Being self-employed I have the joy of buying for health insurance for myself. Aetna discontinued my current plan for 2015. Did I mention just how much I hated Aetna? Last week I used HealthCare.gov to check my options. The application starts with your ZIP code.

I started thinking: how different are health insurance prices between cities?

Short answer: up to 107% more.

The experiment

Which cities?

I picked nine cities for various reasons:

<tbody>
    <tr>
        <td>Lancaster PA</td>
        <td>I live here</td>
    </tr>

    <tr>
        <td>Austin TX<br>Brooklyn NY<br>Portland OR<br>San Francisco CA</td>
        <td>Design/tech cities</td>
    </tr>

    <tr>
        <td>Asheville NC<br>Boise ID</td>
        <td>Friends and family</td>
    </tr>

    <tr>
        <td>Salt Lake City UT</td>
        <td>I read their health costs were lowest in 2014</td>
    </tr>

    <tr>
        <td>Miami FL</td>
        <td>Random geography</td>
    </tr>
</tbody>

What persona?

I used a persona based on myself:

• Individual plan
• Excluded from income subsidy
• 28 years old
• Non-smoker
• Non-parent
• Not pregnant

Note: individuals earning over $46,680 are ineligible for subsidies. I saw the same plans/prices testing with $50k, $100k, and $500k income.

What pricing benchmark?

I want low premiums and high deductibles. Normal health care will never bust my out-of-pocket max, but any hospitalization probably will. Based on my age, fitness, and environment it’s a small risk that I have savings to back up.

Which plans?

My pricing benchmark meant either:

Catastrophic plans

Under 30 my health risks are minimal (aka indestructible).

<dt>Bronze plans</dt>
<dd>Over 30 some catastrophic plans are income restricted, so I might be forced into bronze plans for 2017.</dd>

Catastrophic plans

<tbody class="tlf">
    <tr>
        <td>Asheville NC</td>
        <td>$156</td>
        <td>+3%</td>
        <td>$6600</td>
        <td>$6600</td>
    </tr>

    <tr>
        <td>Austin TX</td>
        <td>$137</td>
        <td>-9%</td>
        <td>$6600</td>
        <td>$6600</td>
    </tr>

    <tr>
        <td>Boise ID</td>
        <td>—</td>
        <td>—</td>
        <td>—</td>
        <td>—</td>
    </tr>

    <tr>
        <td>Brooklyn NY</td>
        <td>$154</td>
        <td>+2%</td>
        <td>$6600</td>
        <td>$6600</td>
    </tr>

    <tr>
        <td>Lancaster PA</td>
        <td>$107</td>
        <td class="good">-29%</td>
        <td>$6350</td>
        <td class="good">$6350</td>
    </tr>

    <tr>
        <td>Miami FL</td>
        <td>$180</td>
        <td class="bad">+19%</td>
        <td>$6600</td>
        <td>$6600</td>
    </tr>

    <tr>
        <td>Portland OR</td>
        <td>$128</td>
        <td class="good">-15%</td>
        <td>$6600</td>
        <td>$6600</td>
    </tr>

    <tr>
        <td>Salt Lake City UT</td>
        <td>$139</td>
        <td>-8%</td>
        <td>$6600</td>
        <td>$6600</td>
    </tr>

    <tr>
        <td>San Francisco CA</td>
        <td>$208</td>
        <td class="bad">+38%</td>
        <td>$6600</td>
        <td>$6600</td>
    </tr>
</tbody>

<tfoot>
    <tr>
        <th>Mean</th>
        <th>$151</th>
        <th>&mdash;</th>
        <th>$6531</th>
        <th>$6531</th>
    </tr>
</tfoot>

Bargain: -29% Lancaster, -15% Portland
Expensive: +38% San Francisco, +19% Miami

The out-of-pocket max for an individual in 2015 cannot exceed $6600. Only Lancaster had a plan under the max. Boise had no catastrophic plans for me (probably an income exclusion).

