Obamacare: The Importance of Silver Plans

Last Saturday I met with a client who had set up her account on healthcare.gov.  She knew what her subsidy was going to be and she was ready to pick a health insurance plan.

She showed me a print out of her plan options that included the premiums after her subsidy. As we looked at the list, we could see the co-pays, deductible, and maximum out-of-pocket for each plan, though not the complete summary of benefits.

When we looked at the Health Net Silver plan information, it did not match the name of the plan, which was “$30/$50/$2000”. On her printout, this plan’s details said, “$10/$20/$500”. It took me a moment to realize why there was a difference:  This woman’s income is less than 200% of the federal poverty level, so she gets help with her co-pays, deductible, and maximum out-of-pocket – in addition to her premium subsidy.

This help only comes with Silver plans.

This Health Net Silver plan will cost this 61-year old woman $119 per month. Her deductible will be $500, and she gets unlimited doctor visits for co-pays ($10 for primary care and $20 to see a specialist). She has been paying $800 per month for a $10,000 deductible plan for herself and her two daughters. One of her daughters got the same plan for $64 per month while the other was told by healthcare.gov that she qualifies for Medicaid (AHCCCS in Arizona). But will she be covered by AHCCCS, and when?  That’s another story.

200% of the Federal Poverty Level (FPL) is:

$22,980 for a single person.
$31,020 for a couple
$39,060 for a family of three
$47,100 for a family of four

Individuals or families making less than these amounts need to look at Silver plans and how their income substantially lowers their co-pays and deductible.

I was aware of this Silver plan help, but I had not yet seen a real life example. Of course, I haven’t seen many real life examples of people getting subsidies because people I have helped only recently went through healthcare.gov to get enrolled. I have worked with more clients who are not getting subsides and enrolled directly through Health Net or Blue Cross Blue Shield of Arizona.

The good news is that healthcare.gov is working. It did not get overwhelmed by traffic – unlike the Blue Cross Blue Shield of Arizona online enrollment applications.

Website overwhelmed

I wrote yesterday about the Blue Cross Blue Shield of Arizona website getting overloaded. Late in the afternoon, I heard from a hardworking Broker Services representative at BCBS who told me a paper application would be the safest bet for a client of mine. The BCBS rep emailed me a paper application which I forwarded to my client.  She filled it out and faxed it to BCBS (before their midnight deadline last night).

This client chose a BCBS plan because she and her husband (who is on Medicare) spend half the year in Montana and she has seen a doctor there. The BCBS plan gives her access to healthcare providers across the country who are affiliated with Anthem/Blue Cross Blue Shield Association. That is a big plus (and really a necessity) for snowbirds or people who travel in their RVs.

People overwhelmed by lies about Obamacare

I talked to another woman who has health insurance now but says she can’t afford it, and she says it doesn’t fit her health needs. I have told her she will get a good subsidy that will make her health insurance affordable, and she will have plan choices that are much more comprehensive than what she has now.

She told me, “I don’t want to do Obamacare, so I’m looking at other options”.  I informed her that her only good option is to go through heathcare.gov and get a subsidy. But she’s heard so much negative talk (and lies) that she is afraid of Obamacare. That is a shame because she says she can’t afford her bare-bones plan with a $5,000 deductible – and she has some health issues. Obamacare is meant for people like her – but the anti-Obamacare campaign has confused and frightened her. They should be ashamed.


So the deadline for January enrollments is tonight (December 24). But there are still lots of people who have held back on enrolling. I have one client who is self-employed and wants to meet with her accountant in January so she can get an accurate estimate of her 2014 income. I think she’s being overly cautious, but she still has time to enroll in January, February, and March.

I’m betting the final deadline will be moved from March 31st to the end of May or June.  Why not extend the Open Enrollment Period to the end of June? This would match the initial enrollment period for Medicare Part D when it was introduced in 2005-2006. And that was for a $10 or $15 per month drug plan that was not being attacked every day by opponents.






Leave a Reply

Your email address will not be published. Required fields are marked *