Private vs ACA insurance

[retire48in2018]

Is there any meaningful private insurance outside ACA? I have started looking and everything that I am finding has significantly limited indemnity.

Like a limit for cancer of $72,000.

Anyone know?

 

[Aerides]

Right, you will only find odd lame policies outside the ACA. The exchange is really just that - insurance providers now offer plans via the marketplace, so you know what you're getting.

Off-market place is only for temporary plans, or emergency only type plans, not for bread and butter health insurance. Everything that used to be considered "private" (ie, direct to consumer, no employer middleman) moved to the exchange after adapting plans for compliance.

The ACA is really the broad law, and it applies to everything, even employer plans. So you would compare buying via healthcare.gov vs. the wild west.

 

[retire48in2018]

I don’t need all the extra stuff that got put into ACA

We’re looking for what was catastrophic insurance to shift the high $ risk, get the insurance prices for any visits and we can manage the typical yearly costs - to have an affordable premium.

Just hoping there is something not as expensive as the exchange stuff

 

[rodi]

I don’t need all the extra stuff that got put into ACA

We’re looking for what was catastrophic insurance to shift the high $ risk, get the insurance prices for any visits and we can manage the typical yearly costs - to have an affordable premium.

Just hoping there is something not as expensive as the exchange stuff

There are high deductible plans on the ACA. Look at the Bronze metal level. Look for plans that are HSA eligible. By definition they are catastrophic. They get you the negotiated rates and catastrophic coverage.

 

[RetiredHappy]

@Aerides. Not where we live. ACA plans are offered by mainly smaller no-name/unknown companies who are also Medicaid providers. Most top specialists here don't take these ACA plans. I buy an off-exchange private insurance plan which is more expensive than ACA and widely accepted by specialists.

 

[PaunchyPirate]

Right, you will only find odd lame policies outside the ACA. The exchange is really just that - insurance providers now offer plans via the marketplace, so you know what you're getting.

Off-market place is only for temporary plans, or emergency only type plans, not for bread and butter health insurance. Everything that used to be considered "private" (ie, direct to consumer, no employer middleman) moved to the exchange after adapting plans for compliance.

The ACA is really the broad law, and it applies to everything, even employer plans. So you would compare buying via healthcare.gov vs. the wild west.

That is not how it works in my part of Pennsylvania. In my county, we have 2 private market insurance providers that provide the full run of health insurance. One is the local Blue Cross/Blue Shield affiliate and the other is the insurance company arm of the dominant hospital system, UPMC. Together, they probably control 99% of the private health care policies in all of Western PA.

Both of them sell policies on the state’s ACA exchange. UPMC sells the same plans off of the exchange as well. Blue Cross sells the same plans off the exchange too, but also have additional plans off the exchange that are not sold on the exchange. For example, there are Blue Cross PPO plans that I can buy off exchange that I cannot buy on the exchange. Not just inferior policies. Both companies use the medal-level categories off and on the exchange. I’m pretty sure that these policies are ACA-compliant, just like employer-provided plans must be. But in order to get an ACA subsidy, I must buy via the exchange, so that’s disappointing since I’d like to have.

Blue Cross also sells catastrophic plans off exchange. They are clearly labeled as such.

 

[ShokWaveRider]

One of my BFFs has just had a Liver transplant while on an ACA plan. You do not want to see the bills, they are ludicrous. No cost to him other than MOOP. Drugs too. So I would go with an ACA plan over any other private one..

 

[Aerides]

That is not how it works in my part of Pennsylvania. In my county, we have 2 private market insurance providers that provide the full run of health insurance. One is the local Blue Cross/Blue Shield affiliate and the other is the insurance company arm of the dominant hospital system, UPMC. Together, they probably control 99% of the private health care policies in all of Western PA.
.

Well yeah there are a couple of states like PA and CA I think that do their own thing, separate from the exchange. I was generalizing, and yes as with any plan it depends somewhat where you live.

 

[MichaelB]

Not all health insurance plans meet ACA requirements. Those that don’t cannot be considered comprehensive coverage. Those that do all share some attributes important to us all, such as

Guaranteed renewable
No limit or ceiling on payouts or coverage
Essential health benefits
No cost sharing for recommended screenings
Pharmaceutical coverage

All ACA plans cover the same things. There are two difference between them. One, the breadth and depth of provider network. Less expensive plans mean smaller networks. Two, the cost sharing. That is, what part of the overall cost of health caree is paid by the insurer and how much is paid by us.

 

[badatmath]

@Aerides. Not where we live. ACA plans are offered by mainly smaller no-name/unknown companies who are also Medicaid providers. Most top specialists here don't take these ACA plans.

Same here. Basically appears useless. HMO style, limited choices.