Let’s Do The Numbers…

Well, it’s November 1st, and you know what that means. It’s that time of the year again, when the so-called “Open Enrollment” period for buying next year’s health insurance plans begins.

To celebrate, I thought I would use Dr. Wacasey’s Equation to compare the latest offerings for 2017 in my neck of the woods, the Dallas/Fort Worth Metroplex.

Unfortunately, unlike my previous comparison of 2016 plans that had six different health insurers, now it seems us Metroplexians are left with only two – count ’em, two – health insurance companies to choose from. One of which is Superior HealthPlans, a newcomer to the DFW market, while the other is Blue Cross and Blue Shield, the only company returning from last year.

Gone from last year’s roundup are Aetna, Cigna, Oscar, Scott & White, and UnitedHealthCare. This kind of loss of competition does not bode well for pricing, although unlike our friends in Arizona who are seeing up to 116% increases in their Premiums, North Texans have suffered relatively little it seems, at least for this year.

Superior HealthPlans is an El Paso-based company that is a subsidiary of the Centene Corporation, which is itself a St. Louis-based “multinational healthcare enterprise” with a stated mission “to make healthcare more accessible.”

Superior HealthPlans has been selling health insurance to Texans since 1999, but mainly to the poor through Medicaid. Now it’s entered the  marketplace to sell plans to individuals, and with a stunningly catchy name for their plans – the “Ambetter” series. I mean, how awesome is that for a brand name?!? The only thing better would be a competing line of products or services called “Amnot.” I can envision myself directing all kinds of creative, attention-getting commercials:

Actor 1: “How bout an ice-cold bottle of Ambetter beer?”

Actor 2: “Ambetter? Amnot is the only beer I’ll drink.”

Or maybe I could’ve named my twins Ambetter, and Amnot?

Sorry, I got carried away for a bit. You can’t blame me for admiring the genius of these marketers though, because when it comes down to it, that’s what selling health insurance is really all about, anyway. The creative art of selling you on the idea that you should “spend as much as you can, so you can save as much as you can…”

But as I’ve shown again, and again – and again – that is almost never the case.

So to demonstrate my point – once again – for the 2017 season, I’ll compare different plans in a variety of scenarios. Just as I did in chapter 7 of my book, for each comparison I entered my real ZIP code, listed my age as 47, did not list any dependents, did not check the tobacco user box, and put my income as $100,000 a year to avoid any gifts from taxpayers (otherwise known as subsidized Premiums). Oh and, in no case did I actually sign up for the insurance. I already have mine, thank you.

Here are the three Ambetter plans – a Bronze, a Silver, and a Gold – I picked for our first comparison, involving just me, as an individual:


As we move from Bronze to Gold, the Premium goes up, the deductible comes down, and the Out-of-pocket maximum – wait a minute – take a look at the Silver plan. At $7,150, it’s the highest of the three O values. Meaning you get punished for buying it, if you happen to get hit by a train and max out your Out-of-pocket maximum.

Here’s the breakdown of these plans using Dr. Wacasey’s Equation:


Some things never change, it seems. And once again we see that going for the Gold is, well, just downright foolish. So is going for the Silver, with a W of $12,474 (that’s $1,217 higher than the W for the Bronze). And yet what I find most interesting – and appalling – about the healthcare.gov website is this page, that entices you to go for the Silver by promising that “Extra savings on out-of-pocket costs – only with a Silver plan.”

Wow, I mean just wow. Here we have an example of our government telling you – a lie. Because as my analysis shows, spending $1,217 more for Silver than you would for a Bronze isn’t any “Extra savings on out-of-pocket costs.” It’s a lie. Told (and sold) to Americans by the Obama administration, who are working hand in hand with the insurers to get you to spend more money by buying the Silver plans. Shameful.

OK, now that I’ve got that out of my system (or maybe I haven’t), let’s talk about the only other health insurer that I have to choose from, Blue Cross and Blue Shield. I’ve discussed this company before in my book, so I’ll just say that the big change for the Blues in 2017 has to do with the fact that they are only offering the “HMO” plans now. You know, the ones where you have to stay “in-network,” or else…here are the Blues offerings for individuals that I picked to compare:


Now on this actual screenshot from the healthcare.gov website, for some reason the Bronze is on the left, the Silver is on the right, and the Gold is in the middle. I’m not sure why, but I couldn’t change it even after going back through and repeating the process.

