Why do so many people here get Bronze ACA plans?

[Recursion]

I'm losing count of the number of posts people have written talking about how awful their bronze ACA plan is. As far as I can tell these aren't young single adults looking for catastrophic coverage, but middle-age and above people looking for functional health insurance.

Why would you go for a bronze plan in that situation?

If you're even coming close to meeting your deductible with a bronze plan on a regular basis, you're going to save money by getting a silver plan (which is why the "I can't afford it" argument makes no sense to me -- you're already paying that to your doctors; pay less to an insurance company).

[VanillaRhapsody]

1. EXACTLY!!!!

I don't understand why ANYONE would choose the bronze myself....the side by side comparison....it just doesn't make sense...

[Nuclear Unicorn]

97. Because they cn't afford the higher monthly payment. Their only viable option is to

shell-out for a near ruinous monthly payment with a use-prohibitive deductible. The other option is a higher premium that leaves them unable to make rent, buy groceries, etc.

You act like people have unlimited finances and have simply made a poor choice.

[NuclearDem]

2. I imagine the lower monthly payment is enticing.

Bronze plans are mostly worthless though. I just bought a silver plan with an 1,150 deductible, and with the tax credit, only pay 139 a month.

[Recursion]

12. Bronze plans are great for people who don't go to the doctor

If you're a 20-something male* in good health it's not a bad deal; I don't know that I went to the doctor for about a decade there personally except in the military. I would have loved free preventative care and a liability cap of $6K when I was 27 or so, personally...

* I say "male" because in my experience younger men just don't go to doctors unless they absolutely have to.

[dembotoz]

3. money and the lack of it

[OKNancy]

4. Here is why my husband got the bronze plan

He is 62 and in good health. Look at the costs for people nearing Medicare age. It's outrageous.
The deductible is $6000.00 per year. The cheapest good bronze plan with no subsidy is 450.00 per month.
We just can't afford more than that.

We are using it as a catastrophic coverage. My husband has only been to a dermatologist for a basal cell removal.
Other than that he hasn't been to a doctor in years.

[truedelphi]

31. Oh but many here will tell you that is no excuse because...

[font color=red]Because Obama![/font color=red]

I mean, why are you trying to destroy the Democratic Party!! (Never mind if these fuckwads hadn't given the economy over to the Banks and Big Financial firms, many of us could afford the $ 6,000 deductible.)

[Recursion]

34. He sounds like a good case for a catastrophic plan then

If you don't expect significant health expenses, a bronze plan is great.

[Ms. Toad]

82. The question isn't why didn't you get a more expensive bronze plan,

But why not a silver plan.

The silver plans have subsidies not only for the premium, but also for the subsequent coverage. For a difference of $25 a month, in the silver plan I looked at last night (for someone complaining that his free bronze plan wouldn't cover any expenses until $6300) had an out of pocket maximum of $2250 (and subsidized coinsurance below that).

I do understand the strategy of using catastrophic coverage plans - when I didn't have lots of predictable expenses, it was an excellent choice. Bank the premium savings for the occasional bad year, and even when I had a bad year I still came out way ahead.

[OKNancy]

87. I understood the question. The difference was over $200.00 a month plus

the cheapest silver had co-pays and the bronze didn't.

We don't qualify for much of a subsidy unfortunately. We took money out of our retirement to help out one of our children and that upped our income for the year. Only three more years to Medicare thank goodness.

Oh, and if it came to it, we can afford the $6,000 if something bad happened. I have an IRA that put money into for many years.

I made the smartest decision for our family situation.

[Ms. Toad]

94. I only clarified the question

because your initial response compared two bronze plans

[neverforget]

5. You should probably ask them why they didn't choose a different plan.

My bet is that they don't have the money.

[Dont call me Shirley]

28. BINGO

[hobbit709]

6. Ask my housemate making $9.75/hr and working 35 hrs/wk what he can afford.

[nationalize the fed]

17. + 9.75 @35

While the Democrats passed NAFTA and are trying to pass the TPP and the TTIP the working stiff is stuck with a 35 hour week. Why is that? It benefits Wall Street.

And the Stock Market soars to a new "high". It's a wonderful world when you make a million dollars a month. Vacation homes, yachts and more await. Who cares that the jobs are gone. Have another martini.

[appalachiablue]

101. Got that right.

[Recursion]

18. Well, using Texas's numbers, he can get a silver plan for $61/mo

Which if my math is right would take his paycheck from $608 to $577.50. (Texas still has no income tax, right?)

Does he have $30 of expenses per pay period that he would prefer health insurance to?

[truedelphi]

32. Your math works if: If he doesn't have rent expenses, car insurance,

Transportation expenses to and from work, a utility bill, student loan payments to make, a credit card bill perhaps etc.

Oh and groceries, which are going up about 14% a year in terms of inflation, regardless of what the liars in Washington DC are telling us.

[Recursion]

33. Umm.. if he had none of those he'd be doing great on $1214 per month

What a silly thing to say

Oh and groceries, which are going up about 14% a year in terms of inflation



Right, the secret inflation-hiding cabal strikes again

Food prices are actually down right now: http://www.bls.gov/cpi/cpid1410.pdf

[truedelphi]

35. Recursion, about food - as another DU'er explained to me

The reason we are given these low numbers for the food prices is because when people shop at Safeway,they can buy one four hundred gazillion ounce bottle of soda pop and get four other bottles free.

So that sort of crap drives down the prices.

My household does not see the advantage on living on chips (buy one package, the next one half off!) Nor do we live on soda. I do notice when I go into Safeway, plenty of other people are buying this stuff, but we can't live like that.

