ACA Healthcare Plans

[Anonymous]

I'm looking at enrolling in an ACA plan for 2024, and there are 70+ plans to choose from with premiums ranging from zero to $1000+. Can anyone share tips for selecting a plan?

[Anonymous]

Not really. I was a self-pay with Kaiser, so I was pleased that I could get similar coverage with Kaiser through the ACA — while paying significantly less.

[Anonymous]

Are you okay with an HMO or do you want a PPO?

Do you have doctors you want to continue to see? Check to see if they participate in the plans you're considering.

Do you want to be able to see specialists without a referral? I find this particularly important nowadays when it's so hard to get in with a PCP, but then I'm older.

Depending on what state you're in, that may narrow your choices to a manageable handful. In DC, it's basically a choice between Kaiser and CareFirst, and once you choose with company and style of plan (Kaiser is HMO-only), you just need to do the calculation about cost of premium vs. level of coverage, based on your general health and budget.

[Anonymous]

From Healthcare.gov, the federal government's website about the ACA marketplace:

3 things to know before you pick a health insurance plan
https://www.healthcare.gov/choose-a-plan/comparing-plans/

And this Nerdwallet resource isn't about ACA plans in particular, but much of the advice still applies:

How to Choose Health Insurance: Your Step-by-Step Guide
https://www.nerdwallet.com/article/health/choose-health-insurance

[Anonymous]

PP here. And this resource from KFF (the Kaiser Family Foundation, though not affiliated with Kaiser Permanente):

FAQs: Health Insurance Marketplace and the ACA

https://www.kff.org/faqs/faqs-health-insurance-marketplace-and-the-aca/?view=1

[Anonymous]

Use the tools in there to enter your doctors and prescriptions to see which are covered by each plan.

That's what I do each year during the enrollment period. I always skip the bronze plans altogether because I've found they don't meet my needs. I usually read through the Silver plans and select a few to compare using their compare tool. I'll then do the same with the Gold plans (or do they call them Platinum? I forget.) and compare those. Then compare the final few Silver vs. Gold plans.

I've always gone with a silver plan for the past 8-10 years. I have not had any issues with any silver plan. The most I have ever paid was $320/month. I had emergency surgery a few years ago where the bill was $42k and the portion I ended up owing was $1800.

[Anonymous]

Be careful with deductibles and out-of-pocket expenses. Plan on double the amount the plan requires. The reason is that if you have major medical expenses late in the year (say October or November) and you do satisfy those, they reset on January 1.

[Anonymous]

Thanks for the responses and helpful information!

[Anonymous]

When you filter for which plan has the best quality of care, you end up with Kaiser plans.

We've been at Kaiser for years. It's been fine so far: our experience is that the pediatric specialists seem to be better than the adult ones. I'm not enthused with my endocrinologist, but one of my children has needed to see multiple specialists for an auto-immune disease, and all her doctors have been top-notch.

[Anonymous]

A thing to remember, at least in Virginia, is that NONE of the ACA plans cover normal medical care across state lines. That means if you have a doc in DC, you’d have to switch. It’s also one of the reasons I’m paying for COBRA when I retire.

[Anonymous]

Anonymous wrote:A thing to remember, at least in Virginia, is that NONE of the ACA plans cover normal medical care across state lines. That means if you have a doc in DC, you’d have to switch. It’s also one of the reasons I’m paying for COBRA when I retire.

OK that’s just not true. The plans cover regionally in the DMV. Anthem/Elevance is sold in VA but not DC and MD but they contract with doctors in DC and MD. Same for United, which is not sold on the individual market in DC and MD but is on the small group platform in DC. And there is nothing “special” about the ACA plans vs the other commercial plans.

[Anonymous]

we used eHealth.com and they sorted out all our choices, let us input Rx and our pediatrician and allergist and my Gyn. So much easier than healthcare.gov and the state exchange

[Anonymous]

Anonymous wrote:A thing to remember, at least in Virginia, is that NONE of the ACA plans cover normal medical care across state lines. That means if you have a doc in DC, you’d have to switch. It’s also one of the reasons I’m paying for COBRA when I retire.

This does concern me, and even more so I'm concerned about care outside of my home county but within the same state. I think the ACA plans are designed for care only in your local area and outside of that (outside network) is not covered? Anyone have experience with ACA coverage in one county but getting care in another?

[Anonymous]

Anonymous wrote:A thing to remember, at least in Virginia, is that NONE of the ACA plans cover normal medical care across state lines. That means if you have a doc in DC, you’d have to switch. It’s also one of the reasons I’m paying for COBRA when I retire.

COBRA is great, but it runs out in 18 months. Will you get Medicare then? I had to do COBRA and now ACA. I get Medicare in just over 2 years.

[Anonymous]

Anonymous wrote:

Anonymous wrote:A thing to remember, at least in Virginia, is that NONE of the ACA plans cover normal medical care across state lines. That means if you have a doc in DC, you’d have to switch. It’s also one of the reasons I’m paying for COBRA when I retire.

COBRA is great, but it runs out in 18 months. Will you get Medicare then? I had to do COBRA and now ACA. I get Medicare in just over 2 years.

That is why we are waiting to retire until DH is 18 months from 65. I will still have to go on the ACA for a while but we thought it would be easier if it was just one of us. Plus, we will be in a different state then.