Catastrophic Plan Exemption

[RayNY]

Its not just the OOP. Its also the annual premium cost. You have to combine the two to get the actual annual cost.

Potential maximum annual cost, not actual. It's a disservice to your client to disregard their needs and usage and jump right to the worse case scenario.

Realistically, it's pretty rare to hit your MOOP. Here in my state, it's basically a wash at that point anyway. Argument's sake, Family rates on Oscar's Standard Platinum Premium+MOOP= $24,220, Bronze Premium+MOOP=$24,748. EmblemHealth's Platinum is $24,544, Bronze is $24,808.

Would you really advise your low-to-normal-usage clients to choose a plan that costs $600-700 more every month, just to save $300-600 over the year if they somehow are unlucky enough to hit MOOP?

In my "real usage scenarios", overwhelmingly, the silver/gold plans win out in terms of value. A normal person with normal usage will spend the least over the year on those tiers.

By the "potential annual cost" method, they're the worse value, with the highest Premium+MOOP costs. In real life, it's the opposite.

Heavy users benefit from Platinum, non users benefit from bronze/cat.

 

[dgoldenz]

Its not just the OOP. Its also the annual premium cost. You have to combine the two to get the actual annual cost.

Yeah, but I have not found a scenario yet where a child maxing out the OOP cost would have a better deal than getting Platinum level.

 

[kgmom219]

Potential maximum annual cost, not actual. It's a disservice to your client to disregard their needs and usage and jump right to the worse case scenario.

Realistically, it's pretty rare to hit your MOOP. Here in my state, it's basically a wash at that point anyway. Argument's sake, Family rates on Oscar's Standard Platinum Premium+MOOP= $24,220, Bronze Premium+MOOP=$24,748. EmblemHealth's Platinum is $24,544, Bronze is $24,808.

Would you really advise your low-to-normal-usage clients to choose a plan that costs $600-700 more every month, just to save $300-600 over the year if they somehow are unlucky enough to hit MOOP?

In my "real usage scenarios", overwhelmingly, the silver/gold plans win out in terms of value. A normal person with normal usage will spend the least over the year on those tiers.

By the "potential annual cost" method, they're the worse value, with the highest Premium+MOOP costs. In real life, it's the opposite.

Heavy users benefit from Platinum, non users benefit from bronze/cat.

Ray, normally, I think you are right. But not in this case. And I realize this is zip code specific, but since my 3pm was about this specific issue, I have the numbers in front of me.

No subsidy
6 Specialty meds that run $900/month
Averages 3 hospital stays/year
4 MRI's/annual

$6K 100% plan. $403/month plus $6K = $10,836 (without even getting into the tax advantages of the HSA)

$1K, 80%, $2750 OOP. $703/month. $8436. Assumption is she meets the OOP. $11,186

IF she doesn't meet the OOP, then she lost money. Maybe. But there's no way she's not going to meet it. And she loves the tax deduction. And the no headaches or bills.

You can't make a blanket statement. What works for some clients, doesn't work for others.

And don't get me started on silver plans and/or copays. Copays are playing a huge role in the rate inflation, because no one knows what their healthcare actually costs!

 

[FLM2]

Potential maximum annual cost, not actual. It's a disservice to your client to disregard their needs and usage and jump right to the worse case scenario.

Realistically, it's pretty rare to hit your MOOP. Here in my state, it's basically a wash at that point anyway. Argument's sake, Family rates on Oscar's Standard Platinum Premium+MOOP= $24,220, Bronze Premium+MOOP=$24,748. EmblemHealth's Platinum is $24,544, Bronze is $24,808.

Would you really advise your low-to-normal-usage clients to choose a plan that costs $600-700 more every month, just to save $300-600 over the year if they somehow are unlucky enough to hit MOOP?

In my "real usage scenarios", overwhelmingly, the silver/gold plans win out in terms of value. A normal person with normal usage will spend the least over the year on those tiers.

By the "potential annual cost" method, they're the worse value, with the highest Premium+MOOP costs. In real life, it's the opposite.

Heavy users benefit from Platinum, non users benefit from bronze/cat.

I have a number of clients who will hit their MOOP every year.

Many of them want the security of the Platinum plan even though the lowest annual cost (premium plus MOOP) typically is the Silver HSA because the additional premium over the Bronze HSA isn't as much as the $3000 difference in deductible.

Sometimes the Platinum plan is a better deal as well-in Florida, the UHC Platinum Compass plan only has $1500 MOOP and is lower in cost for those knowing they will hit that level, especially when it is a one person plan.