But in terms of actual food, the inflation is way up.

I just paid $ 5.29 for a package of blueberries - 12 ounces.

Twelve months ago, I paid about $ 3.79 a package, and the package was two ounces larger.

Cheese is up a lot. And most other things that contain real nutrition as well.

[Recursion]

36. Cheese is up 9% (and beef up 17%); those are odd spikes

But bread, rice, legumes, poultry, and fresh fruits and vegetables are all down.

[truedelphi]

38. Poultry might be down in other places - but here in Calif.

The same package of chicken I paid $ 9.50 a year ago now costs $ 11.50.

Lucky for me I love love love legumes, and they are a staple in my diet. I haven't seen the price of peas or beans go up at all. Same with millet, my favorite grain.

[Recursion]

40. I love millet too. Though as a kid, I would complain "my mom feeds me birdseed"

But you do hit on a big problem with the CPI-U: it smooths local spikes over the whole country (and generally focuses possibly too much on urban areas, as the name implies).

OTOH the US's unofficial back-door price control regime via farm subsidies has worked remarkably well compared to a lot of the world over the past 70 years or so.

[Autumn]

49. Wow where do you live? Fresh fruits and vegetables are still sky high here.

[bravenak]

51. Here too.

And they are going up. I paid 6 bucks for two not quite ripe avacados.

[Autumn]

61. I bought three Roma tomato's yesterday, three bucks.

I don't even look at avocados anymore. As for fruit? Forget that except for the occasional banana.
As someone here said. "DU is the center of the under 65 year old, non-employer insurance provided, low-incomed non-state Medicaid expanded, world."
It's a shame these posters who are doing so well have to listen to us in the lower class complain about our insurance rates and stretching a buck to pay for fruit, vegetables and chicken that they "say" have dropped in price.

[bravenak]

66. I don't think I've ever seen this mythical 'drop in prices'.

If I didn't have family medicaid and food stamps I'd have to choose between eating and the doctor. I marvel over how some well off posters (not all) just don't live in what I consider the real world.
I'm scared to actually start making money. We have some of the highest health insurance costs in the nation here in Alaska and the food is extremely high. My next job will probably have to be in the insurance industry to afford to live.

[treestar]

63. The subsidies are based on studies

regarding costs. This isn't a good argument in that the fed has determined that he can afford the amount left after the subsidy. This was not arbitrary but based on government studies. There are many government studies for these types of things for many purposes.

[truedelphi]

68. Oh it was a government study!!

I should have guessed. From the amount of suffering it is causing, I should have guessed that it ws a government study being involved.

(Nothing ever wrong about government studies. Why, in the 1960's, government studies showed we would whip those gooks in Vietnam in a matter of weeks! And that same way of seeing things came along some forty years later, leading us into another "six months tops" war against the people of Iraq.)

Was it a government study that determined that he should pay one third of his yearly income as a deductible? Was it?

Is it a government study that says that us poorer people have to somehow come up with all our available "disposable" income as a deductible before we can utilize the mandated insurance? Oh, maybe you think we can't afford to do it. Well, how is it that as you and are typing at each other, Congress will be seeig to it that some 2.1 trillions of dollars of Bush and Obama tax breaks for the upper elite will continue, so as to avoid having that additional 2.4 trillions of dolars of tax revenue come into the Treasury?

Anyway what I would seriously like is for you and everyone else who is so smug about this to sit down, write out what you make each year on a piece of paper, then divide that amount by one third. Examine that figure. Could you afford your lifestyle if YOU had to pay one third of your yearly monies for a deductible?

[treestar]

70. Well at least they try to come up with numbers based on costs

Government studies determine the poverty level. You can't get food stamps unless your income is at a certain amount. That amount does not come out of thin air.

Child support is determined based on studies of how much income goes into child rearing.

And they are giving you something that you did not have before, so being like that is hardly so virtuous.

[truedelphi]

74. With regards to your smug little last sentence -

In other words, what you' re saying is not so much:

"And they are giving you something that you did not have before, so being like that is hardly so virtuous."

But is instead: You poor people used to have to eat three bowls of crap every time you needed medical help. Now you only have to eat one bowl of crap, so shut the Fuck up!

[hobbit709]

45. He takes home less than $300/wk. If you can't afford the copay it don't matter what you have.

[truedelphi]

69. Like I just typed at someone who is so affluent they don't get it -

Could you afford your lifestyle if YOU had to pay one third of your yearly monies for a deductible?

Glad to see we have you on our side, hobbit709.

[pnwmom]

41. But he would qualify for a subsidy, and they're based on silver plans.

[truedelphi]

75. One of his big gripes is the deductible.

Take a moment here, and write down on a piece of paper how much income yr household generates in one year. Divide that amount by one third.

Visualize that one third amount as being yr deductible.

Now imagine trying to do what he needs to do to utilize his health insurance. Try and imagine having to pay that one third of your yearly income as the deductible!

How would you feel if that was the predicament you were left in?

And how hard would it have been for Congress critters, and Mr Rahm and Ms Fowler, to have had stipulations inside the ACA to make sure that no one in America has to pay a deductible that is more than 10% of their yearly income? That group of bought and paid for puppets fluffed up the provisions to do all sorts of nice things for the Big Hospital Chains and the Big Insurers. But they couldn't take a moment and write in a stipulation that would make the difference between people getting real health care or being left outside the system.

[pnwmom]

80. The ACA provides for lower deductibles and premiums for people at his income.

who choose silver plans.

