We’re regularly asked to recommend plan designs for clients.
Picking the right coverage is often just a math problem, depending on your expected utilization; i.e., high/frequent, low/infrequent or somewhere in between.
Insurers group plans into one of four categories based on actuarial values:
Bronze Plans are intended to cover 60% of your health care costs; Silver, 70%; Gold, 80%; and Platinum, 90%. (Apparently the architects of Obamacare never heard of Crayola!)
One insurer’s product grid has no less than 27 different options. Here’s a sampling and the corresponding premium for a 40 year old:
- Bronze: $6,000 deductible (HSA ‘qualified’), then 50% coinsurance to a max Out of Pocket of $7,000; $548 per month.
- Silver: Office Visit and Rx Co-Pays then a $4,000 deductible with 80/20 co-insurance to a max OOP of $8,000; $573/month.
- Gold: OV and Rx Co-Pays; $1,000 ded then 80/20 to $4,000; $692/month
- Platinum: OV and Rx Co-pays, $0 ded then 90/10 to $2,500; (you don’t want to know!)
Even small groups can offer more than one plan but usually just two or three (not 27, thank goodness). Employee elections can change yearly.
What will they need to decide?
A calculator and Magic 8 Ball.
