DomKen
Posts: 19457
Joined: 7/4/2004
From: Chicago, IL
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quote:
ORIGINAL: TreasureKY
quote:
ORIGINAL: DomKen
Who in their right mind would want to carry only catastrophic coverage? Do you have $20 grand in the bank to spend if you break a leg?
While searching for a plan last year, I found a perfect one for us... a catastrophic plan. Fairly small monthly premium of around $420, covered nothing* until we'd paid out of pocket $10,000, then covered everything at 100% for the remainder of the year. The $10,000 deductible was total for all family members, with 100% paid for any family member(s) afterwards.
We don't need anyone else to pay for our yearly physicals. We don't need anyone else to cover our lab fees or xrays or the doctor visit for a sinus infection. We don't need anyone else to pay for any prescriptions. We're fairly healthy and those expenses don't hit all at once and we're more than able to absorb the costs.
What would impact us financially is a major medical event requiring surgery or hospitalization or other significant healthcare. At which point the catastrophic policy would kick in and relieve us of any costs beyond the $10,000 point. At least until the following year.
We spend perhaps $2500 a year on annual physicals, doctor visits and prescriptions. Including the monthly premiums with the above catastrophic policy, that's about $7500 per year. If something catastrophic were to happen, our total out of pocket for that year would be $15,000 (the $2500 spent on physicals, etc. is credited toward the $10,000 deductible).
The Kentucky Exchange is open now and I've done some initial checking. The cheapest plan for us appears to be a bronze plan that is offered through the Kentucky Health Cooperative and it runs just over $800 a month.
Should we not be eligible for any subsidy (which is doubtful because we make a decent living), we're already worse off financially. Obviously, at $800 a month, the monthly premium is $380 a month more expensive. Even taking into consideration that it covers annual physicals at 100% with no co-pay, we don't spend $4560 on average each year for medical expenses... which is how much those higher premiums are going to cost us.
Essentially, after the annual physicals the bronze plans only start paying after the $4750 per person or $12,700 per family deductible is met. Then, it will only pay 50%, up until we've reached our in-network out-of-pocket maximum of $6350 per person/$12,700 per family.
If something catastrophic happened (assuming just one individual), our total costs (including the monthly premiums, deductible and max out-of-pocket) just for that one person for the year would be $20,700. And we still wouldn't have reached the $12,700 family deductible/out-of-pocket maximums (premiums do not count toward deductibles) and could have additional medical expenses for other family members.
So... you ask who in their right mind would want to carry only catastrophic coverage?
We would. But unlucky for us, we're over 50 and the government says we can't.
If you like your plan, you can keep your plan. 
* I cannot recall at this time, but I do believe annual physicals were covered at 100%. I remember thinking that it appeared as if they'd tried to tailor the plan to abide by the requirements of the ACA.
I've got say that if you think it is wise that 2 people over 50 carry only catastrophic coverage I'll have to disagree. I was in my mid 40's in good health, no diagnosed conditions and normal BP and blood sugar after my last physical. I got a MRSA infection, No one knows how. I was in the hospital for two weeks and came out with one completely failed kidney and one failing rapidly. Total bill to me and my insurance was slightly over 100k. The aftermath involved lots of specialists, nephrologists, transplant surgeons), dialysis, high BP and my blood sugar and A1C is starting to trend towards diabetes. Each dialysis is billed to at around 2500 and I go 3 days a week.
So would you really be able to deal with that with just a catastrophic plan? Would you want to raise school age kids with just a catastrophic plan?
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how much will exchanges save? - 
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