If he lives in a state that doesn't provide subsidies, that's the problem of the state, not the ACA.

If he deliberately chose a bronze plan over a silver plan, then he made himself ineligible for the subsidies.

http://www.nytimes.com/2014/10/18/us/unable-to-meet-the-deductible-or-the-doctor.html?_r=0

People with low incomes may qualify for subsidies that reduce their deductibles, co-payments and other out-of-pocket costs. The assistance is available to people with incomes from 100 percent to 250 percent of the poverty level (from $23,550 to $58,875 for a family of four), but only if they choose a silver plan.

[truedelphi]

81. You simply do not live in the real world that those of us who make

Very little income live in.

I asked you to visualize soemthing, which is important to do from the stand point of upping yr sympathy factor. How would you, I asked, pay for a deductible costing you one third of yr income?

That is a key thing to think about.

And to go on and on about the silver premiums - where do you get off?

Sure he could get a silver premium policy - and if he had wings he could fly over DC and poop on the heds of Congressional leaders.

But he doesn't have the initial funds to get the premium. The subsidies do help, but first of all, you have to have the inital sum to pay the premium. (In my household's case -we needed to have $ 200 a month, before a subsidy would kick in,on the silver package. We didn't have that $ 200. I do know some people my age are dipping into their retirement funds to do this sort of thing, but our retirement had already been wiped out by a Big HMO creating a terrible situation for us.)





If you have NO money, you cannot get a silver premium policy. And it doesn't even have to do with the damn subsidies. You have to pay something up front - and as L00nix clearly pointed out in his OP, the only something that offers a zero month premium is the bronze.

[pnwmom]

83. He would not have to pay a deductible that would cost a third of his yearly income.

So I don't see the point of visualizing that.

Here is the Kaiser foundation's premium calculator. It shows that a 40 year old non-smoker in my state with an income of about $17K a year would owe a premium of about $53 a month for a silver plan, or ZERO dollars for a bronze plan.

The annual out-of-pocket limit for a silver policy, including premiums and deductible, would be about $2250 -- $600 of that would be the premium, with the remaining $1650 for deductible.

And there are many "Essential Benefits" -- like vaccinations, physical exams, colonoscopies and mammograms -- that are covered at no cost and not subject to the deductible.

http://kff.org/interactive/subsidy-calculator/#state=wa&zip=98005&income-type=dollars&income=17000&employer-coverage=0&people=1&alternate-plan-family=individual&adult-count=1&adults[0][age]=40&adults[0][tobacco]=0&child-count=0&child-tobacco=0

[truedelphi]

86. He doesn't have the fifty three dollars.

Jeesh!

[pnwmom]

88. First you said he couldn't afford a deductible that was a third of his annual income.

Now you're saying he can't afford $53 dollars a month.

You keep moving the goalposts with your made up example.

[truedelphi]

96. No I am not moving anything.

Both myself and the OP poster have been consistent.
He stated upfront and with no apologies that he could not
afford more than $ 00.00 a month. He has probably a negative income, and how do you come up with money if you are totally broke?

It is in his OP.

Then he stated that due to not having the money to do anything other than Bronze, he is screwed by the deductible which under the Bronze plan is
over $ 6,000 a year.

Then you moved the goal posts by saying, well, if he came up with money each month, he could do a premium of $ 53 a month, which would then allow him to have the Silver plan which woul d then entittle him to a much lower (by at least half) deductible (Which you still cannot afford on less than $ 17,000 year.)

Even the various Green and other indie candidates said back in 2008 that the people who would probably not be helped by the debated health care reform if tht reform resembled Mitt Romney or Hillary Clinton's Corporate mandated blueprint, they all stated that it would be the group making $ 14 K to $ 29 K a year who would feel some pain. People below those amounts get MediCaid, (usually) and people making more than the 30 K would not be as bad off. But that one group - $ 14 K to $29 K would suffer, and that is exactly how it is.

I have real concerns about DU. Yesterday on DailyKos, someone related their woes relating to low income, and the post got continual replies of real people showing what it is like to live on $ 20,000 a year. (And if you live on less than 17 K a year, 20 K sounds like a fortune)

People get it over there.
People here do not realize that 17 K a year is at least a -200 a month income.

I know all about living on little bits of money, trying to somehow make it on an amount that is negative monies. And losing friendships because I couldn't pay back a measly $ 15 offered as a loan that my millionaire friend wanted back a month later. (Whenyou are broke any amount is too much. Fifteen might as well be fiftyor five hundred or a million. When you' re alredy not eating three emals a day, and one of those emals is margerine on a taco shell, what do you do to come up with $ 15? And food stamps cannot be offered to you if you had gobs of retirement money in your name just months earlier.)

I lost everything due to big fuck meister HMO Kaiser in California, I lost big time. (And just met a friend of a friend who also lost to Kaiser - having to spend her retirement monies at age 60 for getting necessary and imperative back surgery so she could walk, while Kaiser told her it was not needed and wouldn't help. She had the surgery at her expense and it means she now walks and so she did need it. Fuck you Kaiser!) People doing Kaiser might as well do their own damn medicine - as that is what happens in so many cases. And Kaiser erases your entire relevant history of office visits - no lawyers in Calif I have met will sue them as they have teams of lawyers who lie in court and state you never even saw Dr X on such and such a date, with their manipulated computer records to prove their side of the story is true.

