Kevin Knauss: Health, History, Travel, Insurance
The worksheet accounts for deductibles when they may be triggered by a health care service or prescription drug. For example, the Silver 70 medical deductible applies to hospitalization. If the deductible is met, the dollar amount is added and coinsurance for the included in the subtotals. The worksheet also accounts for tier 4 maximum amount of $250 if the drug costs more under the coinsurance of the health plan.
Without an extension of the enhanced subsidies of the Affordable Care Act, older Americans will be hit the hardest by high health insurance rates. The prime culprit is that there are no Affordable Care Act health insurance subsidies for incomes over 400 percent of the federal poverty level. This leaves older Americans potentially paying over 30 percent of their household income on health insurance premiums.
I would suggest that the ACA Premium Tax Credit subsidies are a natural evolution of our society’s desire to achieve equal opportunity and security for all regardless of income or employment.
Another powerful strategy to save on monthly health insurance premiums is the split family members into different plans. Covered California makes splitting family members into different groups very easy. From your Enrollment Dashboard select Manage Groups. Then at the bottom of the page click on Add a Group. Then drag the family members into different groups.
Another alternative is the Bronze HDHP. While the monthly premium is essentially the same as the Bronze 60 at $231 a month, the MOOP is much lower at $7,200. When we total the annual premiums plus the MOOP, the Bronze HDHP saves this consumer $4,808 or 32.5 percent over the Silver 70 health plan.
Unfortunately, the IRS has not issued any guidance for the 2026 tax year with respect to expanded definition of health plans eligible for a Health Savings Account. The language clearly states that the health plan must be purchased through a Marketplace Exchange like Covered California. That would seem to preclude Bronze 60 and Minimum Coverage plans bought off-exchange, direct from the insurance company, as being eligible for the HSA contribution deduction.
The Bronze 60 plan may be a good option for people who are looking to save money and do not use health care services on a regular basis. The Bronze 60 has unlimited office and urgent care visits at $60. You get three specialist visits at $95. Lab tests are unlimited at $50. All other health care services are subject to the medical deductible of $5,800. The Bronze 60 has a maximum out-of-pocket amount of $9,800.
New for 2026 is an orange band on top of the table. This is the income range that California will provide additional subsidy to help lower health insurance premiums for low income families and individuals. The extra subsidy will be provided to incomes up to 165 percent of the federal poverty level. There is a new 165% column indicating the maximum annual income that the subsidy is eligible for.
All Sutter Health Plans are standard benefit designs. That means they mirror the plan structure offered by health plans offered through Covered California. They offer a Bronze 60, Silver 70, Gold 80 and Platinum HMO plans. There is no guessing if your Sutter physician or hospital is in-network with the health plan. This can be the issue for health plans that contract with Sutter.
Blue Shield also offers some plans not offered through Covered California. The Silver 2600 is a High Deductible Health Plan and is Health Savings Account compliant. After you have received $2,600 in health care services, remaining services and prescription medications are subject to 35 percent coinsurance. When the deductible plus coinsurance equals $7,350, you have met your maximum out-of-pocket annual amount.
