Health plan costs have so skyrocketed that even a plan for a single individual can now exceed $1,000 a month. But a new trick, described here for the first time, could save you a bundle.

MrConsumer has long believed that pricing of health insurance is a mathematical game. If a plan has a seemingly low monthly premium, the insurer makes it back by imposing a deductible and higher copays. But a plan with lower copays and no deductible certainly comes with a higher monthly price tag. I am sure the insurers’ actuaries and accountants stay up late at night juggling these variables so that the house wins most of the time.

But it may be possible, though rare, to save thousands of dollars by doing a calculation no one ever suggested you do — find a plan where the health insurance bean counters messed up the mathematical structure of the plan.

So how can you save money when choosing among plans? It certainly helps if you have a crystal ball and know whether you are likely to have a lot or very few medical expenses in the coming year. A less expensive plan may be best for a healthy individual, while a more expensive plan might better protect a person who is likely to need more medical care. That is the traditional advice.

I discovered, however, while doing some extra number crunching to help a friend pick a plan from the New York marketplace-exchange (“Obamacare”) that the cheapest plan at least in his particular instance could be the best option by far even for someone likely to need a lot of medical care. This turns conventional wisdom on its head for some people.

Definitions:

First, here are some simple definitions to get out of the way:

Deductible: an amount of money you have to pay for medical services first before your insurance kicks in.

Copay: a fixed amount you pay out-of-pocket for a doctor’s visit or service.

Co-insurance: is similar to a copay, but it is typically a percentage of the total cost of a medical service that you have to pay out-of-pocket.

Out-of-pocket maximum: the maximum amount of money during the year that you have to lay out for covered services, not including premiums. Once the total of your deductible, co-insurance payments, and copays reaches the policy’s stated out-of-pocket maximum, the insurer pays for your covered benefits in full for the rest of the year.

Background:

In the past, MrConsumer has recommended the high-end “platinum” plan to his friend because it had no deductible and the out-of-pocket maximum was only $2,000. This means he only paid modest copays for covered services starting on day one, had no co-insurance, and once he met the $2,000 out-of-pocket maximum, he would not have to lay out a penny more for covered services for the rest of the year. He paid royally for this coverage: over $1,200 a month in 2018. But by summer, he reached his out-of-pocket maximum making all further services free.

In a million years, I would never have considered a low-end “bronze” plan with a $5,500 deductible, a $6,550 out-of-pocket maximum, and co-insurance on most services of 50% (meaning he would have to pay half the cost of medical procedures). The worry was that if he had a bad health year, this plan could have been so inadequate that it could have cost him a fortune. Or so I thought.

The New Calculations:

For 2019, however, MrConsumer pushed some new numbers, comparing the actual total costs of the four plans offered taking into account not just the premiums, but the out-of-pocket maximum as well. And a big surprise became evident.

*MOUSE PRINT:

This example compares Empire Blue’s four “metal” policy choices in New York for 2019 for an individual. These plans all cover the exact same medical conditions, services, and drugs, and use the same network of providers. The only differences are the amounts of the deductible, copays, co-insurance, and out-of-pocket maximums.

Compare the total annual premium of the bronze plan ($8,043) to the platinum plan ($16,520). Assuming my friend had no need for any medical services during the entire year of 2019 — the best (but unlikely) case scenario — he would save $8,000 by choosing the bronze plan. And now take the worst case scenario (the far right column in the chart above), where he had so many medical expenses that he hit the out-of-pocket maximum in both plans early in the year. In that case, the bronze plan would have cost him “only” $14,593 versus $18,520 for the platinum one — still an amazing savings of $4,000. (Note: there is a scenario where the minimum savings could drop to between $2000 and $4,000, but your head will explode if I try to explain it.)

If my friend needed a family plan, the total savings by choosing the bronze 2019 Empire Blue plan over the platinum one could be even more dramatic — between $15,000 and $24,000.

Where one might have expected the total cost figures in the right column above to be roughly equal (given the games the insurer’s accountants play of charging less in one area, but making it up in another), this was a big surprise to see the variation and potential savings.

The out-of-pocket maximum is a magical number that when combined with the annual premium can give you a truer picture of the real maximum costs of the plan, and help you spot a plan that is a mathematical anomaly in an insurer’s offerings. Such is the case here.

Warnings and Limitations:

A few words of caution. Besides the assumptions and facts mentioned above which might not hold true for other plans at other companies or in other states, if you choose a cheap plan and have an urgent and expensive medical need, you may have to come up with a large deductible and co-insurance right away.

Remember, this new calculation is most beneficial for people who expect to have substantial medical needs in the coming year. It is a treasure hunt of sorts to find the rare cases where the insurers’ accountants goofed up the mathematical structure of their plans making one plan’s total costs significantly lower than the others.

Before selecting a new plan, do a lot of comparisons, find plans with a large network, check to see that all your providers and drugs are included, make sure all the plans compared have identical benefits, crunch the numbers looking for a mathematical anomaly, ask a lot of questions to be sure your understanding of the plans is sound, read the actual policies carefully, and cross your fingers.

Last week, the Orange County California district attorney’s office and other DAs settled a consumer lawsuit against Goop – a lifestyle brand and website created by actress Gwyneth Paltrow. The suit contended that Goop made health claims for various products but did not have substantiation to back up those claims.

For example, Goop touted “Inner Judge Flower Essence Blend” this way:

You can either mix this stuff in water and drink it, or apply it externally to your body “over the liver.” It supposedly would help you get rid of guilt and shame, replacing those feelings with compassion and forgiveness, so as to prevent a spiral into depression. Oh please. What is this, a psychologist in a bottle?

