Miss Attorney Ma'am

How to shop, compare, and buy individual health insurance policy through healthcare.gov

Profile: I am a self-employed, single, non-smoking female over 30 with no children and no current health care expenses living in Memphis, Tennessee. Ouch, that hurts just to type, because that is my entire life status in one sentence according to the US Government.

Goal: lowest monthly Premium for lowest Out-Of-Pocket Maximum, with low Deductible, low Coinsurance rate and low Copays; Health Savings Account eligible preferred.

Out-Of-Pocket Maximum [OOPM] – you pay this before health insurance pays 100% of covered expenses, 2014 limit $6,350 [doesn’t include your premium or uninsured/elected expenses] usually includes:

• Copay or Copayment – you pay this fixed amount for specific services, doesn’t usually count toward the Deductible
• Coinsurance – you pay this at a fixed percentage for covered services after you pay the Deductible
• Deductible – you pay this at 100% for covered services the you pay Coinsurance until you reach Out-Of-Pocket Maximum

Premium – you pay this monthly before the cost of covered services, does not count towards your Out-Of-Pocket Maximum or Deductible

Health Savings Account – you pay into a pre-tax savings account that can be rolled over each year to be used to pay tax-free for qualified services [include deductibles, coinsurance, copay, uninsured medical expenses; does not include premiums and Over the Counter medications] but subject to a PENALTY for any other withdrawal, you must have an eligible High Deductible Health Plan and there are annual contribution limits per the IRS

Summary: Each month you pay your Premium and fund your HSA (in theory, at least your OOPM plus extra for Copays and uninsured services) Then you pay Copays (if you have them), next 100% of Deductible, next Coinsurance until reaching OOPM as you use covered services

Method after the jump…

Method: Prices only apply in Tennessee and reflect my personal notes

1. I looked at each metal level of plans to get a general idea of OOPM
   1. Bronze – $6350-$5300
   2. Silver – $2250-$500
   3. Gold – $6350-$2100
   4. Platinum – $3000-$1500
2. Then I looked at the premiums for each metal level, unsubsidized
   1. Bronze – $129.23-$221.68
   2. Silver – $168.42-$282.87
   3. Gold – $221.30-$352.06
   4. Platinum – $299.41-$368.57
3. I tried using the Narrow Your Results options
   1. Premium range under $300, to include the lowest priced Platinum
   2. OOPM range under $2250, to include all Silver yet excludes all Bronze
   3. Premium range under $200 without OOPM restriction
   4. I did not make selections under Cost-reduced and Deductible since my previous selections covered my goals
   5. Dental, no plans have adult dental options
   6. Plan Type, all the plans are EPO/PPO and no HMO options
   7. Health Savings plan, I’m interested in this too
   8. Medical Service management, doesn’t apply to me

After getting familiar with the terms, I started making my selections to compare

1. Premium range under $200
2. No Charge After Deductible
3. HSA eligible
4. I found 6 plans, and sorted by OOPM
   1. BCBS SILVER S16E $176.31 for $500 OOPM
   2. BCBS SILVER S16S $195.90 for $500 OOPM
   3. BCBS BRONZE B04E $138.41 for $5300 OOPM
   4. BCBS BRONZE B04S $153.79 for $5300 OOPM
   5. BCBS B04P MULTISTATE $186.71 for $5300 OOPM
   6. HUMANA LOCAL PREFERRED BRONZE 6300 $171.10 for $6300 OOPM

That’s about all the information available on HealthCare.gov there’s really no further comparison as to why plans have different premiums even though the side by side comparison shows them to be the same otherwise.

Next I will need to move on to reading the actual Summary of Benefits and Plan Brochures on the insurance providers website http://www.bcbst.com/sbc/plans.do?plan=marketplace-health-insurance-plans before I make a final selection.

UPDATE 1/28/2014

Tried the Marketplace Live Chat option on Healthcare.gov it was useless since they don’t have access to actual plan information.

Called BCBST directly and was explained the the letter at the end of the plan number indicated the provider network, which results in a price difference. I qualify for the lowest priced BCBST Network E because I live in Memphis [large metro]

However, since the plans I inquired about were Cost Reduced Silver plans which I qualified for based on my income, I ended up having a longer conversation about self-reporting income and life changes.  The BCBST agent three-way called the Marketplace support to make further inquiry.  We never did get an answer and were told that a follow up would be required.  Overall, I had a wonderful customer service experience with BCBST and feel confident in moving forward with choosing one their plans.

After spending nearly 24 hours researching healthcare for a healthy person, I feel like playing the SOTU Drinking Game 2014 and giving myself a preexisting condition worth paying for…

I haven’t purchased anything yet, so your advice is appreciated!