Health Care Showdown – Head-to-Head Comparison of an ObamaCare Plan vs. My Employer Plan

The following post is by MPFJ staff writer Travis.  Travis is a customer blogger for Care One Debt Relief Services, and also appears weekly at Enemy of Debt.  Travis candidly shares his personal journey to pay off $109,000 of credit card debt and the tips he’s learned along the way. As a father and husband he provides a unique perspective on balancing debt, finances, and family.

A man has his current health care plan dropped by his provider. 

When he explores what options are now available to him, he finds for similar coverage the premium is much higher, as is the deductible.  Another person claims to have been uninsured for years due to the cost, but now they are able to afford quality health care.

These two types of stories have been reported over and over again in the media over recent months as the The Affordable Health Care Act, more commonly called ObamaCare, continues to be a hotly debated topic.

I currently have health care through my employer, who offers choices for medical, dental, and vision care.  I do pay out of pocket each month for that health care, but my employer picks up a large portion of the tab as part of my benefits package.

As the ObamaCare debate has raged on, I have often wondered what I could get for health care through my state’s government exchange site.  This is where I would turn should my employer decide to drop health care from my benefits package, or if I would have a career change and become self-employed.  I thought it would be a fun exercise to go through the motions of exploring my options, and then comparing to what I currently have through my employer.

 

My Current Plan

First, let’s take a look at some of the high points of my current health care plan

 

Medical:

Annual Deductible (individual/family):                $1181/$3543

Routine/Preventative Services:                               No Charge

Other Office Visits and Outpatient Surgery:       No Charge

Urgent Care and Walk In Clinics:                            15% Out of Pocket, No Deductible

Inpatient Hospital and Surgery:                              20% Out of Pocket, After Deductible

Emergency Room:                                                         20% Out of Pocket, After Deductible + $150 copay

Prescription Drugs / Generic:                                  20% Out of Pocket, of discounted cost / $24 maximum

Prescription Drugs / Brand Name:                        20% Out of Pocket, of discounted cost / $90 maximum

 

Dental:

Annual Deductible:                                                       None

Maximum Annual Benefit (per person):              $500

Routine Exams, Xrays, Cleanings:                         No Charge

Minor Restorative Care (fillings):                           20% Out of Pocket, of negotiated fee

Major Restorative Care (root canals, etc):        Not Covered

 

Vision:

Annual Eye Exam:                                                        No Charge

Frames (once per year):                                             $120 allowance, 20% off remaining balance

Lenses (standard):                                                        No Charge

Contact Lenses:                                                             $120 allowance, 15% off remaining balance

 

MNSure Plan

Then, I visited MNSure, the Affordable Health Care / Obamacare website for the State of Minnesota. 

I plugged in some rudimentary information about my family and it listed 16 different medical plan options.  The options were labeled as Platinum, Gold, Silver, or Bronze, with the coverage, options, and price decreasing respectively.  There were NO platinum options available in my area, which I thought was very strange given that I live in Rochester, MN, the home of one of the best medical facilities in the world:  The Mayo Clinic.

For the sake of comparison, I chose the Medical Applause Gold has plan, which was the top rated Gold plan offered.

Here’s the highlights of that plan:

 

Medical:

Annual Deductible (individual/family):                     $1300/$3900

Routine/Preventative Services:                                    No Charge

Other Office Visits and Outpatient Surgery:             30% Out of Pocket / co-insurance after deductible

Urgent Care and Walk In Clinics:                                  30% Out of Pocket /co-insurance after deductible

Inpatient Hospital and Surgery:                                    30% Out of Pocket /co-insurance after deductible

Emergency Room:                                                               30% Out of Pocket /co-insurance after deductible

Prescription Drugs / Generic:                                         30% Out of Pocket /co-insurance after deductible

Prescription Drugs / Brand Name:                               30% Out of Pocket /co-insurance after deductible

This plan was medical only, and did not cover any dental care.  I had to look separately for a Dental Plan.  I selected a plan that was fairly close to the coverage I have through my employer.  Ironically, it’s the plan that I had for years through my employer (Delta Dental) but is no longer offered.

 

Dental:

Annual Deductible:                                                             $50

Maximum Annual Benefit (per person):                     Data Not Available

Routine Exams, Xrays, Cleanings:                                 No Charge

Minor Restorative Care (fillings):                                 80% coinsurance

Major Restorative Care (root canals, etc):                50% coinsurance

Maximum Out of Pocket Individual:                           $700

 

Vision:

I could find NO information about Vision Care on the MNSure Website.  None. Zero.  Zilch.

 

Cost / Premiums of Plans:

Then I gathered the cost of the programs.  I noticed while doing my taxes that an amount was listed on my W2 stating the amount my employer kicked in for my health care.  I took that amount and divided it by 12 (months) to get my employer’s monthly contribution to my health care.  Then I added to it my payroll deduction for health care to get the final monthly cost of my employer based health care.

