A worked example
3 plans, 3 kinds of year, 9 totals.
The plans are invented. What is real is the shape of the answer: in a normal year two of them are too close to name a winner.
Marketplace plan? Use the deductible and out-of-pocket max on your own plan. Here’s why.
| Plan | Premium / yr | Quiet | Normal (the year the result is decided on) | Rough |
|---|---|---|---|---|
| Plan AMid premium, mid deductible$3,720 premium / yr | $3,720 | $4,620incl. $900 of care | $6,220 (marked)incl. $2,500 of care | $9,720incl. $6,000 of care |
| Plan BHigh premium, low deductible$4,740 premium / yr | $4,740 | $5,520incl. $780 of care | $6,640incl. $1,900 of care | $9,240 (marked)incl. $4,500 of care |
| Plan CLow premium, high deductible (HSA-eligible)$2,220 premium / yr | $2,220 | $3,120 (marked)incl. $900 of care | $6,320 (marked)incl. $4,100 of care | $9,220 (marked)incl. $7,000 of care |
What Beeshur would say: Toss-up. Plan A and Plan C are $100 apart in a normal year, so no plan is named.
Marked = within 5% of the lowest total that year. The result is decided on the normal year.
Clem, from Beeshur. Here for the fine print.
The tradeoff, stated. Plan C has the lowest total in the quiet and rough years, and is $100 above Plan A in a normal year. It gets there by asking you to carry a $3,500 deductible early in the year. That is the tradeoff to sit with, and it is yours to make. Synthetic example
Synthetic example. Each figure is the annual premium (twelve times what you pay monthly, whether you use care or not) plus your modeled share of the year’s care: the deductible, then coinsurance (your share of a bill after that), capped at the plan’s out-of-pocket max (the most your share of in-network care can reach in a year, which premiums sit outside). The three years assume $900 of in-network care in a quiet year, $6,500 of in-network care in a normal year and $48,000 of in-network care in a rough year. One total, taken apart, shows the whole calculation on a single cell.
The deductible is what you pay for most care before the plan starts sharing the cost. Many plans cover preventive care before you reach it.
Quiet yearSynthetic exampleCheck-ups, one urgent care visit, a couple of prescriptions. $900 of in-network care.
Lowest this year: Plan C
Normal yearSynthetic exampleThe above, plus a minor procedure and some physical therapy. $6,500 of in-network care.
Lowest this year: Plan AWithin 5%: Plan A, Plan C $100 apart
Rough yearSynthetic exampleA hospital stay and the follow-up care around it. $48,000 of in-network care.
Lowest this year: Plan CWithin 5%: Plan C, Plan B $20 apart
See this chart as a table
| Plan | Quiet | Normal | Rough |
|---|---|---|---|
| Plan A | $4,620 | $6,220 | $9,720 |
| Plan B | $5,520 | $6,640 | $9,240 |
| Plan C | $3,120 | $6,320 | $9,220 |
Some comparisons end with us saying we can’t call it.
One of the three results Beeshur reports, alongside a cheapest modeled plan and a toss-up. It is not an error and not the comparison failing. It is what we say when naming a plan would mean guessing.
Synthetic example: the same reader, on family coverage, with a fourth plan
Synthetic example. Plan D has two deductibles, both on its summary: an $8,000 family deductible and a $2,000 per-person one. Beeshur asks for both and prices the year at each end: the family sharing one pot, and each person carrying their own.
One family pot
One $8,000 deductible, however the care falls across the family.
Each person
A $2,000 deductible each, so three moderate years cost differently from one hard one.
No total. Beeshur prices the year at both ends of this structure. For Plan D the two ends disagree about which plan is cheapest, so there is no figure here, no ranking and no pick. You get the numbers you entered and the name of the unknown doing it.
Those two runs disagree about which plan is cheapest. Which end you land on depends on whether one person has the hard year or three people each have a moderate one, and nobody knows that in November. So Beeshur names no plan and shows no total, because any total it printed would be one of two answers presented as the answer.
Synthetic example
Where that leaves you. Both limits are on the same plan, so there is nothing here to choose between: you get whichever one your year turns out to need.
Why the documents will not settle it
The answer depends on how your family’s care falls, and nobody knows that in November. What you are really deciding is whether to take a plan whose cost you cannot bound in advance. What Beeshur will not do is pick one of the two answers and hand it to you as the answer.
One more thing this changes: a withheld result withholds the whole comparison. With Plan D in it, none of the four plans carries a total, and you get the figures you entered for each.
We would rather hand you a shorter answer than a confident one we cannot support.
Ready to price your own?
Synthetic example. In a normal year Plan A and Plan C land $100 apart, inside the band Beeshur treats as a toss-up, so it names neither. Your own plans will land somewhere of their own.