ACA Silver vs Gold plan and how do I calculate my deductible cost per year?

So I am self employed and health insurance premiums are tax deductible for me. But I am having a hard time figuring out if the silver plan will save me more in the long run with its high $5400 deductible vs the more expensive gold plan with $0 deductible.

My income does not qualify me for cost sharing reduction on the silver plan. Me(40), my wife(37) and 2 young kids under 7. We are all relatively healthy. But I do get diagnostic imaging once a year. And my wife twice a year to monitor a previous health issue. We’re currently are not on any medications.

Silver plan Premium $813 a month Deductible individual $5,400/ Family $10,800 Out of pocket max $9100/$18,200 Coinsuance for inpatient hospital service 30% after deductible is met Copay for ER visit $450

Gold plan Premium $1268 a month Deductible $0 Out of pocket max $8700/$17,400 Copay for inpatient hospital service $330 per day no coinsurance Copay for ER visit $350

I did the math and it’s $5460 more a year for gold. But I can deduct the premiums from my taxes. So let’s say it saves me 30%($1638). So now it’s really about $3,822 more a year for gold.

My question is how does one figure out how much of the deductible will be used up in a year. I know the way a deductible works is health insurance doesn’t kick in until the deductible is met, so you are responsible for the out of pocket cost for the service and you still need to pay copay. But in my experience if the doctor charged like $1000 to the insurance company for a scan my out of pocket on that wouldn’t be $1000, it would be only a percentage of that and it would go toward my annual deductible. If we do 3 scans a year and we all just have routine check ups and nothing major will we end up using more than $3,822 in a year?

Then I suppose one hospital stay on the silver would pretty much cost us the $8700 out of pocket max or worse $17,400 if more than one of us in there. So it would nullify any savings we had over the gold plan for the next 3-6 years.

submitted by /u/blingwrx
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