Bronze plans

<tbody class="tlf">
    <tr>
        <td>Asheville NC</td>
        <td>$220</td>
        <td>+13%</td>
        <td>$6275</td>
        <td>$6400</td>
    </tr>

    <tr>
        <td>Austin TX</td>
        <td>$165</td>
        <td>-15%</td>
        <td>$6300</td>
        <td>$6300</td>
    </tr>

    <tr>
        <td>Boise ID</td>
        <td>$156</td>
        <td class="good">-20%</td>
        <td>$3950</td>
        <td>$6350</td>
    </tr>

    <tr>
        <td>Brooklyn NY</td>
        <td>$308</td>
        <td class="bad">+58%</td>
        <td>$3000</td>
        <td>$6350</td>
    </tr>

    <tr>
        <td>Lancaster PA</td>
        <td>$167</td>
        <td>-15%</td>
        <td>$4000</td>
        <td>$6350</td>
    </tr>

    <tr>
        <td>Miami FL</td>
        <td>$190</td>
        <td>-3%</td>
        <td>$6500</td>
        <td>$6500</td>
    </tr>

    <tr>
        <td>Portland OR</td>
        <td>$149</td>
        <td class="good">-24%</td>
        <td>$5250</td>
        <td class="good">$5250</td>
    </tr>

    <tr>
        <td>Salt Lake City UT</td>
        <td>$157</td>
        <td class="good">-20%</td>
        <td>$6300</td>
        <td>$6300</td>
    </tr>

    <tr>
        <td>San Francisco CA</td>
        <td>$245</td>
        <td class="bad">+26%</td>
        <td>$4500</td>
        <td>$6250</td>
    </tr>
</tbody>

<tfoot>
    <tr>
        <th>Mean</th>
        <th>$195</th>
        <th>&mdash;</th>
        <th>$5119</th>
        <th>$6228</th>
    </tr>
</tfoot>

Bargain: -24% Portland, -20% Boise, -20% Salt Lake City
Expensive: +58% Brooklyn, +26% San Francisco

Only Portland had a significantly lower out-of-pocket max.

The results

• Portland stands out in both tiers as a bargain.
• Lancaster, Boise, and Salt Lake City are economical.
• Brooklyn and San Francisco are crazy expensive — surprise.

Annual liability range

Comparing premiums vs premiums + OOP max these are the best/worst cities:

Catastrophic plans

• $1284 min $7634 max in Lancaster
• $2496 min $9096 max in San Francisco

Bronze plans

• $1788 min $7038 max in Portland
• $3696 min $10046 max in Brooklyn

In conclusion

Where you live may swing health care costs heavily:

• +107% for using no health care.
• +43% for using maximum health care.

What I’m actually paying

Lancaster is super affordable for me. My doctor is in-network, so I bought the $107/mo catastrophic plan. The next plan up was $145/mo with negligible benefit differences. I wager on staying healthy and pocketing the extra $456.

Compared to prior years:

<tbody>
    <tr>
        <td>2013</td>
        <td>Aetna<br>PPO High Deductible 3000 with HSA</td>
        <td class="a-right tlf">$88</td>
        <td class="a-right tlf">$3000</td>
        <td class="a-right tlf">$3000</td>
    </tr>

    <tr>
        <td>2014</td>
        <td>Aetna<br>PPO High Deductible 3000 with HSA</td>
        <td class="a-right tlf">$91</td>
        <td class="a-right tlf">$3000</td>
        <td class="a-right tlf">$3000</td>
    </tr>

    <tr>
        <td>2015</td>
        <td>Capital Blue Cross<br>Healthy Benefits Value HMO 6350</td>
        <td class="a-right tlf">$107</td>
        <td class="a-right tlf">$6350</td>
        <td class="a-right tlf">$6350</td>
    </tr>
</tbody>

<tfoot>
    <tr>
        <th>&nbsp;</th>
        <th>YOY Difference</th>
        <th class="a-right">+17.5%</th>
        <th class="a-right">+111.6%</th>
        <th class="a-right">+111.6%</th>
    </tr>
</tfoot>

Switching from PPO to HMO should’ve been cheaper, but it wasn’t. That’s the cost of national healthcare reform.

On the bright side, it’s just me. Insuring a family is crazy expensive.