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Unpacking BCBSRI’s rate request part 2 UPDATED

January 13, 2012

UPDATE: These calculations don’t reflect the fact that deductibles DID NOT count towards the out of pocket limits for the old plans but they do for the new ones. See new charts reflecting the difference here.


I’m taking a closer look at Blue Cross Blue Shield’s proposed rate increases and plan changes for Rhode Islanders who buy their own insurance (often called “direct pay” customers).  Part one explained what those plan changes look like. For part two, I’m calculating how much someone might pay under the proposals. I’m using myself as an example.

I’m a healthy 29 year old woman who pays for a family health care plan. Let’s assume I qualify for BCBSRI’s “Pool II” preferred rate. “Pool II” plans are a cheaper option for folks without expensive chronic illnesses.

According to this chart, I’d pay $775.90 a month under the new Vantage Blue Direct 1500/3000 plan.  The old plan charged me $747.06 a month. Not a big change. But let’s say I get sick, or someone in my family needs medical care. How much more could I pay a year?  Here are the costs if my family was on Healthmate Direct 500/1000.

This chart calculates the difference in how much I’d have to pay if I actually used my insurance. It’s an increase of $1,358 or a rate increase of 9.73%.  Now of course, if you’re healthy you won’t notice these changes.

Let’s try one of the other health plans. What about Healthmate direct 2000/4000-

Whoa. High deductible plans are supposed to offer low monthly premiums in exchange for a higher deductible. It’s appealing to healthy people who don’t have many medical needs but still want the security of health insurance. You might have to spend $2,000 /$4,000 before your health plan kicks in, but you’ll have help paying the bills if you get hit by a car or develop cancer.

Under the changes for this plan, if I had a terrible injury I’d pay a total of $22,345 out of pocket, or $9,516 more than the old plan.  At a cost increase of 74.18%, that’s not the kind of financial protection I’d expect from my health insurance. How many people have an extra $9,000 to spend on medical emergencies?

But before folks start throwing stones at BCBSRI, remember- for the most part these charges reflect the actual cost of health services. For every dollar you send to your health plan, about 82 cents pay for actual medical care.

Health insurance plans have to find that money somewhere. In the short term, BCBSRI had to choose- request a double digit rate increase or hide the charges. I’m just showing you where they are.

6 Comments leave one →
  1. January 16, 2012 8:22 am

    This is very helpful (even though I don’t live in Rhode Island). I wish health insurance companies or employers would provide such worksheets so people can actually understand the potential costs of the plans they choose.

    • January 16, 2012 9:53 am

      Interesting idea. Who knows, maybe that could be a requirement in the future. It’s always better when people are informed. Hopefully that means they make wiser choices.

  2. Carol permalink
    February 16, 2012 3:28 pm

    I was most concerned about the change in deductibles, especially after the chance to pick a higher deductible plan has passed. I see they reduced the % premium increase but did they address this issue in their ruling.

    • February 16, 2012 4:49 pm

      Hi Carol- The health insurance commissioner hasn’t ruled on the rate request, so we’ll have to see what happens. As far as I know, the only change BCBS made to its request was the new average premium increase. I’ll be sure to write about the commissioner’s decision as soon as it comes out.


  1. Unpacking BCBSRI’s rate request « The Pulse: health care in RI
  2. Adjusting those Blue Cross Blue Shield rate changes « The Pulse: health care in RI

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