Going Platinum
Well, I did it. I waded through the fire-swamp of the NY State of Health online insurance marketplace, I got cleared to apply for insurance for next year, and I finally got to compare my current Bronze plan to the various alternatives. One delightful thing I noticed was that, as the plan levels got fancier, they started offering out-of-pocket maximums in sync with deductibles. So, your premium would be higher with a Silver plan — say, $442 a month — but you’d have a deductible of $5900 that also represented your total out-of-pocket costs. Once you spent $5900, you were done for the year.
I called an Oscar rep to have them help me walk me through it and to point out anything that I miss, and the fellow let me know that if I scrolled all the way down to the Platinum plans (!) I’d find that they would save me substantial amounts of money over the course of the year.
Well, the Silver Plus plan I was considering had a $5900 deductible, right? I was sure to max out that sucker giving birth. Over the year, then, I would spend ($442 x 12 =) $5304 on monthly premiums plus $5900 for a total of $11,204.
If, however, I opted for one of those fancy pants Platinum plans, my monthly outlay would be a much higher ($628 x 12 =) $7,536, but after that my only financial responsibility would be for a $1000 deductible/out of pocket max. Total annual cost to me: $8,536.
Would I rather spend over $11,000 on health care this year, or about $8,500? That seemed like a pretty straightforward — if still grim! — choice.
Obamacare’s been in the news a lot lately. Not only have patients been complaining that deductibles are hard to afford; now insurers are chiming in to say they aren’t making enough money. UnitedHealth, specifically, which is not a huge player in the game but a significant one, issued a dire warning that it may back out of the exchanges altogether unless things improve for their bottom line.
UnitedHealth said last week that it was considering whether to pull out of the Affordable Care Act’s insurance markets because it’s losing hundreds of millions of dollars.
Until recently, Obamacare has been viewed as a boon to health-care firms, sending them millions of new customers and creating paying patients for drugmakers and hospitals. …
“We cannot sustain these losses,” UnitedHealth Chief Executive Officer Stephen Hemsley told analysts on a Nov. 19 conference call. “We can’t really subsidize a marketplace that doesn’t appear at the moment to be sustaining itself.”
Aetna has cited similar issues. Aetna Chief Financial Officer Shawn Guertin said earlier this month that people are buying coverage “and then staying for only a few months and then dropping again, and obviously getting service along the way.” And Anthem has said that while it was willing to wait, it may take several years for the new insurance markets to stabilize.
For what it’s worth, I’m with Krugman: Obamacare may be experiencing some turbulence — all three-year-olds do — but overall it’s still a success. It helped me get insurance when I had no other access to it. It’s taught me to be a more assertive patient. And it’s still helping me, because even though my spouse is now insured full-time, the health insurance at his office is set up for individuals. A family plan would be hugely expensive and wouldn’t actually offer much. So I’m deeply, fundamentally grateful for the option.
Here’s to 2016, then, the year I go Platinum.
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