It’s open enrollment time again and, starting tomorrow, I’ll be able to update my current healthcare plan via the New York State of Health website. I’ve already started “shopping” for plans using a handy tool which enables me to preview all available plans for 2020.
I’m sitting here, staring at a long list of terrible health insurance options not because I want to, but because I have no choice.
I'm not doing this because I love my health insurance plan or even because I want to keep my current doctors. I'm here, yet again, because I have a 30 day window to either renew my current plan or choose a different (hopefully better?) plan. The options to cover a couple range from $915/month to stick with my current plan (the cheapest one available) to a staggering $3600/month for the most expensive platinum-level plan.
For those that don’t purchase their health insurance on the exchange, there are five plan levels available — bronze, silver, gold, platinum and catastrophic. Ranking is based on cost of the plan and out of pocket expenses, with bronze having the highest out-of-pocket expenses and lowest premiums. Higher-tiered plans have lower out-of-pocket expenses and higher premiums.
Catastrophic plans are only available if you’re 30 or under or qualify for them based on income (I’m not and I don’t). They provide the exact same benefits as my current bronze plan, but without coinsurance or copayments (meaning, nothing is covered until you pay $8000 in medical expenses).
A hard look at the numbers
Bear with me, here. I’m about to do some math. It is difficult for the average layperson to compare healthcare plans because there are several things to consider. The bottom line is that all plans in the ACA provide the same benefits and coverage, but the cost of getting that coverage varies based on metal level and insurance company.
Here is a breakdown of pricing by level for my health insurance company of choice, by metal level (including my current plan this year vs. next year):
These prices are for a plan that covers only myself and my husband. My 15-year-old daughter will be covered through Child Health Plus which will cost me about $45 to $60 per month but has no deductibles, coinsurance or copayments. That is, until she turns 19. Child Health Plus is a CHIP program and is collaboratively funded by the state and federal government. I enrolled my children in CHIP in 2014 and it was nothing short of life changing. That year, I paid $60/month to cover both girls and literally everything was included (my daughter had extensive treatment for her cancer that year).
There are a lot of numbers in the above table, so I’ll summarize the most important ones. I look at the third column (monthly premiums) to determine the day-to-day financial impact that paying for health insurance has on my family. A monthly premium of $276 is much more affordable than a $662 monthly premium. At $914 and $1243, respectively, the gold and platinum plans are completely out of reach for me.
Assuming that my ACA subsidies will shave roughly $650/month from my monthly premium, the bronze plan is the obvious choice. I’ll only pay $276/month plus another $45 to $60/month for my daughter’s plan. This is a 15% increase over last year, but I can live with that. There’s also one perk this year compared with last — my individual deductible has been reduced from $7,600 to $4,425. Note: that’s a per person deductible, so my husband also must pay that amount before he sees any benefits.
After the premium cost, the second to last column is the most important one. That tells me how much I’ll pay if something terrible goes wrong: cancer, a heart attack, a car accident, a chronic diagnosis requiring expensive medication, etc. etc. It’s the number I used to ignore before my 11-year-old daughter was diagnosed with cancer in 2012.
That year she was not enrolled in Child Health Plus. I had included my kids in a family plan which had a $9,000 family deductible and a $12,000 out-of-pocket max. I mean, why not? We were a young family and the girls were healthy. When my daughter was diagnosed, we spent every penny of the $12,000 max in a single day.
When you’re in the unenviable position of choosing from a list of terrible options, make sure you look at that number. Anything can happen at anytime — one ambulance ride can cost $1500. One air ambulance ride can cost $35,000 (side note: did you know most ambulance companies are private and don’t accept insurance?)
Pro tip: Think of your out-of-pocket maximum as the amount of money you’ll need to raise from your GoFundMe account after the accident/illness/bad thing that happens.
If you look at it like that, then all of the above plans — regardless of metal level — are equal, with the exception of silver which, inexplicably, costs $4K to $5K higher than every other plan. I suspect that’s because silver plans are the most popular level (that’s based entirely on my own cynicism and not any actual facts). The final column, the one highlighted in yellow, lists the total cost for each plan when you factor in the annual premiums. There’s no real choice here. If something bad happens, then they all look pretty much the same.
And trust me when I say this: bad things do happen.
Political talking points are meaningless
I know what you’re thinking. Well, I know what some of you are thinking. I’ve heard the talking points a thousand times. People like their private health insurance. A public option will eliminate choice. There’s no way we can pay for it. Think of all the jobs that people would lose! It’s socialism. It’s not the health insurance companies that are the problem, it’s the pharmaceutical companies and the overpriced cost of care at hospitals or specialty offices.
On that last point, I will concede only slightly. The cost of drugs in the U.S. is out of control, as is the cost of anything related to healthcare (please see my ambulance reference, above). To this point, I want to say that health insurance companies enable skyrocketing costs because they mask the true price of care.
Do you know how much your last mammogram cost? How about your last blood draw? What about that sick visit that required a strep test and a prescription of antibiotics? I’m betting you don’t because the amount you paid was either 1) a copayment or 2) a percentage of a negotiated cost, also known as coinsurance. This obfuscation is a huge part of the problem. These costs are there even though we don’t see them. They’re why insurance companies routinely deny treatment, medication, and services even when they will clearly benefit patients.
Imagining a system that isn’t broken
Sometimes I close my eyes and imagine what it would be like if I didn’t have to worry about “shopping” for health insurance. Oh, the relief of not trying to predict the next big medical catastrophe or worry about my ACA subsidies suddenly going away. It doesn’t seem that complicated, you know?
Here’s what worries me. I’m not sure that the majority of our politicians understand this struggle. After all, they have great health insurance through the ACA, though it’s not entirely free. Additionally, the median net worth of senators and House members is about a half a million dollars. These are the people that can comfortably afford a $3500/month platinum plan, so how can they understand what universal healthcare means to me?
I would gladly pay more taxes for access to medical care when I need it. I’d give up all my current doctors and providers if I had this guarantee. I’d hand the administrative and logistical reins of managing healthcare over to the government (state, federal — it makes no difference to me), if it meant lifting this terrible burden from my back.
A note to politicians: I hate my current healthcare plan. I am ready to walk away from the oppressive restrictions of a private insurance company so that I have the freedom to get sick without worrying about how I’m going to pay to get better.
But, of course, that’s not going to happen this year. Tomorrow I’ll select my plan, perpetuating the cycle of underinsurance and I will continue to hope for good health for myself and my family in 2020. We’re going to need it.