Bronze objectively better than Platinum on NY Marketplace? I must be missing something!
Hi All,
Thank you in advance for your help. My family (2 adults 2 kids) is going onto NY ACA for the first time and I am pretty overwhelmed, but I think I have a handle on things. However, I think I might be missing something because it seems like the Bronze plan I'm looking at is objectively better than the Platinum by Emblem.
The difference in premium a month is $2,350 which over a year is $28,200. It seems like I could select Bronze and spend $18,900 on meeting the out-out-of-pocket max and still have $9,300 in my pocket. At this point I pay $0 for covered services while the platinum still has an out-of-pocket-max of $4,000.
Doesn't this mean Bronze is better in every way assuming I have the means to absorb a big chunk of medical costs in the beginning of the year? Is there any difference in how willing they are to approve claims or prescriptions between Bronze and Platinum? The network appears to both be Millenium? I must be missing something? Bronze also seems better than Silver and Gold…
**Bronze**
cost per month: $2,573
deductible: $9,200
max: $18,900
[plan doc](https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/plans/individual-and-family-plans/plan-documents/2024/on-exchange/millennium-bronze-benefit-summary-2024-emblemhealth.pdf)
**Platinum**
cost per month: $4,923
deductible: $0
max: $4,000 family
[plan doc](https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/plans/individual-and-family-plans/plan-documents/2024/on-exchange/millennium-platinum-benefit-summary-2024-emblemhealth.pdf)
For the comparison between Bronze and Silver/Gold, it's similar.
**Silver**
cost per month: $3,379
deductible: $4,200
max: $18,900
[plan doc](https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/plans/individual-and-family-plans/plan-documents/2024/on-exchange/millennium-silver-benefit-summary-2024-emblemhealth.pdf)
**Gold**
cost per month: $4,067
deductible: $1,200
max: $11,800
[plan doc](https://www.emblemhealth.com/content/dam/emblemhealth/pdfs/plans/individual-and-family-plans/plan-documents/2024/on-exchange/millennium-gold-benefit-summary-2024-emblemhealth.pdf)
Bronze vs Silver, the difference is $806 with a annual total of $9,672. They have the same out-of-pocket max. I can spend the entire difference in premium paying off my whole deductible and half the out-of-pocket-max and silver still has $4,200 in deductible left and double the size of the out-of-pocket max left. One big difference is that prescription costs in Bronze go against the deductible first while Silver prescriptions don't. But again, the premium difference is more than the entire deductible.
Bronze vs Gold, the difference is $1,494 with a annual total of $17,928. This is almost the same as the Bronze out-of-pocket-max. Like the Bronze vs Platinum comparison, doesn't this mean Bronze is better?
To be honest, none of these marketplace plans seem great, and Emblem is among the more expensive of the Family options (but they are all way more than my old COBRA insurance from my employer). The reason I chose Emblem is b/c their formulary lists all of my wife's meds – she has 2 meds that alone cost $3,000 and $1,000 per month (and that's AETNA's negotiated price!). Missing even one means we'd pay a fortune for non-negotiated prescription price.
– What am I missing in these comparisons?
– Is Emblem a decent company?
Also, the NY ACA website, when you compare family plans (not when you get details on a single plan), seems to indicate that only couple and 1 dependent are covered. That has to be a typo?
Thanks again so much, my family and I really appreciate your input!
submitted by /u/hamilkwarg
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