[pnwmom]

99. You just repeated that his deductible was $6K a year.

But for a person of the stated income, the total out of pocket, including premium and deductible, is about $2250. This is true whether he is on the silver OR the bronze. Check it yourself on the Kaiser ACA calculator. That is more trustworthy than a copy of a Humana statement unconnected to anyone's income.

I am very sorry you had trouble with Kaiser --but their Obamacare calculator isn't specific to Kaiser. It gives general numbers that apply to all insurance policies. They are set based on a person's income and other criteria, not based on Kaiser's own policies.

[truedelphi]

100. Okay sorry if I was wrong about the amount of the deductible

But when you' re living on negative income, $ 2,200 a yr is too much.

Money you don't have is still money you dont have whether it is fifteen bucks, or 2,200 bucks.

And when you are popoor you don't have credit cards. (Which isthe one thing that keeps many in the middle class happy - they can still get that new dress or new electric tool do-hickey ech month as a reward, because they can charge it.)

If as a poor person you get in trouble with your credit, it could mean your car loan goes from 9.9% to 29% - so you are forced into not going in and doing stuff medically unless you want yr whole life upended. So you just put off the medical issues hoping they don't kill you.

[pnwmom]

103. I wish Obamacare had gone much farther than it did. The Medicare expansion

should have happened in all states. And I support single payer as the next goal. I do understand that people on low incomes are already stretched to their limits.

I just don't like it when Obama or the Dems or Obamacare are blamed for problems that are really due to the Rethugs. Obamacare didn't go far enough but it benefited millions, including millions who now qualify for Medicaid. And the reason we couldn't go farther, at least to a public option, was because of the Rethugs -- along with the independent, Joe Lieberman. After Ted Kennedy died we didn't have enough votes in the Senate to pass an ACA with a public option.

Let's just keep our eyes on the target -- good health care for all -- and the real opposition. And that's not Obama or the Dems.

[NYC_SKP]

7. Are you sure about this?

I've been shopping for a new plan.

For California, an individual plan with Anthem Blue Cross costs about the same per year after you add in the copays for visits and meds, though the premium is lower for Bronze.

And, the maximum out of pocket is the same: $6,350. Also, it's about the same for Blue Shield.

I'm going with a Bronze because I know I'm going to have another head surgery to fill in the hole in my skull created when they removed the infected chunk that resulted from an earlier procedure.

Because of that I know that I'll have met the deductible and the OOP so there's no reason to pay the higher premium.

For other folks, I believe it's a wash, but if they have very few visits and prescriptions, Bronze might be cheaper for a year's worth of coverage.

For states without Medicaid Expansion, I have no idea. I don't qualify in any event.

Anthem sucks, I'm still fighting them, hope that Blue Shield is better.

[davidn3600]

8. Because otherwise they pay a much higher premium they can't afford

And no...they are not always paying that to their doctor anyway.. if they can't afford it, they just don't go to the doctor.

There was a study by Gallup not too long ago that showed people are still skipping healthcare visits, tests, and procedures today at the same rates as they were before ACA was passed.

So assuming that is true, right now you cannot claim that ACA has improved healthcare in this country. If people are still skipping needed procedures because they can't afford it, then the ACA has failed to change anything about the status quo.

The problem is our politicians believed access to healthcare was the biggest problem, but it wasn't. The biggest problem is affordability. That has always been the biggest problem.

[AgingAmerican]

9. The cost

IT's all they can afford.

[Recursion]

13. No, I've seen a lot of threads where people talk about their current health care expenses

"Prescription W costs $X, treatment Y costs $Z and this doesn't help".

[AgingAmerican]

24. Some people cannot afford the better plans nt

[Doctor_J]

10. Paying what they can afford, and hoping they don't get sick? that's insurance in a nutshell

As far as I can tell these aren't young single adults looking for catastrophic coverage

why the "I can't afford it" argument makes no sense to me

You are not in their situations, so these comments mean nothing

[CottonBear]

11. It is all they can afford.

It is only for emergency use. No one who gets Bronze can afford basic care costs. Bronze is the last means to avoid total financial disaster.

edit: Those of us in states without Medicaid expansion were screwed. Most hospitals, doctors & dentists do not accept the Bronze plans or the ones that do are not within a 1-2 hour journey by car. No public transit is available.

[RadiationTherapy]

14. It must be because shopping for health insurance is so gosh-golly simple!

Or maybe it isn't. In either case, your useful information won't reach as many eyes due to the condescending tone. I am surprised you don't wonder how this information is being relayed to people who need it and if that process can be improved.

[Zorra]

15. Let them eat cake? nt

[Le Taz Hot]

20. You beat me to it.

An incredibly stupid and insensitive OP. From the same person who thinks what we should learn from the last Democratic election shellacking is that we should move even further to the right.

[Recursion]

37. If your medical expenses exceed the premium difference, that's not "eating cake"

If you simply aren't going to the doctor I don't see why you care what your insurance plan is. I'm talking about people who are claiming to have both bronze plans and predictable medical expenses.

[Zorra]

50. If you simply don't have the money to pay the premiums, then you simply don't have the money

the premiums.

If they get a Silver Plan they can't afford, and then can't pay the premium, then they have no insurance at all.

People do what they can under their respective circumstances. Far too many hard working families in the US are struggling just to put food on the table right now.

Hence the analogy that has been used as an example for describing the conditions of class/wealth polarization that brought about the French Revolution:

"Starving Peasant": "Your Highness! The People have no bread!".

(Probably) Fictional "Royal Lady": "Why, then, let them eat cake!"

