Healthcare.gov Prices are in. Here’s What I Found

After a massive fail back in the fall with website reliability at healthcare.gov, I was curious what my user experience would be like TODAY – and I was REALLY curious what insurance premium quotes on the new public insurance exchanges look like.




So I went exploring, did some cost comparisons, and even tested out public versus private exchanges. What I found was… surprising. I’ll share what I found, but the purpose of this post is to inspire you to go exploring as well – and share what you found in the comments.

If you are unemployed, self-employed, have thoughts about being self-employed, or your employer offers no health insurance or very poor insurance – you’ll definitely want to pay close attention.

obamacare-prices

Getting a Premium Quote on Healthcare.gov

I had hoped to get a healthcare.gov premium quote back in November when the health insurance exchanges first opened. I left demoralized. I didn’t see any easy way to get a quote without creating an account and entering a lot of personal information.

That has changed.

Now, you simply go to this healthcare.gov premium quote tool (accessed by putting in your zip code and some other basic information)




To get a quote, you need to enter:

  • if you are looking for insurance for just yourself, family, or a business
  • whether you are looking for health or dental insurance
  • state and county you live in
  • age
  • if you have employer coverage
  • household income to determine subsidy eligibility

No personally identifiable information is required. You can get a quote in under a minute.

Note: your experience with the healthcare.gov website will vary based on state. If you reside in a state that partnered with the federal government to administer the exchange, then you will get a quote on healthcare.gov. However, if you reside in a state that manages its own exchange, you will be re-directed to that site.

Insurance Premiums Rates on Healthcare.gov

I’ll share what I found for myself for what looked to be the two most attractive plans, but plan details and rates are going to be different for every state. And you may have different needs/preferences – so do your homework before making any selections.




My profile:

  • Looking for health insurance (not dental) for my wife and myself
  • both in lower 30’s in age
  • healthy without any high prescription costs or ongoing medical issues
  • located in Michigan
  • we have employer health insurance, but I selected “no” on the drop-down so I could get a quote
  • we are at an income level that doesn’t qualify for subsidies

For a “Blue Cross Select Bronze” plan:

Premium Costs:

  • For both my wife and I: $351/month, $4,212/annual.
  • For just myself: $177/month, $2,124/annual.

To summarize the plan benefits:

  • $11,900/yr. deductible (half that for individual)
  • $12,700/yr. out of pocket maximum (half that for individual)
  • Primary Doctor: $30 Copay after deductible
  • Specialist Doctor: $50 Copay after deductible
  • Generic Prescription: $4 Copay after deductible
  • ER Visit: $250 Copay after deductible and 40% Coinsurance after deductible
  • HSA eligible

What is a “bronze plan”? The metal tiers look like this:

  • Platinum
  • Gold
  • Silver
  • Bronze
  • Catastrophic (only available to those under age 30)

The higher the tier, the more in premiums you pay, but the lower your out of pocket costs will be. Covered California (California’s public exchange) had this comparison of out of pocket costs (not sure if this is applicable nationwide):

obamacare_metal_tiers

The bronze plans are designed to be similar to HDHPs – where you pay more of the cost for your actual care, but less in premiums. They are an attractive option for those who are young, healthy, and have few projected health care expenses. They are also HSA eligible (or at least the plan I looked at was).

But what if you’re not so young and healthy? Here’s a look at an alternative “Silver” plan…

Blue Cross Select Silver:

Premium Costs:

  • For both my wife and I: $455/month, $5,460/annual.
  • For just myself: $231/month, $2,772/annual.

To summarize the plan benefits:

  • $3,300/yr. deductible (half that for individual)
  • $12,700/yr. out of pocket maximum (half that for individual)
  • Primary Doctor: $30 Copay before deductible
  • Specialist Doctor: $50 Copay after deductible
  • Generic Prescription: $4 Copay after deductible
  • ER Visit: $250 Copay after deductible and 30% Coinsurance after deductible
  • Not HSA eligible

Comparing the Bronze and Silver Plans

Being young and relatively healthy, I went in to this premium search thinking that there would be no way I’d select anything other than a plan with the lowest possible premium. After comparing plans… I’m not so sure. Here’s why:

For an annual premium difference of $1,248 (for 2) and $648 (solo) more for the Silver plan, I would lop off $8,600 (for 2) and $4,300 (solo) in annual out of pocket deductible risk (if something very costly like major surgery, disease, or a newborn were to happen).

