Let Them Keep Their Plan!

[Yagents]

Is there a reason to keep a grandfathered plan at this point? A friend/client has a GF plan with BC/BS. A comparable plan with another carrier would save just shy of 2K per year in premium. $100 more deductible, $1600 more OOP max, $30 copay vs 20% co-insurance for office visits for the new plan.

I don't think anyone knows at this point what is going to happen to the old plans, so I can't really advise him on that.

He has a couple issues we would need to make certain are covered with the new plan, mainly hemochromatosis.

Is my reluctance to switch him unfounded?

A GF analysis depends on a couple questions:
Single or how many family members on the policy?
Current premium?
Adjusted gross income for 2012?
Total OOP of current plan?

Plus, hemochrom is tough to insure, but I just got someone approved at Assurant with the condition

If you answer these, I can give you my opinion

 

[ctg]

A GF analysis depends on a couple questions:
Single or how many family members on the policy?
Current premium?
Adjusted gross income for 2012?
Total OOP of current plan?

Plus, hemochrom is tough to insure, but I just got someone approved at Assurant with the condition

If you answer these, I can give you my opinion

Single, 50 Y/O, smoker
Current premium $408/mo (including dental add-on) with 12% increase planned in April. New plan quoted $199.33 + $24ish for a stand alone dental plan. He's adamant about dental coverage.

2012 income about $100K-he owns a bar so declared may differ from actual, if you know what I mean. Not that he can't afford the premium now and he has no complaints with his current carrier, but $2000 saved is $2000 saved.

OOP on current plan is $3400-would be $5000 on the new plan.

Hit his deductible in 2011, but not in 2012-MRI for his knee contributed to that...

I'm thinking I may as well submit an app and see if he's rated up, declined, or ridered.

 

[Yagents]

Single, 50 Y/O, smoker
Current premium $408/mo (including dental add-on) with 12% increase planned in April. New plan quoted $199.33 + $24ish for a stand alone dental plan. He's adamant about dental coverage.

2012 income about $100K-he owns a bar so declared may differ from actual, if you know what I mean. Not that he can't afford the premium now and he has no complaints with his current carrier, but $2000 saved is $2000 saved.

OOP on current plan is $3400-would be $5000 on the new plan.

Hit his deductible in 2011, but not in 2012-MRI for his knee contributed to that...

I'm thinking I may as well submit an app and see if he's rated up, declined, or ridered.

At that income level (above $44k MAGI), he will be paying full price in 2014. My guesstimation is full price will be current group rates +5%, so about $400-500/mo. His new rate up should put him at $450/mo, so he is already at that price, and it will only go higher from there. Sooo, I'd say you have a green light to move him, but be sure he understands you really don't know what will happen in a year from now. OOP on the new plan will be within the new law, so he may be able to keep the plan you move him into, but prep him that the price will pop back up to where he's at now, or close to it, in my estimation. If dental is important to him, be careful of new waiting periods. I looked and my client with hemochrom got a 25% rate up at Assurant and did not rider it. I'd put him in an HSA eligible plan with that type of income. Assurant Core med HSA with 5k deductible, 100% coverage.

Just added: Since he is a smoker, he will have a 50% rate up with Obamacare, so these numbers may change based on that factor, and may change my opinion.......that throws in a wildcard.

Hope that helps.

 

[Ann H]

There is no problem with taking an app, and seeing what the offer would be. But I would be wary to move him from grandfathered status. I used Kaiser's calculator to estimate the Obamacare premium for a male age 50 with a "low cost regional factor", such as Iowa would most likely have. The projected premium is $5583. Add 50% for smoker status, and it's $8374 ($698 monthly). The out-of-pocket is $6250.

 

[ctg]

Thanks! HSA compatible, $2500 deductible, deductible then 0% coinsurance (preventive services - 0% not subject to deductible) brings it down to $150.61/mo. $5K drops to $104.22. BTW, Coventry is who I'm looking at...Assurant doesn't seem to be too competitive here, but worth a look.

I'm not certain if he's willing to move money in and out of a HSA account even if it would save a good chunk of money. He's a "I'll pay more for the convenience" kind of guy.

 

[Yagents]

50 yr old smoker at $104/mo? Either somethings fishy about the plan, or I need to move to Iowa.

Ann, I'm highly skeptical of some of those kaiser rates, some seem just toooo high, but it's all we've got to run with for now.

 

[moonlightandmargaritas]

If we get fair comp on the exchange then its going to be smooth sailing.

Hahahahahaha! Care for a small wager?

 

[GreenSky]

Hahahahahaha! Care for a small wager?

Of course we'll get fair compensation.

It's enough to know that we are able to use our expertise to help our fellow man (and woman). It's the American way or at least the Obama way.

Rick

 

[ctg]

50 yr old smoker at $104/mo? Either somethings fishy about the plan, or I need to move to Iowa.quote]

Yep, double checked. $135 for $3500 deductible, $151 for $2500 on their HSA compatible plans. Primary physician is in network. We'll see if they rate him up a bunch after submitting an app. But I want to be double dang sure he'll get pretty close to the same coverage or better if he changes.

I personally have a Coventry plan-20% coinsurance, $5000 deductible, $10,000 OOP max, generic Rx only. 47 y/o, smoker, $83/mo. Maybe it's all the clean livin' we have here in Iowa!

 

[Ann H]

Iowa is definitely a lower-cost regional area. So is Ohio from what I understand. And, yes, YAgents, I agree with you about Kaiser's calculator. I know they are "guestimating" the premium in Obamacare, but they are the only ones that I know about with a calculator for subsidies, projected premiums, and cost-sharing after 2014.