Bronze vs Silver Health Plan

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abner kravitz
Posts: 505
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Location: Beaufort County, SC

Bronze vs Silver Health Plan

Post by abner kravitz » Sun Nov 03, 2019 1:21 pm

I am choosing a health plan for next year (company-provided for retirees) and there are the usual Bronze/Silver/Gold designations. Based on the deductibles, coinsurance, and out-of-pocket maximums it appears that the Bronze plan is superior at almost every level of spending in terms of total cash outlay. The lower premium more than offsets the higher deductible and co-insurance costs, and the out-of-pocket maximum is the same for all three plans. The decision seems so clear that I worry I am missing something.

Are there advantages to going with a higher level plan (from the same provider) that the math does not take into account? I have read all the source materials and I cannot see any other differences between the plans. I really doubt calling them would yield much insight.

Thanks for any insight

Skyccord
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Joined: Thu Jun 15, 2017 7:04 am

Re: Bronze vs Silver Health Plan

Post by Skyccord » Sun Nov 03, 2019 1:55 pm

Link to the 2 plans you are looking at?

JBTX
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Re: Bronze vs Silver Health Plan

Post by JBTX » Sun Nov 03, 2019 2:16 pm

abner kravitz wrote:
Sun Nov 03, 2019 1:21 pm
I am choosing a health plan for next year (company-provided for retirees) and there are the usual Bronze/Silver/Gold designations. Based on the deductibles, coinsurance, and out-of-pocket maximums it appears that the Bronze plan is superior at almost every level of spending in terms of total cash outlay. The lower premium more than offsets the higher deductible and co-insurance costs, and the out-of-pocket maximum is the same for all three plans. The decision seems so clear that I worry I am missing something.

Are there advantages to going with a higher level plan (from the same provider) that the math does not take into account? I have read all the source materials and I cannot see any other differences between the plans. I really doubt calling them would yield much insight.

Thanks for any insight
It really depends on the specifics of the plan, as they vary. On my last enrollment I figured out that the high deductible plan(called Bronze) was better on a net basis in most scenarios and in the cases it wasn't it wasn't materially worse. The biggest wildcard can be medicines in an HDHP/HSA plan. Years ago I encountered a similar scenario under a different company plan.

There is no strict definition of what is silver or bronze. Bronze may or may not be HDHP/HSA plan.

MikeG62
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Location: New Jersey

Re: Bronze vs Silver Health Plan

Post by MikeG62 » Sun Nov 03, 2019 2:41 pm

abner kravitz wrote:
Sun Nov 03, 2019 1:21 pm
I am choosing a health plan for next year (company-provided for retirees) and there are the usual Bronze/Silver/Gold designations. Based on the deductibles, coinsurance, and out-of-pocket maximums it appears that the Bronze plan is superior at almost every level of spending in terms of total cash outlay. The lower premium more than offsets the higher deductible and co-insurance costs, and the out-of-pocket maximum is the same for all three plans. The decision seems so clear that I worry I am missing something.

Are there advantages to going with a higher level plan (from the same provider) that the math does not take into account? I have read all the source materials and I cannot see any other differences between the plans. I really doubt calling them would yield much insight.

Thanks for any insight
Without seeing the details of your plan options it is hard to say for sure.

That being said, having spent a lot of time looking at my own options (BCBS in NJ), my guess is you will reach your OOP maximum much quicker under the bronze plan that the silver (or gold). So if you model some scenarios for 2020 where you have say two or three outpatient procedures, your OOP costs will be considerably higher with the bronze plan and likely by an amount which more than offsets the savings on premiums. However, if your need for medical care is low you'll come out ahead with the bronze plan and if extensive (i.e., you hit the OOP maximum under all plans) you will also come out ahead with the bronze plan. You kind of have to be in the sweet spot, where you eat up 60% to near 100% of your bronze OOP, to come out ahead with the silver/gold plans. That's at least what my modeling suggests for the plan options available to me.
Real Knowledge Comes Only From Experience

marcopolo
Posts: 2787
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Re: Bronze vs Silver Health Plan

Post by marcopolo » Sun Nov 03, 2019 2:55 pm

MikeG62 wrote:
Sun Nov 03, 2019 2:41 pm
abner kravitz wrote:
Sun Nov 03, 2019 1:21 pm
I am choosing a health plan for next year (company-provided for retirees) and there are the usual Bronze/Silver/Gold designations. Based on the deductibles, coinsurance, and out-of-pocket maximums it appears that the Bronze plan is superior at almost every level of spending in terms of total cash outlay. The lower premium more than offsets the higher deductible and co-insurance costs, and the out-of-pocket maximum is the same for all three plans. The decision seems so clear that I worry I am missing something.