(Regardless of where, and how, phrase originated, the fact remains that the phrase is used as an allegory, and is still completely relevant as an allegory to describe circumstances that brought about the French Revolution, and other instances/events of obliviousness to injustice, inequality, oppression, and poverty brought about by polarized economic class systems).

[Autumn]

48. Cake's pretty pricey. How about peas?

Wow some people who don't have to live with the problems of buying health insurance and coming up with the money to use it just don't fucking get it.

[Erich Bloodaxe BSN]

52. Cake, in context, is not what we recognize as cake today.

It was the dough that slopped down onto the floor of the oven, and was essentially burnt to a char - it was 'caked' onto the bottom of the oven. Basically, it was all of the stuff bakers couldn't sell to anyone who actually could afford anything edible.

[bravenak]

56. That is very interesting.

It makes so much more sense now.

[Autumn]

64. Wow, the ruling class seems to have a lot in common with some of these posters on DU.

Thank you for that explanation. It certainly explains OPs like this one in pure defense of the ACA, because this sorry OP is the defining "let them eat cake" OP of DU. By someone who has no skin in the ACA game.

[truedelphi]

77. ^^^^^^^^^^^^^^^^n/t

[Zorra]

90. Wikipedia has a very different explanation.

"Let them eat cake" is the traditional translation of the French phrase "Qu'ils mangent de la brioche", supposedly spoken by "a great princess" upon learning that the peasants had no bread. Since brioche was made from dough enriched with butter and eggs, making it more expensive than bread, the quote supposedly would reflect the princess's disregard as to the condition of the people.

http://en.wikipedia.org/wiki/Let_them_eat_cake

Brioche (/ˈbrioʊʃ/ or /ˈbriɒʃ/; French: [bʁi.ɔʃ]) is a pastry of French origin that is similar to a highly enriched bread, and whose high egg and butter content give it a rich and tender crumb. It is "light and slightly puffy, more or less fine, according to the proportion of butter and eggs."[1] It has a dark, golden, and flaky crust, frequently accentuated by an egg wash applied after proofing.

http://en.wikipedia.org/wiki/Brioche

[Erich Bloodaxe BSN]

92. Lots of interesting changes occur in translation.

Last edited Wed Dec 3, 2014, 09:38 PM - Edit history (1)

I heard it from a baker who no doubt had made brioche as well in his time. Since brioche is still not 'cake', going by that version, a better translation would be 'let them eat (a different kind of) bread.'

I admit I'll occasionally look at something on Wikipedia, but given that the entire article is basically pointing out that there's no real attribution for anyone having first used the phrase, I think it falls in line with the many 'anonymous' phrases that have come down through history, and is thus open to wider interpretation.

(Edit: Actually, thinking about it, there's not that much of a difference in the implication between either interpretation. Either way, if we assume it's being ascribed to a wealthy person talking about poor people, it shows a person who really doesn't give a damn. I suppose the Marie Antoinette ascribed variation is actually a bit more 'kind' to the rich, since it simply paints them as out of touch and not realizing that the reason the poor have no 'bread' is that they can't afford it. The baker variant shows them as actually knowing and suggesting that poor people should essentially 'trade downward' to 'what they can afford'. It's a 'chained CPI' version of the saying, where if poor people can't afford beef, they can eat chicken. If they can't afford chicken, they can eat fish, if they can't afford fish they can eat cat food.)

[kelly1mm]

16. Short answer = Out Of Pocket Maximums. Here is a good link to explain the concept

http://www.hullfinancialplanning.com/bronze-may-be-the-most-precious-metal-under-obamacare/

and a snip:

If you stop right there, though, you’ll be tempted to believe that you could be on the hook, for example, if you chose the Bronze plan, for 40% of your overall health costs.

You’d be wrong.

Regardless of the plan that you choose, as it stands now, your maximum out of pocket cost for health care, aside from your insurance premiums, will be the federal limits for high deductible healthcare plans (HDHP). In 2014, the limit will be $6,350 for singles and $12,700 for families.

Since everyone’s out of pocket maximums will be the same, regardless of the plan they choose, unless each state decides to change the limits for higher plans (such as California has done with Platinum plans) the math of choosing the plan becomes relatively simple, assuming that you have all of the proper information – namely, how much your healthcare would have cost if you didn’t have insurance covering you (note, this lack of information will make it very difficult for people to make informed decisions).

The way that the insurance companies will get to where you’re sharing the actuarial cost based on your plan level will be through deductibles, copayments, or both.

Therefore, the total cost estimates are simply a factor of premium + expected co-pays/deductibles where expected co-pays/deductibles won’t exceed your out of pocket maximum. If you have high healthcare costs each year, then it will seem to make almost no sense to get anything except a Bronze plan (or, if you qualify, catastrophic coverage plan) because you would hit your out of pocket maximum regardless of what type of plan you choose, so why pay the extra premiums? Of course, if your state lowers the out-of-pocket maximum for a Platinum plan (like California does), then you’ll need to do the comparisons. I’ve done a comparison as an example below.

On the other end of the spectrum, if you’re healthy as a horse and never go to the doctor, then you’d also want to get the highest cost share plan you can get (catastrophic coverage, if you qualify, or Bronze), because, barring an unexpected event – hence catastrophic coverage – you won’t pay the medical profession for any of their services. Thus, why pay the extra premiums for coverage that you don’t need?

[Recursion]

19. You're right that people don't seem to get what the "60%" means; it's averaged over all participants

And like I said above I get that for somebody who just doesn't want to be $150K in debt if he gets hit by a bus, and otherwise doesn't go to doctors, a bronze plan can be great.

