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How to Choose the Right Health Plan on the Exchange as a Patient with COPD [Infographic]

Choosing a health plan can be difficult, especially when you have high-cost health needs due to a chronic disease like chronic obstructive pulmonary disease (COPD). This infographic can help guide you through the process of picking a health plan through the health insurance exchanges. Our scenario follows the hypothetical patient, Chris, a patient with COPD. Follow through, and examine the options to choose the exchange plan that is right for Chris.


This is Chris.

Chris is a 55-year-old person living with chronic obstructive pulmonary disease (COPD). Chris suffers from shortness of breath and coughing. COPD typically worsens over time, so finding the right healthcare plan is essential. Chris is shopping for insurance coverage through the health insurance exchange.

Here are some factors informing the decision.

Chris has 2-3 COPD exacerbations per year and has been to the hospital for an overnight stay once in the past year.


There will be multiple doctor visits in the coming year…

…and a three-day hospital stay in the middle of the year.

Statin

Aspirin

Beta Blocker

Nitroglycerin

Bronchodilator

After Hospitalization, Chris Also Takes

COPD-Specific Inhaler

Antibiotic

Prednisone

Chris qualifies for cost-sharing reduction (CSR) subsidies. CSRs lower the amount you have to pay for a plan's deductible, coinsurance and copays. Chris compares a silver plan with reduced cost sharing and a bronze plan.

  Total Yearly Premium Spending Total Yearly Out-of-Pocket Spending Total Yearly Spending
Silver CSR $636 $1,750 $2,386
Bronze $57 $6,800 $6,857

Lesson

Chris should pick the silver CSR plan. Total yearly spending for this plan was much lower than the bronze plan.

Now, let's imagine that Chris's income is a little too high to qualify for CSRs, but doesn't qualify for a premium subsidy.

  Monthly Premium Deductible Maximum Out-of-Pocket (MOOP)
Bronze $145 $6,800 $6,800
Silver $193 $6,500 $6,500
Gold $367 $1,650 $5,000
Platinum $635 $500 $1,500

Chris has a lot to consider! Premiums are paid each month to be enrolled in a health insurance plan. Deductibles are paid for covered services before the plan begins to pay. The maximum out-of-pocket (MOOP) limit is the cap on out-of-pocket costs paid by the patient for covered services in one year. There are so many options it can be hard to know what's best.

Next, let's look at the total yearly cost of the same plans.

  Total Yearly Premium Spending Total Yearly Out-of-Pocket Spending Total Yearly Spending
Bronze $1,737 $6,800 $8,537
Silver $2,316 $6,500 $8,816
Gold $4,406 $5,000 $9,406
Platinum $7,625 $1,500 $9,125

The bronze plan has the lowest total yearly spending for Chris.

Here's a look at which month Chris will reach the deductible and MOOP with those same plans:

Bronze

Silver

Gold

Platinum

Lesson

When choosing a health plan, consider all of the factors that can affect yearly out-of-pocket costs, such as the premium, deductible and co-pay or coinsurance amounts. Also, it is important to check plans' coverage for doctors and medications.

Bottom Line

Patients with COPD who have high-cost health needs, Like Chris, are liekly to reach the MOOP. Adding the total premiums to the MOOP should give these patients an estimate of total yearly costs.

Want to know more before you enroll? Call 1-800-LUNGUSA (1-800-586-4872) and visit healthcare.gov when you are ready to pick a plan. Data and Analytics Presented by Avalere Health.

This infographic is also available for download as a printable PDF.

Download PDF

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