I had to dip into this for a few years. In the U.S., an ACA ("Obamacare") plan is $500-$2000 a month, depending on the state, with extra assistance for low incomes. There are bronze, silver, and gold plans with higher tiers decreasing copays and annual out-of-pocket maximums but significantly bumping the monthly dues. Private insurance also exists but almost universally has inferior terms (payout caps, gaps in coverage, weasel wording, etc.).
In my experience, for a typical ACA bronze plan, the annual maximum out-of-pocket payout is roughly $20,000, and the monthly dues are about $700, meaning worst case you're looking at ~$30,000 out pocket for a year. Add about 50% if you have children. Sadly, none of this is tax-deductible as far as I can tell.
Another issue with ACA marketplaces that I found was they churn a lot; every year when you have to renew coverage you can have an entirely different set of providers and plans. The constant enrollment and transfer paperwork becomes non-trivial, even without trying to qualify for an income-based discount.
The annual max family out of pocket is legally capped at $18,200, but most plans will be less than that.
>Another issue with ACA marketplaces that I found was they churn a lot; every year when you have to renew coverage you can have an entirely different set of providers and plans.
This is not my experience, I have been able to purchase the same BCBS health plan from the same insurer for many years.
In NJ, I would budget $30k per year for premiums for a gold level plan for a family of 4, assuming you are not getting any premium tax credits. Of course, out of pocket maximum is up to another $18k.
And if you are working for a small business that does not offer a group health plan, you should be able to get premiums reimbursed from employer with pre tax income:
If you have a high-deductible health plan, generally you can open an HSA account, which does allow for medical expenses to effectively be tax-deductible.
There are a bunch of restrictions and loopholes though. I once opened an HSA and then actually had to close it because it turned out my insurance plan had *too* high of a deductible to be eligible, go figure.
COBRA is for temporarily keeping employer provided healthcare after leaving a company and is basically a non-option except as a short term bridge to a new employer provided plan. I believe independent workers generally go to the health care exchanges and buy a private health care plan. Rates vary wildly by state, coverage details, and your age but I've recently looked in Washington state for midrange (silver) plans and they are around ~$400 a month (with no dependents).
I know people who surfed the COBRA wave - ie, joined full-time for a company for a month every year or two to keep COBRA going and then going back to contract work in the interim.
Normally it just means you get to pay the full cost of your health plan, which is often double or more what you were paying as an employee. It's just so you're not immediately ineligible for the employer's group.
Unless yours is also paying the premium those 18 months, which I've never heard of but I suppose is possible.
You can find a bronze plan on the healthcare market place for < $300/month. I'm self employed, paying around that for an HSA eligible plan, and haven't seen a doctor in 5+ year. Mostly keep it for the HSA account/investing, or I'd forgo it. If your spouse has a FT/W2 job, they'd likely get solid health insurance to cover the family.
I mean Obamacare exchanges exist but (as the insurance industry wants) it mostly sucks in terms of costs/coverage. COBRA is still better because you get tied to your former employer's risk pool even though you pay employer share of healthcare costs.
You can buy the same health insurance on healthcare.gov that businesses buy from the same insurance companies.
They even have metal levels so you know you are getting the same actuarial value. A silver BCBS plan from an employer is basically the same coverage as a silver BCBS plan from healthcare.gov.
False in my state, at least. And ours is on the healthcare.gov fallback (the state didn't set up an exchange).
The state of things here:
1) Most insurers don't offer anything on healthcare.gov. Most years, there are two providers on there, though sometimes one will drop off and another will come in, so it does vary a little year-to-year.
2) Zero insurers here offer individual plans outside hc.gov, so if they're not on there—and most aren't—you can't get one. Seriously. Ask them, ask insurance brokers: "nope, no insurers offer individual plans in this state anymore—if it's not on hc.gov, it doesn't exist"
3) The networks for the hc.gov plans usually suck compared to the ones available to businesses. This may not be captured in the "actuarial value".
4) I've also never seen an employer mention which metal-level their plans is so you can compare them, but maybe they can find out if you ask. I know for a fact the top-level employer plans cost quite a bit more than the best-available plans on hc.gov (and they're waaaaaaay better)
You mention BCBS. They do operate in this state. They are not on hc.gov (not the version we see, anyway) and will not sell you an individual plan outside of it, either.
BCBS is also a network, not the insurance company. So you never buy insurance from BCBS, but rather whichever insurance company has chosen to be a franchise, such as Regence, Horizon NJ, Independence, Elevance, etc.
Yeah, my impression is that healthcare exchange plans are much better and cheaper in blue states than out here in flyover country. It's a shitshow out here. A wallet-emptying shitshow. Not exactly worse than before—at least stuff like pre-existing condition exclusions are gone—but definitely not good either.
In my experience, for a typical ACA bronze plan, the annual maximum out-of-pocket payout is roughly $20,000, and the monthly dues are about $700, meaning worst case you're looking at ~$30,000 out pocket for a year. Add about 50% if you have children. Sadly, none of this is tax-deductible as far as I can tell.
Another issue with ACA marketplaces that I found was they churn a lot; every year when you have to renew coverage you can have an entirely different set of providers and plans. The constant enrollment and transfer paperwork becomes non-trivial, even without trying to qualify for an income-based discount.