I'm talking about a lot of threads I've seen where people talk about existing, known health care expenses, and it seems like a silver plan would almost always save you money in that case.

[kelly1mm]

23. Once you actually do the math, you will see that the bronze plan is the best for the vast number of

folks. Lets do a small example:

bronze plan silver plan

Yearly premium after subsidy $0 $2400

Deductible 6000 2000
Co-payment 40% 20%
OOP max 6500 6500


so, if your health care cost were the following, here is what your total actual cash outlays would be

bronze plan silver plan
$0 $0 $2400
2000 2000 $4400
3000 3000 $4600
$4000 4000 4800
$5000 5000 5000
$6000 $6000 $5200
$8000 $6500 $5600
12000 $6500 $6400
16000 $6500 $7200
20000 $6500 $$8000
24000 $6500 $8800


So, as you can see, in the above example you would only save real dollars if your medical expenses were between $5000 and just over $12000 per year. Further, the amount you could save by being in the sweet spot is limited to just under $1000. However, if you have a bronze plan and do not use health care for the year, you save $2400.

Much better upside to bronze unless you are sure you will be in the $5000-12000 range EVERY year.

EDIT Sorry my attempt at a chart did not work - hopefully you can understand it still.

[truedelphi]

72. I am sorry to say this, but the math of chosing a health plan is far

More complex than that.

For FY 2014, my family made $ 70 a month too much to be on Medicaid. Yet despite the fact that we made only $ 70 a month too much, our subsidized insurance premiums would have been $ 200 a month. (The stats done at Social Services showed we had that $ 70 - but where do we come up with the extra $ 130??)

Additionally, we had a problem in choices. We didn't have any choices.

We could choose between the following three and only three insurers in our county on the Calif exchange:

Anthem, which makes you pre-pay if you are on their non-premium plan, and then doesn't re-imburse you. (I have sad stories to tell about this lack of re-imbursment, as does NYC Skip, here on DU.)

Kaiser, which has not a single clinic or doctor in the entire county, so it is not a choice for us. (It might work out well for some County families who work in Napa or Sonoma conties though.) For us, Kaiser was also not a choice, as they had nearly killed my spouse and had caused a medical bankruptcy.

Then there was a third company but I had never heard of them.

Now further west and south of us, in Marin County, there was a Big Insurer who put up the photos of prominent and respected doctors, well known in Marin for being competent and being gifted with latest techniques etc. The doctors' names, little quotes from the doctors were displayed on the website. All leading the unsuspecting person to decide tht this would be a good choice for them, as they too needed to be on the exchange and didn't know which Insurer to pick.

But ha ha ha! Stoopid consumer - you lose. Sure you thought the doctors you liked were on this insurer's network, but that was only sleight of hand, website deception-style.

Not only are none of those photographed and quoted doctors on that network, there is not a single doctor in Marin County who will even take that insurance! SO now the consumer has to travel out of Marin, or else be paying out of pocket. (I can just see some poor scmuck who has fallen and broken his arm trying to navigate through gridlock traffic to get to the doctors he needs to see for his health care.)

Luckily in the last two weeks, the Big Insurer doing this has finally been taken to task. Two other Big Insurers were also guilty of this.

But you have to wonder why fraud like this is allowed... And of course, noone will even see jail time, it will possibly involve fines. So maybe next yer, consuemr s can pay even higher deductibles to help pay for those fines?

[1StrongBlackMan]

21. What amazes me is the number ...

of people on DU that are even affected by the ACA, at all.

Maybe, DU is the center of the under 65 year old, non-employer insurance provided, low-incomed; but, non-state Medicaid expanded, world.

[Recursion]

22. There's a saying in India, "there's a problem for every solution"

This is a side note, but what's amazing to me as someone who has pretty much lived in big east coast cities, is how many people own their own houses in these situations, which has never even been imaginable to me...

[Erich Bloodaxe BSN]

53. I'm under medicaid now as a result of the ACA.

Previously, Ohio didn't cover single, childless adults between 18 and 65, no matter how little income they had.

[1StrongBlackMan]

57. Shhh ...

We cannot allow the fact that millions ARE benefitted overshadow the posters to anonymous messages boards that CLAIM to not be benefitted.

[treestar]

65. Wow, so cruel!

Like telling single people they are worthless.

[Erich Bloodaxe BSN]

67. Every year, nurses have a day where they have a get-together at the statehouse

and smaller groups meet with the legislators for their districts. A few years back, pre-ACA, I asked ours about why they wouldn't cover adults under medicaid, and was told they simply couldn't afford it, because they needed the money for incarceration issues. I suggested maybe Ohio needs to stop throwing so many people into prison.

[JEB]

25. I'm 63, self employed and my income varies from year to year.

So I have a bronze plan and hope I stay healthy until I turn 65. I did get my free flu shot. Only time I see a doctor unless we cross paths around town. I'm lucky to still be in excellent health.

edit to add: I think it will save the house for my family if I die a long slow death in hospital etc.

[mountain grammy]

26. We went bronze for my husband. He's only 6 months from Medicare

We are lucky to be pretty healthy and rarely need to see doctors, so we just wanted catastrophic coverage just in case for 2014 and until Medicare kicks in, May, 2015. The premium was $255/month, but we just got notice it will double, so we think we'll tap into VA benefits for the next 5 months. I have Medicare, lucky me!

My daughter has a silver plan and it's saved her hundreds of dollars on prescriptions. With a subsidy, her premium is $55/month. She earned more than we estimated so will have to pay some of her subsidy back, but it's capped at $350 for her income level, around $20k.

