We might not have a functioning government today (or the last six years, really), but one thing we do have today are healthcare exchanges. Yes, despite the best efforts of secret Canadian mole Ted Cruz, the exchanges have gone live this morning. And like one million people trying to get tickets to see Neutral Milk Hotel at BAM, things are moving a little slowly and are being spurred along by a healthy use of the “refresh” button as we all see what kind of tex credits we get for plans, and how much insurance will cost after that. So, it’s a good thing we’re here to let you know what you can expect from the tiers you can choose from, huh? That way you can sign up quicker and get out of people’s way. Teamwork!
Our information comes from New York State, which laid out the benefits and costs of the standard health insurance plans in each tier (catastrophic, bronze, silver, gold and platinum) offered by the nine companies which are eligible to sell plans to Brooklyn residents on the health exchange market. The PDFs, which you can find here, will give you what you need to know about the most basic plans you can get.
All of the tiers are required to offer plans that cover 10 essential services: doctor’s visits, emergency room care, hospital care, pregnancy and newborn care, mental health and addiction, prescription drugs, rehab, lab services, preventative care and pediatric vision and dental (sorry blind, cavity-ridden adults). After that, it’s a matter of how much the plans in each tier will help you and how much money, if any, you’ll get as a tax credit to purchase insurance. You find that out when you apply though.
CATASTROPHIC TIER ($186.20/month to $418.93/month): Will basically cover the bare minimum for you to avoid paying the tax penalty at the end of the year.
Deductible: $6,350 for individual, $12,700 for family
Office visit co-pay after deductible: Three free visits per year to a primary care doctor, additional visits covered in full after deductible limit is reached
Prescription coverage: Covered in full only after deductible reached
This is going to be the cheapest tier you find, but keep in mind that these plans still cost a fair amount of money and you don’t even get a tax credit to purchase one. Want more bad news? The exceptionally high deductible means that until you manage to spend that much on health care, you’re paying for everything out of your own pocket. The one advantage this tier is that you get three free doctor visits before you have to do it out of pocket. But aside from that and preventative care like a physical (which is covered in full by other plans), everything else isn’t covered until you hit that deductible. So don’t get hit by a bus if you get this tier.
BRONZE TIER ($307.12/month to $547.95/month, before subsidies): Way better than catastrophic, still limited in many other ways
Deductible: $3,000 for individual, $6,000 for family
Office visit co-pay after deductible: 50% co-insurance
Prescription coverage: $10 copay for Tier 1 drugs, $30 for Tier 2, $70 for Tier 3
Yes, the plans here are more expensive than the catastrophic ones, but this the first tier with tax credits actually kick in. You still aren’t eligible for a copayment on this tier, outside of prescription drugs. Which means even after reaching your deductible, you’re paying 50% of the cost of a covered service or a product.
SILVER TIER ($359.26/month to $642.43/month): Here is where you’ll start actually feeling like you have insurance
Deductible: $2,000 for individual, $4,000 for family
Office visit co-pay after deductible: $30
Prescription coverage: $10 copay for Tier 1 drugs, $30 for Tier 2, $70 for Tier 3
With a big enough subsidy, you could end up paying under $130/month for a silver tier plan. Also, hooray, you’re in copay land! Copayments hover around $50 to $100 for most services, topping out at $1,5000 for substance abuse rehab, so maybe look a little higher if you’re thinking of exploring the exciting life of the junkie for a little while.
GOLD TIER ($395.76/month to $759.68/month): Now you’ll not only feel like you’ll have health insurance, but also that it’s worth it to have it! This is also where it gets pretty expensive though.
Deductible: $600 for individual, $1,200 for family
Office visit co-pay after deductible: $25
Prescription coverage: $10 copay for Tier 1 drugs, $30 for Tier 2, $70 for Tier 3
Here’s a tier you’ll wish you could have but probably won’t be able to afford. If you get a subsidy that you feel makes this tier affordable on a plan from a decent provider, go for it. Maternity care is about the same in the gold and silver tier, in case you’re planning on getting pregnant soon, just keep in mind the deductible you’ll have to reach on the silver tier is over twice as much as on the gold tier.
PLATINUM ($443.24/month to $869.39/month): This is rather expensive
Deductible: None
Office visit co-pay after deductible: $15
Prescription coverage: $10 copay for Tier 1 drugs, $30 for Tier 2, $60 for Tier 3
This is a tier for your Mike Bloombergs, Mort Zuckermans and casual Rolls Royce owners. You know, rich people, who can afford it. Of course, maybe you’ll get an awesome subsidy and you can go around rubbing in people’s faces that you’re cash, home and income poor, but you’re health care rich.
So, that’s what you’re looking at with your standard plans on each tier, if you’re ever able to load the damn health exchange website to buy some insurance. Do you have any ideas for what you’re going to focus on buying? When you go shopping, keep in mind that these are offerings from the standard plans from each provider. And that you shouldn’t pick a plan based only on how cheap it is, because then your in-network coverage will end up only being covered by guys who went to Hollywood Upstairs Medical College.
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Which plan pays for tattoo removal?
y’know, 444 a month is expensive, but a couple years ago when I was looking into getting health insurance as an individual, the cheapest I found, and we aren’t talking “no deductible” or anything paricularly great, and it was an hmo, so id be limited to their network, was 750 or so a month. so this is a pretty good deal.
Hats off to doing the Journalism that the mainstream press failed to do for a couple of years.
I mean, to publish THE ACTUAL prices! Bravo. Seriously, you have done the sort of work that a real Newspaper reporter should do.
Now for reference, my existing Blue Cross “Tea Party” Plan is 0 precent deductible, pretty much a Platinum Plan.
I pay $890 a month. Granted this is in NJ but probably about the same as NY expense wise.
So it does beg the question, ObamaCare premiums are pretty much EXACTLY the same as the existing Blue Cross “Republican Tea Party” rates … so what was the point? I mean this is the “affordable care act”, wasn’t it suppose to decrease those rates? And does that mean the existing rates were “affordable”? I see why the real rates have been hidden!