ObamaCare Simplified

The Patient Protection and Affordable Care Act (ACA), also known as Obamacare, requires everyone to have health insurance by March 2014 or pay a penalty based on their total annual income. To help lower-income individuals and families afford insurance, the government will pay a portion (subsidy) of the monthly insurance premium. The amount of the subsidy varies based on income and family size. 

Once income reaches four times the poverty level, the subsidy disappears, as follows:

INDIVIDUALS
$45,960

COUPLES
$62,042

FAMILY OF 3
$78,120

FAMILY OF 4
$94,200

FAMILY OF 5
$110,280

...etc

For individuals who qualify for a subsidy, the federal government created healthcare exchanges where individuals can shop for and purchase insurance. There are four categories of insurance coverage: Bronze, Silver, Gold, and Platinum. Each category differs in terms of monthly premium, deductibles, and copays. A Bronze Plan has the lowest monthly premium, but the highest deductible and copays. Platinum has the highest premiums, but lowest deductibles and copays. California’s healthcare exchange is www.coveredca.com. You can log on, enter your annual gross income, family size and ages, and view the plans available for you. Each plan shows your monthly premium costs and corresponding benefits, copays and deductibles. Higher incomes result in lower subsidies and higher premium costs.


Bronze Plan May Be
Best Choice

In nearly all cases, the difference in monthly premium costs between the Bronze and Silver plans is substantial. In these cases, an individual could purchase the Bronze Plan, buy a Prestige membership, and still save money compared to purchasing a Silver Plan. In addition, Silver Plans still have high deductibles and copays (except where family income is below 2.5 times the poverty level). This represents additional out-of-pocket expenses for healthcare.


Potential Cost Savings

The following examples illustrate the potential cost savings of purchasing a high-deductible Bronze plan plus a Prestige membership,
compared to buying a more expensive Silver Plan:


Example 1

Family of four with gross annual income of $65,000. 
Adult ages: 34 and 36 with two children.


cost_ex1_breakdown.jpg

*Note: Estimated copays are based on national average of four visits per year for each family member with one fourth of those visits to an urgent care clinic. Actual copay costs will depend on actual number and type of patient visits.

The family in this example will potentially save $1,032 on their everyday healthcare costs and gain all the benefits of Prestige HD membership.


The table below shows the difference in monthly premium cost for Bronze versus Silver Insurance Plans and the estimated annual cost savings when you purchase a Bronze Plan and Prestige Membership instead of purchasing a Silver Plan for families of various ages and income levels.


Example 2

Couple with gross annual income of $35,000
Both Adult ages: 35


cost_ex2_silver.jpg
cost_ex2_breakdown.jpg

*Note: Estimated additional costs are based on Silver Plan copays for the national average of four visits per year for each family member (three primary care visits and one urgent care visit). Actual costs will depend on actual number and type of patient visits and could be less or substantially more than estimated.

This couple will potentially save $950 on their everyday healthcare costs AND gain all the benefits of Prestige HD membership


The table below shows the difference in monthly premium cost for Bronze versus Silver Insurance Plans and the estimated annual cost savings when you purchase a Bronze Plan and Prestige Membership instead of purchasing a Silver Plan for couples of various ages and income levels.

cost_ex2_table.jpg

Example 3

Individual with gross annual income of $35,000
Age: 35


cost_ex3_bronze.jpg
cost_ex2_silver.jpg
cost_ex3_breakdown.jpg

*Note: Estimated additional costs are based on Silver Plan copays for the national average of four visits per year for each family member (three primary care visits and one urgent care visit). Actual costs will depend on actual number and type of patient visits and could be less or substantially more than estimated.

This individual will potentially save $609 on her everyday healthcare costs AND gain all the benefits of Prestige HD membership


The table below shows the difference in monthly premium cost for Bronze versus Silver Insurance Plans and the estimated annual cost savings when you purchase a Bronze Plan and Prestige Membership instead of purchasing a Silver Plan for individuals of various ages and income levels.


Making the Right Choice for Your Family

The above information is for comparison purposes only. Any actual cost savings will depend upon the number and type of healthcare visits incurred by each person. Healthy individuals and families frequently find that buying a high-deductible insurance plan and combining it with a Prestige membership represents their most cost-effective healthcare option. Please note that though a high-deductible insurance plan may reduce your annual premium, it could  result in greater overall healthcare costs if you experience a major medical event, such as a serious accident or major surgery, due to the higher deductible. Therefore, every person and family should carefully weigh the benefits and risks associated with different options to determine the right choice for themselves. Prestige highly recommends you make  these decisions in concert with your insurance agent. Prestige Urgent Care has connections with multiple insurance agents and can assist you in finding an agent if you do not have one already.