Quote:
Originally Posted by tophcfa
The biggest advantages of the Bronze tier is that you pay the lowest premiums and if your health care needs are minimal it’s absolutely the cheapest plan. That huge advantage is offset by the fact that if your health care needs become extensive, the pay as you go becomes lots more work for the same cost. That disadvantage is what makes the pricing of the bronze tiers premiums so cheap, as the hassle of paying as you go discourages the insured from seeking health care unless it’s absolutely necessary.
Kind of long winded, but hope that helps.
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The tiers have changed a LOT since the ACA was first passed. Also medical needs of subscribers change from one year to the next, especially as we get older. As of January 1, my new plan will be BlueSelect Bronze 2139.
I'm expecting to need hip replacement surgery next year. The customary cost, for operation, facility fee, doctors and anasthetics, pain meds, follow up visits, scans and xrays and whatever the heck else they do, will be somewhere around $25,000.
Under my CURRENT plan - BlueSelect Silver 1443A, I pay $436/month just to be on the plan. It has a 7000 per person deductible and a 8500 per person out of pocket expense. Having the procedure at the hospital instead of a surgical center is only covered to something like 40%, leaving me with having to pay 60% of the balance. Certain other parts of the surgery aren't covered at all, though I'll get some kind of schedule of fees discount. It's pretty complex, lots of things that are and aren't covered, covered only partly, with a bunch of exclusions.
The tl;dr is I'll likely be on the hook for around $15,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.
For the NEW plan, it's a $9100 out of pocket max, 0 deductible. That basically means I pay for all my expenses as I go, and once it hits $9100 total payout, everything else is covered at 100 or with a reasonable additional copay (like $50 for a doctor's visit for a sprained ankle or whatever else).
This new plan will cost me $146/month, for myself and beloved spouse.
The tl;dr of the new plan is I'll be on the hook for around $10,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.