Health care: This is about promises you can’t keep and why your bronze plan might not mean ‘worst,’ period

“That means that no matter how we reform health care, we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what.”

~ President Obama in a speech
to the American Medical Association,
June 15, 2009

A-choo! [Only I really mean to cough “bullshit” into my hand.]

I am among the dozens? hundreds? millions of Americans who are losing their health-care plans. I recently received a polite letter from my health insurance provider that said “your current Blue Cross and Blue Shield of Illinois (BCBSIL) health insurance plan will no longer be available after December 31, 2013.”

Wha-what?!

Not to worry, BCBSIL has new options available Jan. 1, 2014 that comply with the Affordable Care Act, and I get to choose my new plan.

So does the offer of new options mean I get to keep my health-care plan, period?

No, of course not. If it did, this post would be complete. Period. And it’s not. Period.

Let’s go shopping for an Affordable Care Act-compliant health care plan and see how much it’ll cost us, shall we?

I’m a generally healthy middle-age adult who doesn’t smoke and rarely sees a doctor for anything beyond preventative care (though I had a doozy of a story to tell about my last mammogram — read that here) so I currently have a high-deductible PPO plan that costs me $197.03 a month. The deductible is $2,500 a year, out-of-pocket maximum is $3,000, 80% co-insurance and no office visit co-pay (just a note: that no-copay thing means I pay 100% of doctor’s visits — or $100-$150 — unless it’s preventative care).

BCBSIL doesn’t offer exactly the same plan (surprise, surprise, particularly to folks whose last name is Obama) but a similar PPO plan (considered a “silver” plan) with a $3,000 deductible, $6,350 out-of-pocket maximum, 80% co-insurance and $35 office co-pay (meaning I would never pay more than $35 for a doctor’s visit) would cost me $372.68 a month.

Ouch.

That’s [a-choo] $2,107.80 more a year for me.

By the way, the new plan would provide maternity care. Which is worthless since I’m menopausal.

OK, wait a minute. I could be irate about this and call up Fox News to complain, but let’s go back to the “generally healthy” part. I have a high deductible plan because I rarely see a doctor anyway. I just need enough coverage to prevent me from facing bankruptcy should the worst happen (i.e., surgery, cancer, coma). So let’s look at the cheapest possible option from BCBCIL.

It’s a “bronze” plan called “Blue Choice Bronze PPO” (I think the “Choice” part limits my doctor options, but I can’t tell for sure). That plan has a $6,000 deductible, $6,000 out-of-pocket maximum, 100% co-insurance and no office visit co-pay. That plan is actually less than my current plan: $185.50 a month.

Since I don’t spend a lot of time seeing doctors anyway and the odds of me reaching either the $2,500 deductible or $6,000 deductible are slim, it’s actually cheaper for me to go with the bronze plan.

In fact, and here’s the important part most Americans might not realize, the bronze plan is cheaper for me even if the worst happens.

Here’s the math:

  • On the bronze plan, I’d pay $2,226 a year in premiums and $6,000 for the maximum out-of-pocket, which is $8,226 in a year.
  • On the gold plan, I’d pay $5,216.76 a year in premiums and $3,250 for the maximum out-of-pocket, which is $8,466.76 in a year — $240.76 more.

A-choo.

Those health insurance companies would have us believe gold or platinum is more desirable, but in fact, they just more expensive.

Sure, it’s no fun to write a $150 check to see a doctor about my labored breathing or plantar fasciitis, but it’s way worse to write a check for $434.73 every month for the gold plan premium whether I see a doctor or not.

So, we have two lessons here, both of them about language. No. 1 is for those of us whose last name is Obama: Better to admit your mistake. You shouldn’t have promised people could keep their health-care plan, period. All things change, always. Leaders of the free world should know such things. And No. 2 is for generally healthy people who rarely see doctors: Bronze isn’t bad. Just because it’s the last health care plan on the list doesn’t make it the worst one. Leave the high monthly premiums to the super-users of the health care system.

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