Are there advantages to going with a higher level plan (from the same provider) that the math does not take into account? I have read all the source materials and I cannot see any other differences between the plans. I really doubt calling them would yield much insight.

Thanks for any insight
Without seeing the details of your plan options it is hard to say for sure.

That being said, having spent a lot of time looking at my own options (BCBS in NJ), my guess is you will reach your OOP maximum much quicker under the bronze plan that the silver (or gold). So if you model some scenarios for 2020 where you have say two or three outpatient procedures, your OOP costs will be considerably higher with the bronze plan and likely by an amount which more than offsets the savings on premiums. However, if your need for medical care is low you'll come out ahead with the bronze plan and if extensive (i.e., you hit the OOP maximum under all plans) you will also come out ahead with the bronze plan. You kind of have to be in the sweet spot, where you eat up 60% to near 100% of your bronze OOP, to come out ahead with the silver/gold plans. That's at least what my modeling suggests for the plan options available to me.
This consistent with the modelling I have done as well. While, it is plan specific, i think this is good general starting point.

If you have low medical expenses, a Bronze plan comes out better. If you have very high expenses, a Bronze plan comes out better. This came as a surprise to me when i modeled the numbers, it is not how the tiers are typically portrayed. There is a narrow window where the higher tier plans come out ahead. How narrow that is depends on the plan specifics you are considering. The window gets even narrower (almost disappears in our case) if you consider the benefits of having access to (and fully taking advantage of) an HSA plan. You can only get that in a high deductible plan, it seems they are mostly only available at the Bronze level.
Once in a while you get shown the light, in the strangest of places if you look at it right.

the way
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Re: Bronze vs Silver Health Plan

Post by the way » Sun Nov 03, 2019 5:23 pm

marcopolo wrote:
Sun Nov 03, 2019 2:55 pm
If you have low medical expenses, a Bronze plan comes out better. If you have very high expenses, a Bronze plan comes out better. This came as a surprise to me when i modeled the numbers, it is not how the tiers are typically portrayed. There is a narrow window where the higher tier plans come out ahead.
btw, here are some sample numbers. My area has a bronze HSA plan with a $6,900 deductible AND OOP max. Or for $5 less per month, the second bronze HSA plan has a $6,800 deductible, 40% co-pay, and $6,900 OOP max. I thought this was weird since this makes the plans identical except for a tiny $250 window.

I.e. you pay the first $6,800 in both cases. For the next $250, you either pay the first $100 or 40%, but once you fulfill that $250 you end up at the same $6900 OOP max. The end result is the cheaper plan saves you $60 in premiums, while also being better in the tiny window (I wonder if they accidentally reversed the premiums or something).

There is also a silver HSA for $85 more per month with a $3,000 deductible, 15% co-pay, and $6,500 OOP max. That means bronze is cheaper (due to prems) up to $4200 in expenses. From $4200 to $22,200, silver is cheaper. After $22,200 bronze is the better deal again.

But the savings are not really remarkable (relative to total prem and deductible costs). The max savings of bronze over silver is $1020 occurring when you have < $3000 in expenses. The max savings of silver over bronze is $2295 and occurs at $6900 in expenses (ie $6900 OOP for bronze vs $3585 OOP + $1020 extra prems for silver).

Topic Author
abner kravitz
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Location: Beaufort County, SC

Re: Bronze vs Silver Health Plan

Post by abner kravitz » Mon Nov 04, 2019 8:48 am

Skyccord wrote:
Sun Nov 03, 2019 1:55 pm
Link to the 2 plans you are looking at?
I can't provide a link - the details are on a password-protected site so not sure how to do that. The particulars are

BRONZE: Monthly Premium $241, Deductible $6,000, Coinsurance 70%, Out of Pocket Max $13,800
SILVER: Monthly Premium $471, Deductible $4,000, Coinsurance 80%, Out of Pocket Max $13,800

rantk81
Posts: 265
Joined: Tue Apr 18, 2017 8:12 am

Re: Bronze vs Silver Health Plan

Post by rantk81 » Mon Nov 04, 2019 8:55 am

abner kravitz wrote:
Mon Nov 04, 2019 8:48 am
Skyccord wrote:
Sun Nov 03, 2019 1:55 pm
Link to the 2 plans you are looking at?
I can't provide a link - the details are on a password-protected site so not sure how to do that. The particulars are

