[quote=citydweller]I’ve just been looking at the Covered California sight and it appears I don’t qualify for any tax credits (I’m single with good income). However, it looks like I can sign up for the Kaiser Bronze 60 HSA HMO for $392 per month ($4,500 deductible and maximum out of pocket for one person is $6,350). I currently have an individual plan thru Anthem/Blue Cross which costs $720 per month ($2,950 deductible and max out of pocket is $11,810).
It has been years since I’ve even reached my current deductible, so the cheaper plan seems like a good idea.
I have a couple questions, Does anyone have experience with Kaiser and would you recommend it? Also, does “maximum out of pocket” really mean what it says? In other words, once I’ve spent $6,350 in medical bills in one year, is EVERY other bill paid by the insurance?[/quote]
citydweller, I haven’t had the chance to look at CoveredCa’s charts on your behalf, but would surmise you are a “boomer.”
Do you have an HSA at present? That “Kaiser Bronze 60 HSA HMO” is nowhere near equivalent to your present coverage, IMHO. Not only do you currently have a much better carrier, your deductible is much lower than the Bronze plan (lowest, cheapest plan on the exchange). You also likely have a PPO with a large choice of providers. As a “boomer,” you’re likely not going to want to go from “choice” to “locked into an HMO.”
An HSA makes the most sense if you know you will have W-2 or taxable self-employed income to fund it going forward.
What is troubling to me, though is that you stated your present out-of-pocket maximum is $11,810, which is a typical out-of-pocket cost for a family plan, not an individual plan.
Was your policy “grandfathered” by Anthem/Blue Cross, citydweller? In other words, was your policy already in effect in March 2010, when the HCRA was signed into law? Something doesn’t seem right with you having a (very reasonable) $2950 deductible and a soaring $11,810 maximum out of pocket requirement. That is, in effect, an $8,860 annual coinsurance requirement!
In all of the plans I’ve ever seen offered on paper, the coinsurance requirement was 75% or LESS of the deductible.
Is your coverage part of a family plan, citydweller? And how are you figuring out your current out-of-pocket maximum expense?
In the absence of the answers to those questions, I think you should leave well enough alone for now, citydweller. ESPecially if you have a “grandfathered” plan and are 55+ years of age. There are worlds of difference between a Kaiser HMO (ESP a 60% one that needs the infusion of MSA $$) and an Anthem/Blue Cross PPO.
“Open enrollment” for CoveredCA runs though March 2014, IIRC. Your coverage is not going away so you have plenty of time to make a decision for 2014. And of course, there’s always 2015.
If my old, “grandfathered” coverage wasn’t “going away” on 12/31/13 (my carrier, Aetna is leaving the state), I wouldn’t even be remotely interested in signing up on the exchange.
