First-Time ACA - Opinions Wanted

[TickTock]

After my retirement in March, we will go on ACA healthcare.

Our philosophy on insurance:
1. Primary objective is to avoid disaster (say, $100k in medical bills in one year)
2. Once #1 is met, secondary objective is to minimize likely total out-of-pocket costs.

We have several HMOs and one PPO provider (with ten different options). We've decided to use the PPO, as we do want to travel some, and even a local HMO out of network provider could easily wreck the savings of lower HMO monthly premiums. The lowest premium PPO is $3,650 more per year for the two of us than the lowest HMO premium. It galls me that healthcare premiums will likely be our single biggest expense category, but you deal with reality as it is rather than what you want to be.

Within the ten PPO options, the lowest premium is looking good to us. Without going into all the options (we'll do that offline again for a second time before making the final decision), the lowest premium plan has an $18k deductible and $18.9k out of pocket max. You basically burn through the entire deductible before getting any help from the plan (except for drugs).

To get into day one benefits, like fixed costs for PCP and Urgent Care visits, yearly premiums go up by $850. Deductible lowers to $14k; same out of pocket max.

Premiums go up from there. Max doesn't vary much; the top plan has 'only' a $1,500 deductible, but yearly premium is $6,500 more.

We're both in reasonably good health. Understanding that the best plan is only knowable after the fact and given our priorities, is there anything major that we're missing? This is new to me and while we've both researched the topic (DW is a very good researcher), we don't know what we don't know.

 

[USGrant1962]

We go with a Bronze plan with a high deductible and OOP max for the same reasons. We are reasonably healthy and want medical insurance, not medical pre-payment.

 

[Aerides]

Another factor is, if you have doctors you already prefer/like - are they in your plan? If you don't have any already picked, look at those available, and their closeness to you, whatever is important.

We are happy with a HD/HSA plan with reasonable premiums, Bronse, that has most of our preferred docs and hospital access. A PPO also so we can go straight to a specialist when needed (which, seems to be more often every year after retirement!).

 

[TickTock]

Another factor is, if you have doctors you already prefer/like - are they in your plan? If you don't have any already picked, look at those available, and their closeness to you, whatever is important.

Yes, this is part of the research that DW did - making sure our preferred PCP, specialists, and hospital networks are in network. I didn't mention that in the original post - thanks for pointing that out!

 

[TickTock]

A PPO also so we can go straight to a specialist when needed (which, seems to be more often every year after retirement!).

I read over this the first time - yes, the PPO doesn't require a referral to see a specialist while the HMOs do. An important point.

 

[GenXguy]

I read over this the first time - yes, the PPO doesn't require a referral to see a specialist while the HMOs do. An important point.

You may see an option for POS instead, as I do, and have.

With the Health Alliance Point of Service (POS) Individual plan, you receive two Policies under one Plan. You receive an HMO Policy that explains your in-network benefits and an Indemnity Policy that explains your out-of-network benefits.

 

[FLSUnFIRE]

HDHP Bronze PPO maxing out the HSA and paying out of pocket. If I travel far I'll get a travel policy. BCBS plan so have some coverage in the US.


Prior to FIRE, I made sure my docs were on the plan I was choosing and they've remained since '21, other than that, HSA eligible, and premium are my primary criteria. My deductible and max OOP are the same and I haven't come close to hitting them. Being able to contribute unearned income to HSA is helpful for MAGI too.

 

[TickTock]

You may see an option for POS instead, as I do, and have.

With the Health Alliance Point of Service (POS) Individual plan, you receive two Policies under one Plan. You receive an HMO Policy that explains your in-network benefits and an Indemnity Policy that explains your out-of-network benefits.

I don't see a POS option, but I'll go back and look specifically for it. Thanks!