[ericbarrett]

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.

[lotsofpulp]

>the annual maximum out-of-pocket payout is roughly $20,000,

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

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.

https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...

>Sadly, none of this is tax-deductible as far as I can tell.

It should be tax deductible if you are self employed:

https://www.healthinsurance.org/obamacare/self-employed-heal...

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:

https://www.healthcare.gov/glossary/qsehra/

[dml2135]

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.