Question about ACA Plans for those familiar ...

[IlliniDave]

Wow, the price of plans have gone up a lot in the last two years! Bronze plans I was pricing into my retirement planning that were $450-$550/month seem to go for $800-$1200/mo now.

My question is regarding "out of network" expenses on the ACA plans. All plans I was looking at for a state I'm interested in (IL) list out-of-network expenses as "not covered".

Questions are, if someone happens to know:

1. If there are out-of-network expenses, do they at least count against the out-of-pocket annual max? Sort of reads like they don't, but since it's not enrollment season it's hard to find any real information.

2. How do the plans handle medical expenses that might come up when someone is traveling/away from home and using out-of-network is the only viable option?

The ACA plans aren't all that much different than my employer's retiree group plans in that regard. The one I was looking at from my employer was $575/mo in 2019, and jumped to $1175/mo in 2020. I can knock that down to $825/mo (up from $505 in 2019) if UHC has a viable provider network in that part of Illinois.

I'm now for UBI!

[Frita]

When we had the bronze plan (but not in IL), any out-of-network expenses did NOT count toward the deductible or out-of-pocket maximum. It did not matter if we were somewhere where the only option was out-of-network, like a different part of the US or another country, or all local providers were out-of-network.

P.S. I hope your insurance doesn’t double again next year. The system is quite broken IMO.

[Lemur]

1.) They don't count.

2.) Unsure...but I know most digital nomads look for travel health insurance or global health insurance?

[Alphaville]

not sure about obamacare but thought i’d chime in

$1500/mo is the cost of my family’s very satisfying group plan, but the employer covers 2/3 of it, which makes the mental accounting less painful, but it’s just the old carmax balloon commercial scenario.

[IlliniDave]

Frita and Lemur,

Thanks.

Mine hardly went up at all this year or last year, which is why the premium jumps in the retiree and ACA plans were such a surprise.

Agree ACA is really broken if that's all a family could get for $2,000 bucks a month or whatever Bronze is for a family. By comparison my employers plan for active employees (modeled generally after ACA Bronze) sort of penalizes you for going out of network: a higher OoN deductible and higher cost sharing in the transition band between the deductible and OoP max. But the OoP max is the OoP max. To not have any means to cap the OoP max can be close to not having insurance at all.

For my planning it's frustrating I won't be able to get a look at the fine print until maybe open enrollment for 2022.

Alphaville, I'm happy with my employer's plan too. But I can't stay on it when I retire. They have a similar one with the same provider (UHC) for retirees (the ~800/mo option) but it's unclear if UHC has a viable network in North Central Illinois, and I can't get the fine print to see if the in-out/network is handled like the employee plan or like ACA until after pull the plug. The potential lack of a viable network means the COBRA option to keep my present plan for a few months after leaving will at least provide an OoP max while it lasts, but then I'm stuck.

My only hope is if the merger of corporate behemoths goes quickly and I am eligible to buy into retiree plans for the legacy businesses that do have a presence up there. Right now they haven't tried to merge any of that, both corps are operating on their pre-merger policies.

[jacob]

ACA is hard to generalize since individual cost depends on size/competitiveness of the insurance in the specific county one lives in. The other key issue determining the effective price is of course one's income and whether one lives in a medicaid expansion state. J+G recently wrote a nice overview here viewtopic.php?p=218586#p218586

That one's price can end up anywhere between <$100/month and >>$1000+ suggests optimizing for both income and location. In a way, it's like dealing with real estate taxes which also vary by ~two orders of magnitude depending on where one lives.

[IlliniDave]

Jacob, thanks, it's not really the cost thing that worries me, though its irritating, it's the huge "out of network" hole the plans seem to have wrt out-of-pocket max. While away from home you effectively have no catastrophic coverage.

In the county in question there were five ACA providers in 2019 and I think 49 total plans. Maybe not great but far better than some areas. Unfortunately by hanging around long enough to get an actuarially fair early pension, I screwed myself out of subsidies. I'll have to keep my fingers crossed that the lower-cost retiree plan is viable in Illinois, or that another that is viable appears as the merger settles. Of course with 30-60% or higher annual inflation of premiums, I might be panhandling before I'm eligible for Medicare.