In any case, when you look at the Dr. Wacasey’s Equation analysis don’t get confused by the order of the plans; I’ve placed the Bronze, Silver, and Gold where they should be, from left to right:


AGAIN we see that the Bronze is…the best. At least when it comes to saving money. And what do you know? The Silver is the worst plan, with a W value of $13,738 – that’s $1,421 MORE than the Bronze ($13,378 – $12,317), and it’s even $226 MORE than the Gold. So why again is the Federal government – your government – enticing you to buy a plan that could end up being the most expensive of all three? Could it be that the bureaucrats are working in collusion with the health insurers? Given the latest exposures rocking the Presidential election, I don’t find it hard to believe, folks.

Vote your conscience.

Oy, ok. So let’s look at the Individual + Spouse plans, to se if they’re any different. Here’s the Ambetter (I still love that) offerings:


The Premium difference between the Bronze and Gold plans is $358.36 a month ($1,101.16 – ($742.80). So what do you get with this scenario if you go for the Gold, instead of the Bronze?


Nada, but a big fat $3,400 extra (or $25,914 – $22,514) on the W, if you get hit by a train. And the Silver plan (recommended by the fine folks at Obama, Inc.) wouldn’t end up saving you anything on those “out-of-pocket” costs, either, because you’d spend $2,439 more than you would have with the Bronze plan (that’s $24,953 – $22,514) if you get really, really sick.

Finally, here are the HMO plans offered by Blue Cross and Blue Shield:


Again, the order is mixed up so that the Gold is in the middle – which is easy to spot because it has a $500 DEDUCTIBLE! The one you’ve been looking for…that great coverage you just cannot find these days anymore. But is it really so great?


Well, I guess not.

Check out my book to see how you can save on health insurance, and health care. And remember,

It’s not the COSTS of health care that are outrageous…it’s the CHARGES.

Physician. Health Insurance Agent. Author. Health care humorist. Medical satirist. Disruptor. At your service. My name is Kevin Wacasey, and I’ve been practicing medicine since 1994. When I graduated from medical school, I took an oath to do no harm to my patients. To me, that includes financial harm. But since health insurance took over health care over 40 years ago, health care prices have skyrocketed. And despite what we’re told by the media every day, it isn’t the costs of health care that are outrageous; it’s the charges. So if you’ve ever wondered why we spend so much on health insurance and health care, then come along and join me as I explore the crazy world of Healthcareonomics. Health care doesn’t have to be expensive. Let me show you how. For speaking opportunities and to pass along your questions/comments, please email me at drw@healthcareonomics.com.

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1 Comment

  1. Suzette H.

    Thank you for taking the time to do this, Dr. Wacasey. Some of us are old enough to remember when health care in America was fantastic! BEFORE managed care! And that’s the absolute truth. When I was young, EVERYTHING was covered by my insurance: BECAUSE MY DOCTOR MADE THE DECISIONS ABOUT MY HEALTH. My insurance co. (Ambetter) exists first and foremost to GET RICH, not for the health of the patient. My husband’s grandfather died of colon cancer. My husband has had cancerous polyps removed during a colonoscopy. Ambetter won’t pay until the $7000 deductible is met IF there has ever been a polyp! Shameful! So they don’t cover those most at risk because they have found a loophole in the law. This incredibly bad plan comes at a cost of $1700/month. If there has never been a polyp, they pay under the heading of “preventative care”. But once there has been a polyp, they don’t consider it preventative?!? There isn’t anything more ‘preventative’ than a colonoscopy: the procedure itself removes the cancer!

    This can happen because Ambetter doesn’t give a s**t about the health of the people they are supposed to be ‘managing’. Managing their bank account is what they are doing. Sorry, I’m furious. But I remember when we had healthcare. Actually, 2 years ago before Trump came in my healthcare was MUCH better under Obamacare. Trump scared everyone and, in the uncertain economic climate, all the good companies abandoned Washington state and Ambetter moved in.

    Although I agree with your analysis, the comparison only applies if a person goes over the ‘maximum covered’. i.e., on the Gold plan, my deductible is $2000; on the Silver $7000. If I spend over $5000 but under $7000 out of pocket, the Gold may be a better choice. The analysis also ignores prescriptions (which Ambetter counts towards deductibles except for generics): once my $2000 is met, they cover certain prescriptions. Still, rather than paying $400/month for Januvia, we just get it from Canadian On-Line Pharmacies for $80 for 3 months. Something is SO WRONG in America. We let corporate greed run the country and are too ignorant and afraid to look at how other countries are successfully managing healthcare.

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