When should you pick a Gold, Silver or Bronze plan. It may seem like an easy decision, yet it’s more complex than you may think. Especially since buying a Gold plan is much more expensive than a Silver or Bronze plan. You need to take your total medical expenses and monthly premiums into account. Below are three basic examples the insurance companies provide to give you a summary of what you might expect. They keep their scenarios the same for all expenses per major medical expense to help you choose which of the Gold, Silver or Bronze plans to pick. The three examples are; Having a Baby, Managing Type-2 Diabetes and Breaking a Leg. See the images below for context. (Scroll all the way to the bottom to see the comparison of the Gold to the Silver plans.)
HAVING A BABY: We generally recommend a women having a baby to pick a Gold plan. The rest of the family can choose a different plan if they have other needs. As you can see on the Gold Plan it would cost about $960/year for the total maternity and delivery expenses. The Silver Plan it would cost about $3,460/year and the Bronze Plan would be approximately $7,720/year. For a 35-year-old woman the Gold plan would cost about $100/mo more than the Silver Plan. Clearly an easy decision.
TYPE-2 DIABETES: In this example, most people that have Diabetes pick a Silver plan. The main costs are generally insulin, bloodwork, and specialist visits to the endocrinologist. Under the Gold Plan the estimated cost per year is $1,780/year, on the Silver plan it would be about $2,320/year or a Bronze would be $4,820/year. For a 55-year old person, a Gold Plan would cost about $175/mo more. Not always the best decision to upgrade, unless you have a very expensive prescription or other health needs that warrant the upgraded plan.
BREAKING A LEG: If you have a minor fracture it would cost about $1,420 on the Gold Plan, about $1,600/year on the Silver plan and $2,800 on a Bronze plan. Not likely enough difference to justify buying the Gold Plan.
Overall use your best judgement which choosing a plan for yourself for the next year. Open Enrollment is November 1st to December 15th for a January 1st start date of the next year. You usually can’t switch plans mid-year, yet there are some exceptions. Most people use prior years history of medical use to determine which carrier and plan to choose, yet intuition and just having a feeling to upgrade or downgrade is usually right from clients that we talk with the next year. The key is having insurance in case of a $100,000 or $1 million dollar health issue. The max out of pocket someone on an Affordable Care Act, or individual health plan is $9,100 for 2023. So the insurance is protecting your assets and future, not just the copay for a specialist or getting your prescription drugs at a bit lower cost. That’s where the largest chunk of money goes towards protecting. Hope this summary helps. For more information or questions on your individual health plan give us a call or text to 425-802-2783 or wahealth@heffins.com
Gary Franke, Tamara Chandler, Brianna Crawford & Melissa Tibbs
Heffernan Insurance Brokers
Individual Health & Medicare Specialists
1100 Bellevue Way NE, Ste 8A-545
Bellevue, WA 98004
425-802-2783 (call or text office line)
wahealth@heffins.com
www.wahealthplan.org