Hope this information helps someone.

[Ex Lurker]

27. It's all academic. After SCOTUS kills the subsidies next summer, none of it will be affordable

Sorry to be such a downer, but I'm pessimistic about how all this turns out. I'm in Louisiana and that bastard Jindal has already said there will be no state exchange.

[Recursion]

30. Disagree. Roberts has shown he'll kick the ACA but not shoot it

I don't think he's interested in getting rid of it, just making it suck.

[Rstrstx]

39. I just don't see Roberts striking down the subsidies

To do so would require him to do a 180 on his decision to invalidate the Medicaid expansion. He struck that down because he thought the federal government was acting too coercively against the states. I think he'll apply the same logic and conclude that if the federal government is required to withhold money from states that didn't establish exchanges it would be considered overly coercive.

Ironically the right-wing would normally be totally against this case because it would impose draconian measures on states that don't want to do what the big bad federal government tells them to do. But since it's Obamacare they'd walk over hot coals or sell their grandmothers to satisfy their wet dreams of getting the law struck down, whatever it takes.

If only Chevron precedence applied (as many on the right hope) I'd say this case would be a close call, but between Roberts' love of keeping the feds from threatening states and the "Pennhurst doctrine" that requires statutes dealing with the withholding of federal money should be held to an extra high level of unambiguity the government should prevail.

[1StrongBlackMan]

59. Taking it a little further ...

Ironically, the anti-ACA crowd seem unable to recognize that they are hold X conflicting, but always present, thoughts ... the SCOTUS (and government) is bought and paid for by corporate America, including insurance giants ... the ACA is a gift/give away to insurance companies ... Why would Roberts go against his corporate masters?

I think Roberts got caught between his (conservative) hatred of the federal government coercing the states, his (conservative) hatred of the federal government using tax money to do stuff for (poor) people, and his corporate pay masters, with the pay masters hoping that killing the exchange requirement would not hurt their bottom-line ... it has.

[KingCharlemagne]

29. My wife and I could only afford the Bronze plan. It was very confusing when I first signed up. The

bronze plan (with subsidies) only cost us $2/month but the silver plans cost in the vicinity of $4-500/month (with subsidies). So I looked at it as a pay now (Silver) or pay later (Bronze) proposition and, not having any money, chose the pay later proposition. I got a letter a couple weeks back saying that while I might have chosen the Bronze plan b/c of the lower premiums (Duh!), with some mysterious tax credit, I would be better served with a silver plan.

That 'tax credit' never came up when I originally signed us up (a very frustrating and maddening experience I might add). I suppose it's possible I somehow missed it in the midst of the constant crashes and reloads of the Covered California site. But I was pretty careful to review options before I signed us up for the Bronze plan and the site never once mentioned any tax credit that would make the silver plan come within our reach.

[truedelphi]

73. Here is something I have been wondering -

I never was able to get through to the Calif Covered phone line.

And after seeing how long it took me just to try and get through, I gave up.

We found out that due to low income, two local hospitals have charity programs that will pay our expenses this year. Next year, our income wil be high enough that we will have to choose some piece of shit insurer, but I have no idea what to expect.

Once a person chooses an Insurer, what happens next? Do you get a policy in writing, on plain paper? Or are you totally relying on what someone with a HS education tells you over the phone?

[KingCharlemagne]

78. The CA Covered phone line was a giant circle jerk, IIRC, during the

initial sign-up. After navigating through its various phone trees in a vain attempt to speak to a human being, one terminated at a message informing one to go back to the same coveredca.com which had published the phone number in the first place! That is the classic definition of a circle jerk, imo.

As I recall, I got swamped with paper after signing up, a lot of it on glossy paper- and card stock with lots of pretty graphhics and what-not. But I do not recall ever seeing a formal policy at any point. So my understanding of what was and was not covered at the time came from that glossy P.R. materials.

[truedelphi]

79. Yikes! The policy holder who is payng the mandated premiums, doesn't even

Get a printed out policy!

What a totally insane world we live in.

[steve2470]

42. Eventually, hopefully, the American people will get sick of bronze coverage....

Many many people can only afford bronze, and if you get really sick, too bad so sad, hello medical bankruptcy or being in debt for many years. Medicaid sucks also, but hey, it's better than nothing.

SOCIALISM!!!!!!!!!!!!!!!!!!! Once a reliable majority of likely registered voters, who vote in OFF-year elections lose their fear of that word, we will get REAL health care aka single payer.

/rant off.

[Justitia]

43. premium cost - our bronze prem is $1000 / mo, silver would be $1200 / mo

Husband is self-employed, 63 yrs old, we do not qualify for subsidy.

Its huge $$$, but after being uninsured, we are grateful to have anything available.
Being self-employed, 55+, with a pre-existing condition, prior to ACA we couldn't get coverage - AT ANY PRICE.

[steve2470]

44. +1 nt

[Recursion]

47. Wait. that means you make $100k a year

If you don't qualify for a subsidy it means the premium is less than 9% of your income

[kelly1mm]

54. Not neccesarily. They could just be over 400% of FPL ($64k for MFJ w/no dependents). No subsidy

if you are at 401%, even if HI would be 50% of your income. If at 401% of FPL the HI would be over 9.5% of income they would qualify for a waiver of the penalty though. No help with the HI, but would not be penalized for not buying HI.

[wyldwolf]

46. Some do, others haven't and say they have because they want to criticize the ACA

Look at some of the exchanges in this thread. Nearly all the objections are neatly debunked yet some still continue the argument, kitchen sinking the issue by bringing up other issues.

