuming you can even find a company willing to insure you. Fortunately under Obamacare they can’t do that anymore…). As I noted previously, medical insurance plans under the ACA are divided into Bronze, Silver, Gold, and Platinum ‘levels’; the difference being that with Bronze plans you pay 40% of expenses until you hit the out of pocket maximum and deductible limit; with Silver, 30%; Gold, 20%; and Platinum 10%. Since I’ll be seeing the doctor a lot and getting tests, Bronze is out because while the premiums are the cheapest, those out of pocket payments will add up. Because I won’t be seeing him an AWFUL lot, and don’t expect (or want) to have extremely expensive procedures done to my poor creaky body, Gold and Platinum are out because they’ve got large premiums, and high pocket and deductible limits. In other words, I may pay out only 10% of the costs each trip with a Gold or Platinum plan, but with the premium payments I’d have to go to the doctor pretty often, or have so many expensive things done, that I reached the deductible and out of pocket caps fast to come out ahead. Bronze is if you go seldom or for small things or are trying to get by as cheap as you can, Gold and Platinum is if you go often for big things and have plenty of money… so that leaves Silver.
On the Exchange I specified I wanted to see only Silver plans, and my choices shrank from 27 to 10.
But my early examination of the plan data had revealed something else. As I said, three different insurance companies were offering plans; but two of those companies were offering three Silver level plans that seemed to be exactly identical to what each other had available. Both companies had a basic plan with a $1000 deductible, a $1100 out of pocket maximum limit, and no co-pays, for (approximately) $590 a month. A Health Savings Account plan with a $750 deductible, a $1150 out of pocket maximum limit, and no co-pays, for (approximately) $540 a month. And a non-HSA, preferred plan with a $500 deductible, a $1500 out of pocket maximum limit, and no co-pays, for (approximately) $625 a month. In other words, each company was basically offering the same as the others’ plans. The only difference between them I can see so far is the brand name. It’s like back when the airlines were regulated, they couldn’t really offer much different to passengers, so it came down to image. I’ll keep digging into the plan details to see if there are differences at the fine print level, but I haven’t found anything yet.
And it doesn’t stop there. One of these companies, in addition to the three plans that are the same as what its rival has available, is offering three other plans; and looking at them closely, it appears all three are just variants of those other three plans. They’re being offered over a multi-state area so the premium is slightly lower; but it very much looks like there’s no benefit difference between those multi-state three and the above detailed three. So for all practical purposes, it appears these nine plans are really just three plans with slight differences between them. The tenth plan IS different; the third company is a Health Management Organization that is offering a very low deductible but very high out of pocket plan with low monthly premiums. The other two companies are Preferred Provider Organizations. So what it comes down to is that I really only have four plans to chose from. Which makes it easier. But more variety might have been better.
Still, this is what I’ve got. It’s time to start looking through details and, once I’ve examined those, compare plans. Before making any decisions, though, I think I’ll speak to one of the trained ‘assisters’ called Navigators who are available to help people get through this process and answer health insurance questions. The Washington site provides people with a list of Navigators in their area. Washington state has gone to great lengths to make this process as easy as possible; which is good, because help is definitely needed.
