Health Insurance for Cheapskates: Why You Shouldn't Just Pay the Fine
If you are relatively healthy and don't have any chronic conditions, then a Bronze Plan might be your best bet. Keep in mind all insurance plans have to cover 10 basic areas, what's known as the 10 essential benefits. These are outpatient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services such as cancer screening and pediatric services.
You won't have to pay anything for preventive services but you will have to pay for the other services. How much? Depends on which Bronze Plan you choose. It makes sense to check that any plan you're considering covers your favorite doctor and any specific brand-name prescription medications and also has a good network of providers.
If you get a Bronze Plan instead of paying the fine, at least you get something in return, says Christina Postolowski, senior policy analyst with Young Invincibles, a nonprofit organization in Washington, D.C. that represents the voice of 18-to-34-year-olds in the healthcare debate.
This coverage is already better than most types of insurance you used to get on the open market, which usually didn't cover a pregnancy or treatment for depression or drug abuse. The Affordable Care Act also puts a limit on how much you'll have to pay out of pocket if you get sick. Meanwhile, it prohibits insurers from putting caps on how much they'll spend on you each year or over your lifetime.
"You may see a bit of a price bump but when it comes time to dig into your pocket and pull out your insurance card, it's going to cover some stuff that wasn't covered before," says Burke.
Plus, if you do take advantage of essential benefits, many of which are preventive, it means you're in charge of your life and healthand studies have shown that you'll probably live longer and healthier as a result. With fewer medical bills.
Q: I'm cheap, why would I want to pay for a Silver Plan?
In general, a Silver Plan is going to balance out higher premiums with fewer out-of-pocket costs. So it might make sense if a particular Silver Plan has better coverage for specific needs you know you will have.
Also, you can get cost-sharing subsidies under Silver Plans, but not under other plans. (Cost-sharing refers to the deductibles and copays you have to pay yourself.) These subsidies are available to families that earn up to 250% of the federal poverty level.
That would be about $59,000 for a family of four. Or check where you fit on the poverty-level scale at Needymeds.org or FamiliesUSA.org.
Q: Is there any reason a cheapskate would want a Gold or Platinum plan?
Peace of mind is one reason: Knowing you have excellent coverage no matter what fate throws your way.
Bear in mind that the government also provides subsidies for single and family plans for incomes up to 400% of the poverty level (about $92,000 for a family of four). These subsidies are available for all plans and they're paid directly to your provider. "A chunk of the premium gets sent right to [the insurance company] from the U.S. Treasury," says Burke.
Depending on what you earn and what subsidies you're eligible for, it might be worth your while to go Gold or Platinum. You can estimate your subsidies by using this calculator on the Kaiser Family Foundation website.
So check out what's available in your area and your price range. If you don't mind dealing with the (hopefully temporary) glitches, you can apply online at Healthcare.gov Or apply the old-fashioned way, by phone: 800-318-2596, available 24/7, or download an application and mail it in.