For this crock of **** and unsubstantiated claims about two other products, Paltrow’s company agreed to pay $145,000 in settlement, without admitting any wrongdoing. So much for the company’s statement of values:

We test the waters so that you don’t have to. We will never recommend something that we don’t love, and think worthy of your time and your wallet. We value your trust above all things.

The case against Goop arose because our friends at TruthinAdvertising.com cited more than 50 unsubstantiated health claims made by Paltrow’s company, and sent them to some of the California DAs.

Here are some of the claims made for other flower essence products previously available on the Goop website. They include products to help “cure”: a broken heart such as from death of a loved one; emotional trauma from divorce, OCD, or bad dreams; infertility; auto-immune conditions; writer’s block; perfectionism, talking too much, etc.

Scroll down the list.

For more about the case against Goop, here is an ABC Nightline story.

Continuing our look at line extensions of popular over-the-counter products, we turn our gaze to Systane — a leading brand of eye drops.

Here are two of their lubricating eye drop products:

The product on the left is regular Systane “long lasting,” while the one on the right is Systane Ultra “high performance.” Based on its name and description, Systane Ultra seems to be a premium product offering “extended protection.”

A check of the active ingredients of both products, however, reveals a surprise.

*MOUSE PRINT:

Both regular Systane and Systane Ultra have exactly the same active ingredients and seemingly in the same strength! So is this just another marketing gimmick like the one we spotlighted where regular Aleve and Aleve Back & Muscle have identical active ingredients?

We asked Alcon, the maker of Systane, what the actual difference is between these two products, and why they sell two different products with the exact same active ingredients.

A spokesperson for the company explained that the secret is primarily in the inactive ingredients which differ slightly between the two products. According to her that is why the “Ultra” product performs better.

“Compared to Systane, Systane Ultra has a unique mechanism of action due to the inclusion of sorbitol, which serves to optimize the viscosity of the drop to minimize blur by delaying the cross-linking of other inactive ingredients until the drop is actually in the eye. The way the inactive ingredients cross-link once Systane Ultra is dropped into the eye results in the creation of a viscoelastic protective layer over the ocular surface that reduces friction and is maintained between blinks for prolonged ocular comfort. Finally, the interaction of Systane Ultra with natural components of the tear film (e.g., calcium, zinc, and magnesium) strengthens the cross-linking of the protective layer and prolongs retention of the active ingredients on the ocular surface.” –Alcon spokesperson.

Got that?

Given that the “Ultra” product is nearly 50% more expensive, does it then last 50% longer than their regular one? The company didn’t answer that question.

Who would have suspected that two products with identical active ingredients would function differently because of the inactive ingredients? And that poses a problem for label readers who would not be able to glean that fact simply by examining a product’s contents.

Many people like Aleve because its pain relief is supposed to last for 12 hours. Now they have a new product — Aleve Back & Muscle Pain — and a new commercial to help launch it.

We were curious about the new product and wanted to see what additional ingredients they added. So we checked the back of the regular package and compared it to the new one.

*MOUSE PRINT:

They are exactly the same. The only difference is the box.

We asked Bayer why they came out with a “new” product that really was just the same as the old one. A spokesperson replied:

Aleve Back & Muscle Pain offers the same long-lasting pain relief from Aleve. This product is meant to help consumers understand the various pains Aleve can relieve.

We say, the answer is: marketing and taking up shelf space!

We received an email from John S. of Massachusetts last week inquiring about an urgent care center that he goes to and that he has heard advertised on the radio. It is called American Family Care.

The consumer says that while he has gotten good care from a physician’s assistant there, their radio ads tout their great doctors.

Indeed a review of their website reveals repeated claims that they are staffed by physicians (and other medical professionals).

——

There’s no need to make an appointment, you can just walk right in to see a doctor.

The company’s website also claimed that all its doctors are board-certified.

ORIGINAL WEBPAGE

MOUSE PRINT* CHECKS THE CLAIMS

We called 10 Boston area American Family Care locations last week and asked if they always had a doctor on duty. In nine out of 10 locations, they said “no” — not every day, maybe three days a week, it depends on the week, it’s the luck of the draw, today it’s a nurse practitioner, not on Wednesday, etc.

But a funny thing happened just a day after we started asking the company’s chief marketing officer questions about its claims about locations being staffed by board-certified doctors. The webpage where the company talked about its board-certified doctors was changed to read that it had board-certified doctors at “many” of its locations. And it also removed claims that all its doctors were board-certified and that they periodically check to make sure the board-certification is still in effect.

REVISED WEBPAGE

We asked the company to explain why it was representing that patients could see a doctor without an appointment when, at least in the Boston area for the locations checked, it was a hit or miss affair at the time. (Staffing levels may differ in other parts of the country.) We also wanted to listen to or get a transcript of the radio commercial the company was running to see what they were claiming about their doctors. The company never answered our questions nor provided the commercial despite three requests.

One last thing. Not every patient and not every medical issue requires the attention of a doctor. Other health professionals are well-equipped to handle many routine medical problems. The point, however, is that if a company tries to distinguish itself as being staffed with doctors, that is whom patients should reasonably be able to see if they so choose when they visit.

Do you know who’s treating you when you go to an urgent care center? Is it a doctor, a physician’s assistant, a nurse, or some other type of clinician? You have a right to know. Ask!