While out-of-pocket costs in the ACA marketplace are definitely too high for too many enrollees, in practice silver plans rarely have an actuarial value of 70%, since more than 90% of silver plan enrollees in 2024 also had the Cost Sharing Reduction (CSR) subsidies that attach to silver plans at low incomes. More than 90% of those with CSR-enhanced silver plans have coverage with an actuarial value of 94% or 87% -- higher than in most employer-sponsored plans.
For sure. OOP is way too high for too many in the marketplace -- and even 94% AV leaves too much exposure for people with income under 150% FPL.
In Texas and some other states and regions, gold plans are cheaper than silver. But even gold plans have deductibles averaging north of $1500 and out-of-pocket maximums usually over $7000.
I served 68-71 USMC. Slightly over two years of that stint was out of Camp Lejeune of which noise months were in Cuba. It was only recently the USMC admitted the water was tainted at LeJeune. I went from having to pay to no charges.
Except any appointment I want at Tucson is months out. So, I call them and we pick a commercial doctor and I go there for treatment. The charge and the VA discounts in ~70% and pays them the balance. It works but it is weird.
I ran into one issue. The doctors checked out my issue and then stated they want to do a Comp. blood test, cholesterol workup, and blood pressure whatever. The blood test was done two months prior so I said no. My cholesterol is below the limit at ~114 without drugs. Blood pressure is usually 110 over 70. They were attempting to upcode me and I told them "no."
Talked to the VA and changed outside commercial doctors. VA is short of staff
While out-of-pocket costs in the ACA marketplace are definitely too high for too many enrollees, in practice silver plans rarely have an actuarial value of 70%, since more than 90% of silver plan enrollees in 2024 also had the Cost Sharing Reduction (CSR) subsidies that attach to silver plans at low incomes. More than 90% of those with CSR-enhanced silver plans have coverage with an actuarial value of 94% or 87% -- higher than in most employer-sponsored plans.
True. But a third of people who sign up for ACA plans buy the bronze plans, which have low upfront premiums but higher out-of-pocket costs. See https://www.kff.org/affordable-care-act/state-indicator/marketplace-plan-selections-by-metal-level-2/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
For sure. OOP is way too high for too many in the marketplace -- and even 94% AV leaves too much exposure for people with income under 150% FPL.
In Texas and some other states and regions, gold plans are cheaper than silver. But even gold plans have deductibles averaging north of $1500 and out-of-pocket maximums usually over $7000.
Merrill:
You may already know this.
I served 68-71 USMC. Slightly over two years of that stint was out of Camp Lejeune of which noise months were in Cuba. It was only recently the USMC admitted the water was tainted at LeJeune. I went from having to pay to no charges.
Except any appointment I want at Tucson is months out. So, I call them and we pick a commercial doctor and I go there for treatment. The charge and the VA discounts in ~70% and pays them the balance. It works but it is weird.
I ran into one issue. The doctors checked out my issue and then stated they want to do a Comp. blood test, cholesterol workup, and blood pressure whatever. The blood test was done two months prior so I said no. My cholesterol is below the limit at ~114 without drugs. Blood pressure is usually 110 over 70. They were attempting to upcode me and I told them "no."
Talked to the VA and changed outside commercial doctors. VA is short of staff