In other words, if in just one of every seven years I have something costly come up that takes me up to my out of pocket deductible, my premium savings for going with the lower cost Bronze plan would be completely wiped out. If I have two years in seven with high costs – I’ve lost a good chunk of money with the lower cost Bronze.

This is an oversimplification and for illustrative purposes, but you get the idea. I did not think the deductible difference would be that dramatic for that low of a premium difference. If I look back on the last seven years, I probably would have come out ahead with the bronze plan. The next seven? I would consider myself very lucky not to have a pricey year or two. But I’m not an insurance actuary, so who knows.

Also noteworthy – any costs would have a 30% co-insurance with the silver plan, but 40% with the bronze.

And on top of that, the co-pays for visits to a primary care doctor for the bronze plan are after deductible, while the co-pays for the silver plan are before deductible. This means, 100% of the cost of the visit would not be covered with the bronze plan until you met your full annual deductible.

If you are discouraged from the getting essential medical care for fear of paying a high annual deductible, is that worth the premium savings, when they are not overly significant? (curious to hear your answer to that in the comments).

One big comparative downside to the silver plan versus the bronze is that it is not HSA eligible, for new contributions.

Catastrophic Plan Costs for those Under Age 30

Then there’s the healthcare.gov catastrophic plan – only available to those under age 30 (unless you claim a “hardship exemption”). I’d be doing a disservice to my audience (mostly under 30) without covering.

So, lets go back in time to the age of 25… ah, yes…

Premium Costs:

  • For both my wife and I: $248/month, $2,976/annual.
  • For just myself: $124/month, $1,488/annual.

To summarize the plan benefits:

  • $6,350/yr. deductible per individual
  • $6,350/yr. out of pocket maximum per individual
  • Primary Doctor: $30 Copay before deductible
  • Specialist Doctor: No Charge after Deductible
  • Generic Prescription: No Charge after Deductible
  • ER Visit: No Charge after Deductible
  • Not HSA eligible

Hmm…. that doesn’t sound so catastrophic at all! This is a very affordable and surprisingly generous plan – and if you are under age 30 and do not have health insurance because you are afraid of the cost – you should definitely consider it.

But there is one big downside to the catastrophic plans: they are not eligible for the government subsidy. So you may actually pay less, if you have a lower income, for a higher service plan that is eligible for a subsidy. If your income is over the level eligible for subsidy, this will not matter.

It’s also surprising and disappointing that the catastrophic plans are not HSA eligible (at least the Blue Cross plan I viewed was not).

Public Exchange vs. Private Exchange

I also wanted to find out private exchange prices versus the public exchange. Prior to the public exchange launch, I was left with the impression that private exchanges would still exist and there would be a service offering on them that was significantly different than what I found on the public exchanges. In particular, I thought I would see lower premium HDHP-type plans that did not meet public exchange eligibility requirements.

The biggest private exchange that I am aware of is eHealthInsurance.com. I put in the same parameters highlighted earlier to see what I’d find. The results were different, but not in the ways that I was expecting:

  • HAP, Humana, United Health, and Aetna all offered plans that were not on healthcare.gov (versus just Blue Cross and Priority Health on the public exchange). However, the prices were not competitive to the public exchange plans, surprisingly.
  • Public exchange plans were in the private exchange, all with the same prices, plans, and plan details. I was not expecting to see them there.
  • There were not any lower premium HDHP plans in the private exchange, as I was hoping for.

Also, plans purchased off of private exchanges are not eligible for subsidies. I found it odd that the public exchange plans were, in fact, in the private exchange and have similar pricing, but with the one huge downside of not being eligible for subsidies.

You may have different results in your state, but if you don’t see cheaper plans on a private exchange, then is it worth closing the door on a subsidy? Probably not.

Speaking of those Subsidies

All prices that I’ve shared here are without subsidy. If you purchase a plan through a public exchange you might be eligible for an Advance Premium Tax Credit (APTC) (aka the government subsidy) to help you pay for your premium each month. Eligibility is dependent on your income level (up to 400% of the federal poverty level) and size of household.

There is a premium subsidy calculator here, to help you determine what subsidy, if any, you might be eligible for. And here’s a chart to help you determine if you may be eligible.

As noted previously, catastrophic plans do not qualify for subsidies.

Healthcare.gov Premium Quote Discussion:

  • What premium/plan results did you find in your state?
  • Are these premiums/plans higher or lower cost than you had anticipated?
  • Have you purchased a plan off a public exchange?

Related Posts:

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