Employer Based Healthcare Monthly Cost:         $1746.61

MNSure Based Healthcare Monthly Cost:           $1316.30

 

Plan Comparison:

Medical:

It’s fairly obvious that the medical coverage through my employer is leaps and bounds better. While both plans offer preventative care at no charge, my current healthcare plan provides immediate coverage on the most common types of health care needs such as urgent care, ER visits, and prescription drugs.  All of these are subject to the deductible for the MNSure plan.  Even once the deductible is met, my current plan provides better coverage.

Dental:

Both plans provide bi-yearly cleanings and exams at no charge.  My current plan provides better coverage on minor procedures such as fillings, but the Delta Care provides better coverage on major procedures.  Plus Delta Care has a maximum out of pocket limit.  This is one of those times when it’s really hard to judge which one is better.  For day to day life, my current plan is better, but if a major dental situation arose, we would have a large bill to deal with.

Vision:

I couldn’t even find information about vision care on the MNSure website.  So, my current plan wins by default.

Cost:

My care through my employer is quite a bit higher per month.  I don’t actually see this as an out of pocket expense because my employer foots the bill for most of the cost, but we need to compare total cost for an apple to apple comparison.  Is an extra $450 a month worth having vision care and the better medical care?

If I were footing the bill all by myself, I would say “No.”   That’s over $5000 a year annually, and our out of pocket expenses for health care wouldn’t come anywhere near that if we had to purchase healthcare completely on our own, and had the option between these two plans.

 

Final Thoughts:

I learned several very important things by doing this exercise.

  • The healthcare I have through my employer is really good.
  • The true cost healthcare is crazy expensive!
  • I would likely make much different choices if I had to foot the full bill for my healthcare.
  • The government sponsored websites may not give all the options you need (where’s the vision care??)

While I gained some really great insight into my current healthcare, as well as the options available through the government exchange, I didn’t really gain any insight as to whether ObamaCare has really been a detriment to people who had previously been purchasing healthcare on their own.

How about you, readers?  Do you purchase your own healthcare? What has your experience been when choosing your healthcare after the implementation of the Affordable Healthcare Act?

Image courtesy of photostock / FreeDigitalPhotos.net

Comments

  1. Good stuff Travis! I will say that vision coverage is mostly unnecessary in today’s climate. You can get an eye exam for $60 at Costco (or other places). You can also get cheap eyeglasses or contacts online. Vision coverage just doesn’t seem very relevant anymore.

  2. I haven’t looked at health care plans after the affordable care act finally kicked in but when I was self employed before the medical plans I could even purchase were extremely limited. The coverage compared to an employer plan was pretty minimal even with the most expensive plans. There wasn’t an option at all to get the same kind of coverage as an employer plan even. Pretty big difference and if anything major had happened I would’ve been stuck with a pretty big medical bill.

    It really seems like the affordable care act is trying to even that up and from your comparison is getting close. Scary to think of but when I was self-employed I was one of those people who had healthcare but it just didn’t cover enough to make a difference if anything major happened.
    Christine @ ThePursuitofGreen recently posted…Spreading the EcoMy Profile

    • Great comment, Christine. I’m going to go on the record and say I’m not a big fan of the ACA. I DO think that healthcare needs major reforming in the US, but I don’t think the ACA is the answer. That being said, if what you say is true – that it seems like the legislation has pushed things in the direction of offering better plans to those who aren’t covered under employer plans, then score another point for the ACA. Thanks for your thoughts!
      Travis @debtchronicles recently posted…No Contract Cell Phone Plans Exposed! Are They Really Better?My Profile

  3. The ACA, as it is written, does not include dental or vision care. That was an individual choice left up to the states.

  4. I looked at MNSure as well, even though I have coverage through my employer. It’s crazy how much more expensive it is if you’re not getting coverage through your employer. I don’t remember the specifics, but while the premiums we would have had to pay were similar, the level of coverage that we would receive through MNSure was much less. The deductibles were higher, the co-insurance levels were worse, and overall we would end up paying a ton more for medical care. I guess for now I’m glad that my small business employer has decided to continue with our health coverage instead of paying the tax – which in the long run would be cheaper for them.
    Peter recently posted…Boost Your Retirement Account Balance By Making Money On The Side While Keeping Your Day JobMy Profile

  5. Your small business employer is not paying anywhere near what is showing on your W-2 as their share of health care premiums paid. Not only is that business taking those health care premiums off as a business expense, they get government tax credits and subsidies on top of it. Been that way for decades.
    Wendy recently posted…File Your Taxes for FREE!My Profile

  6. I don’t have an individual plan now, but I have in the distant past and paid a pretty penny for essentially only catastrophic coverage. I’m really glad now to have the option of getting health insurance on my own, as pre-existing conditions made that impossible the last time I looked onto it. That said, your current coverage is astoundingly good compared to my current employer-sponsored plan, and cheaper too — as is the Minnesota gold plan you describe. I’m now curious what I might be able to get on my own.

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