I get it. I'd love single payer, too. But trying to discourage others from taking advantage of the ACA and spreading disinformation (willfully in some instances) isn't going to get you single payer.

[dilby]

55. I would guess it's what they can afford.

Most of them probably had zero insurance before this because they could not afford it then either. The system is broken and the only fix is single payer not giving more money to private corporations who hope you die before they have to pay out.

[Capt. Obvious]

58. Which plan did you choose off of the ACA marketplace?

[Cal Carpenter]

60. That's funny. I'm losing count of the number of posts

where assholes play stupid about what real life is like for people living in poverty.

[Lex]

71. The OP is saying if you're already paying for doctor visits and medicines

then if you got under an ACA plan, you might save money.

[treestar]

62. True, the I can't afford to use it argument

is pretty lame. Right up there with the one about how the ACA is insurance, not health care.

[TexasTowelie]

76. I did some number crunching back in March and this post might help explain

why the bronze plans are probably the best fit.

See post #74 in this thread: http://www.democraticunderground.com/10024560423

I concluded with these remarks:

With that in mind, why should people risk paying the additional premium for a silver policy when they really need to insure against a large catastrophic loss? Unless there are other benefits (e.g., larger provider networks), I don't understand why anyone would choose anything other than the bronze plans. It makes more sense to save the difference in premiums between the two different plans to self-insure (particularly if a medical savings account that accepts pre-tax contributions is available), or if one views the situation over the long term and realize that they only need to save one or two years to build that savings account.

[SomethingFishy]

84. Wow...

I'd explain the reality of being poor to you but since you had to ask, I don't think you would understand. I haven't seen a raise in 10 years, not even a cost of living raise. I work hard and make decent money but my wife is very sick, do you have any idea of how expensive it is to take care of a disabled person?

Frankly your post is insulting. You use your life as a basis to judge everyone else's. I'm happy you can afford good insurance, some of us aren't that lucky. I already work 70 hours a week, and take care of a home, a disabled wife, and 3 kids. But hey, I'm an idiot for only buying what I can afford, I should be like you and get the better plan because... it's going to save me money..

[Recursion]

91. Don't give me that sanctimonious crap

I grew up on WIC and AFDC and lived for months with the only income I had coming from rifling through people's trash cans for cans and bottles to go recycle and slept on the couch of whichever increasingly-tired-of-me friend would let me that night.

I should be like you and get the better plan because... it's going to save me money..

Yes, it is. If you spend more than $300 a year on medical expenses, than a $25/month silver HMO is probably going to save you money.

[Lex]

93. You completely misunderstood the OP.

He is saying if you are ALREADY paying doctor visits and medicines throughout the year in an amount equivalent to getting into a bronze plan, you should get into a bronze plan AND SAVE MONEY.

I don't understand why people can't understand his post --- if "you're already paying that to your doctors" . . .

[madville]

85. There's not much difference between bronze and gold

In the end. If I pay $1200 in annual premium and $5000 out of pocket/deductible for a bronze it's no different than paying $4700 in annual premium and a $1500 annual deductible/out of pocket.

The insurance company is making the same money either way. It's actually better to get the bronze because if you don't use it that year at least you saved several thousand in premium, there is no potential for savings with a gold plan, it's guaranteed you're gonna pay more even if you stay healthy.

[Capt. Obvious]

89. Which plan did you choose off of the ACA marketplace?

[darkangel218]

95. The OP lives offshore, so no ACA for him i suppose.

But he seems to know better than most of us how it works and what plans people should chose.

[truedelphi]

98. Captain Oblivious,he states clearly in his OP that he is stuck w/ Bronze.

It is the only option for someone making less than 17 K year, and who has a negative income.

With Bronze, he has a deductible of over $ 6,000 a year.

[Capt. Obvious]

105. Here is his OP

What the fuck are you talking about?

Why do so many people here get Bronze ACA plans?

I'm losing count of the number of posts people have written talking about how awful their bronze ACA plan is. As far as I can tell these aren't young single adults looking for catastrophic coverage, but middle-age and above people looking for functional health insurance.

Why would you go for a bronze plan in that situation?

If you're even coming close to meeting your deductible with a bronze plan on a regular basis, you're going to save money by getting a silver plan (which is why the "I can't afford it" argument makes no sense to me -- you're already paying that to your doctors; pay less to an insurance company).

[SheilaT]

102. After reading through this thread, I was likewise struck

at how many posters on DU live at or below the poverty line.

In any case, I think perhaps one underlying factor that so many people here are buying Bronze ACA plans is because they've been trained over the years (by Walmart, et al) to always buy the cheapest one available. Not to research carefully and see if something a little more expensive would be better for their needs, but to always and only go by price point.

I'm sure I'll get flamed here, with several posters essentially screaming at me about how I haven't a clue how truly poor and sick they are, and I'll say if you're that poor and that sick you sincerely have my wish that things could somehow get better for you.

Of course, in an unrelated topic, I've been assured many times that it is completely impossible for any person over 60, no over 50, no make that over 40 to ever get a job. Oddly enough, I've been hired some eight different times starting at age 56. What am I doing wrong?

[LWolf]

104. Who says they're paying their doctors?

Some of them may be racking up doctor bills they can't pay.

Instead of defaulting on silver plans that they also can't pay.

Many pay for the bronze plan for catastrophic reasons, and to comply with the law, and then simply don't go to the doctor.

Because they can't afford to.

Which is exactly why fucking INSURANCE isn't the answer.