BRONZE: Monthly Premium $241, Deductible $6,000, Coinsurance 70%, Out of Pocket Max $13,800
SILVER: Monthly Premium $471, Deductible $4,000, Coinsurance 80%, Out of Pocket Max $13,800
Just by those numbers, the Bronze seems like the clear winner to me.
HOWEVER, did you check if the Silver plan offers some services with fixed co-pays BEFORE the deductible? That's one thing that can make a difference.

I have a similar situation from my employer, with the "lower payroll premium" plan seem like a clear winner -- UNLESS you utilize a WHOLE LOT of services that have pre-deductible fixed co-pays associated with them. (As it turns out, on my employer's plans, the choice is still kind of silly, because the co-pays on the "more expensive" plan are still pretty high -- to the point where they are probably on par with the co-insurance amount of the "less expensive" plan... so I go with the "lower premium" bronze'ish level plan.)

Topic Author
abner kravitz
Posts: 505
Joined: Tue May 05, 2015 7:42 am
Location: Beaufort County, SC

Re: Bronze vs Silver Health Plan

Post by abner kravitz » Mon Nov 04, 2019 9:01 am

rantk81 wrote:
Mon Nov 04, 2019 8:55 am
abner kravitz wrote:
Mon Nov 04, 2019 8:48 am
Skyccord wrote:
Sun Nov 03, 2019 1:55 pm
Link to the 2 plans you are looking at?
I can't provide a link - the details are on a password-protected site so not sure how to do that. The particulars are

BRONZE: Monthly Premium $241, Deductible $6,000, Coinsurance 70%, Out of Pocket Max $13,800
SILVER: Monthly Premium $471, Deductible $4,000, Coinsurance 80%, Out of Pocket Max $13,800
Just by those numbers, the Bronze seems like the clear winner to me.
HOWEVER, did you check if the Silver plan offers some services with fixed co-pays BEFORE the deductible? That's one thing that can make a difference.

I have a similar situation from my employer, with the "lower payroll premium" plan seem like a clear winner -- UNLESS you utilize a WHOLE LOT of services that have pre-deductible fixed co-pays associated with them. (As it turns out, on my employer's plans, the choice is still kind of silly, because the co-pays on the "more expensive" plan are still pretty high -- to the point where they are probably on par with the co-insurance amount of the "less expensive" plan... so I go with the "lower premium" bronze'ish level plan.)
Good point, and I am going to go through the 200 page fine-print today to make sure. All the summaries indicate that everything is the same between the two plans except for the numbers I posted, but want to make sure.

The Bronze definitely seems like the way to go. For total billing between $18K and $39K the Silver is a little better, but in all other scenarios the Bronze wins.

Thanks to all for your input.

rantk81
Posts: 265
Joined: Tue Apr 18, 2017 8:12 am

Re: Bronze vs Silver Health Plan

Post by rantk81 » Mon Nov 04, 2019 9:06 am

abner kravitz wrote:
Mon Nov 04, 2019 9:01 am
Good point, and I am going to go through the 200 page fine-print today to make sure. All the summaries indicate that everything is the same between the two plans except for the numbers I posted, but want to make sure.
The co-pay info should be available in the SBC (Summary of Benefits and Coverage) sheets, which are usually only a few pages long. Probably not necessary to go through the exhaustive multi-hundred-page plan document.

Topic Author
abner kravitz
Posts: 505
Joined: Tue May 05, 2015 7:42 am
Location: Beaufort County, SC

Re: Bronze vs Silver Health Plan

Post by abner kravitz » Mon Nov 04, 2019 9:15 am

rantk81 wrote:
Mon Nov 04, 2019 9:06 am
abner kravitz wrote:
Mon Nov 04, 2019 9:01 am
Good point, and I am going to go through the 200 page fine-print today to make sure. All the summaries indicate that everything is the same between the two plans except for the numbers I posted, but want to make sure.
The co-pay info should be available in the SBC (Summary of Benefits and Coverage) sheets, which are usually only a few pages long. Probably not necessary to go through the exhaustive multi-hundred-page plan document.
Good to know. Thanks.

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