My Health Insurance went....Down

[Pete123]

I recall a thread where folks were bummed about Obamacare health insurance increases.

 

They sent me a $160 increase.  It has turned out that I'm getting a $90 decrease.

 

Here's how.  I have bought through a broker, Phil Martin and team 615-884-3535; for years, though there are many others. 

 

He sent me four options.  I took about an hour looking through them, thinking about my best guess of what I'll need this year, and researching the only expensive prescription that I take.  

 

I was able to determine that I could probably go with a plan that costs about the same.

 

I don't expect any big medical expenditures this year.  So I called my Phil's office and was able to determine that the policy that is $90 less would work fine.

 

I'll have to pay more if something happens to me, though as mentioned, I don't expect anything.

 

Thought I would share incase someone else can benefit.

[Sam1]

Glad that you could save, but I learned back in 2011 that no one plans to leave the house in the morning and come back home 4 weeks later with a $500,000 medical bill :)

[Pete123]

I totally understand.  My plan has an out of pocket max of $7000.

[bersaguy]

I totally understand.  My plan has an out of pocket max of $7000.

Is that forever or for a year?

 

Edited December 15, 2015 by bersaguy

[quickbiscuit]

Sounds like it didn't actually decrease; you just opted for a cheaper plan. I dare say that no one is getting the same coverage for less money this year.

[bersaguy]

Back in 1986 on a beautiful Spring My son had an automobile accident that took less than a second to happen but my insurance company paid 3.1 million dollars over 4 years in medical and I still lost him. I don't think any one can count on when they can or will get sick but with that said every day is a challenge we all face.

 

Every one will get screwed in one way or another by ACA if you are forced to purchase it. Your premiums may be low but the deductibles is what will destroy most people. How many people can just pull 3 or 4 grand out of the bank to pay a doctor or hospital before insurance begins to pay anything and how many times can a person do it if another family should fall sick in same time period?...................................................jmho

[Pete123]

The out of pocket max is $7000 per year.

 

My purpose in sharing my experience is to possibly help others manage their health insurance cost - not to have it picked apart by TGO members.

 

As I mentioned in my original post, I will have to pay more out of pocket if something happens to me.  I'm saving money because I won't have co-pays, but will have to pay the negotiated discount up to a max of $7000.

 

I didn't reduce cost by blindly going for a plan that costs less. As mentioned, I did research and then called the broker to clarify questions.

Edited December 15, 2015 by Pete123

[Sam1]

If you were referring to my post, I didn't mean for it to appear to nitpick your plan. Experiencing the opposite side of the spectrum, I stick with the higher cost plans to minimize catastrophic cosrs.

[Pete123]

If you were referring to my post, I didn't mean for it to appear to nitpick your plan. Experiencing the opposite side of the spectrum, I stick with the higher cost plans to minimize catastrophic cosrs.

 

I can appreciate where you are coming from.  The difference between our views comes down to risk tolerance.  No one has a right or wrong risk tolerance.  As of right now, I don't need any procedures like a colonoscopy and don't expect to need surgery.  

 

Two years ago I slipped on ice and dislocated my shoulder.  If something like that happens this year, I'll lose any money I saved and more.

 

My 'nitpicking' comment may have been a little too strong.  There is no such thing as a free lunch, especially with health insurance.  

 

I suspect we have TGOers that can't pay any more.  Working with a good broker as well as taking time to research based on the needs I think I'll have this year has allowed me to manage cost better, though I'm achieving this by accepting more risk.

Edited December 15, 2015 by Pete123

[Jonnin]

Back in 1986 on a beautiful Spring My son had an automobile accident that took less than a second to happen but my insurance company paid 3.1 million dollars over 4 years in medical and I still lost him. I don't think any one can count on when they can or will get sick but with that said every day is a challenge we all face.

 

Every one will get screwed in one way or another by ACA if you are forced to purchase it. Your premiums may be low but the deductibles is what will destroy most people. How many people can just pull 3 or 4 grand out of the bank to pay a doctor or hospital before insurance begins to pay anything and how many times can a person do it if another family should fall sick in same time period?...................................................jmho

 

Yep.   We planned ahead and have enough to pay a big deductible.  My new plan has a rolling over cash account for what isn't used (unlike some plans with a use it or lose it setup),  great all around coverage, and a high deductible that I have set aside if I need it.  I don't know if its and ACA plan or just one of many options we were offered.   But you are right, most people won't set aside the money ahead of time, and some people can't (though most of them find $150 a month to spend on toys like phones and tv... which would cover it...).   

[Patton]

Sounds like it didn't actually decrease; you just opted for a cheaper plan. I dare say that no one is getting the same coverage for less money this year.

I have also heard of more than one health care plan that appeared more economical that didn't meet ACA standards resulting in penalties.

[Pete123]

Yeah, there are risks with any purchase.   Cost management can work very well, though there are risks with it.  In the same manner, paying more doesn't ensure a better, or even adequate, outcome.

 

I think the key for me is to invest more time into research as the importance of the decision increases.

[Randall53]

Obamacare does have some cheap insurance. Finding a dr. that will take it is another matter all together. Obama lied. You don't ALWAYS get to keep your doctor. Now that they have had some experience with Obamacare, some doctors are refusing to take more plans as they figure things out.

[Pete123]

Obamacare does have some cheap insurance. Finding a dr. that will take it is another matter all together. Obama lied. You don't ALWAYS get to keep your doctor. Now that they have had some experience with Obamacare, some doctors are refusing to take more plans as they figure things out.

 

Yes, the key is to look at the network your plan supports to ensure you can see who you want to before making a selection.  Also, another thing I evaluated is one particular medicine I take.  It's not generic and it is expensive.  So, when when doing research, I looked at how BCBS of TN (my current provider and the provider for the new plan) categorize this medicine, and was able to figure that out.

 

In thinking about some of the pitfalls shared in this email, I realize that I have covered all of them.  This isn't because I'm smart, but because I work with a solid broker.

 

Here's the math on mine.

 

My insurance was increasing to $606.95.  I selected a plan for $371.52, which reduces my cost for the year by $2,852.16.

 

Both plans are with BCBS of TN.  Both are on the same provider and prescription network

 

The difference between the two plans is that the less expensive one has a deductible of $5,500 and the other one has no deductible.

 

Both have a maximum out of pocket of $6400.

 

So, I'm taking a risk and making a bet.  I'm betting that I won't have anything significant happen this year.  If I bet well, then I'll save $2,852.16.  

 

If I haven't bet well, then I have to pay $5,500 before the policies basically become equal.  

 

As I would pay $2,852.16 to have no deductible, the effective risk is $2,647.84.

 

So, I'm betting $2,852.16 that I won't have to pay $2,647.84, which are odds that I'll take.

 

As you can see from the detail I've provided, I did research supported by a good broker.  

 

My point being that others on the forum may be able to do a similar analysis and possibly manage significant cost.  The research allows effective risk criteria to be developed.

[Omega]

So, this broker, how does that work?  Who do they work for and who pays them?

[Pete123]

The broker receives a commission from the providers. Some would argue that means they work for the providers.  It really depends on the individual.  

 

The guy I use was was a referral from a friend.  He has looked out for me well through the years.  One time he suggested a more expensive policy, though I kept asking questions.  His contact info is above.  I'm comfortable sending folks to him, though as with anytime you are dealing with a sales person you have to pay attention.

 

When I first moved to TN I used the yellow pages to find one.  He was worse than terrible.  I would suggest asking around to find a good broker.  Small to medium business owners are good folks to ask.  If they have insurance for themselves and their employees then they are probably working with a broker and have a good feel for them.