2 ms·

They’re substantially worse. ACA plans have worse networks, higher deductibles, and higher max out of pockets. Imagine if they didn’t? No employer under 50 emp

by koolba 7y ago

They’re substantially worse. ACA plans have worse networks, higher deductibles, and higher max out of pockets. Imagine if they didn’t? No employer under 50 employees would bother getting group coverage as they could get better coverage for less via the QSEHRA route.

tptacek 7y ago
I had ACA coverage before we offered group health insurance to our employees and did not find these things to be true: the network for my ACA silver plan was the same (fine) network as we get now, the deductible options are the same (but I was opting for higher deductibles to go with an HSA on the ACA plan, which is what I think most startup employees should do), and the out-of-pocket costs were the same. I suspect that a lot of people alarmed by ACA costs are really just observing that their employers were subsidizing a lot of stuff for them. That's true! Employers who give you group coverage directly are usually giving you a shadow pay raise in the background to make the numbers look better! But for startups, the difference between the individual market and the small group market probably aren't usually that big --- as you'd expect, since a small startup isn't really aggregating much risk.
- runako 7y ago
  My POV (from GA) is that this is going to be highly state-dependent. For example, the first couple years of the ACA there were N vendors providing ACA plans materially similar to small group plans. Today, most of those vendors have abandoned the individual market. So the quality of plans/carriers available to ACA purchasers vs small groups is vastly different today. In 2015 it was the case the $500 in the individual market was roughly equivalent to $500 in the small group market. Today, $500 (or $1000) spent in the individual market won't buy you the same coverage as $500 in the small group market.
- simmons 7y ago
  As a sibling comment points out, the value of ACA plans may vary quite a bit from state to state. I don't know how it is elsewhere, but here in Colorado the major insurance companies only provide a special, lousy version of their product on the marketplace. It's not uncommon to find health providers that claim to take Anthem or Cigna insurance, for example, only to show up and be told that "Anthem Pathway" and "Cigna Connect" don't count. Astonishingly, they don't seem to be willing to sell regular plans to individuals for any amount of money. (Source: self-employed.)
  - tptacek 7y ago
    That's common in the small-group market too: the insurers have a network they advertise, and then smaller subset networks they offer for a lower price. So, I know it's true that you have to be careful not to accidentally subscribe for the small-network version. It's definitely not the case in Illinois that the large-network plans aren't available on the exchange; they are. Couldn't tell you about California or New York, though.
lotsofpulp 7y ago
My healthcare.gov options were easily better than employer offered options. Especially if an employer doesn’t offer an HSA plan, that’s tens of thousands of dollars out of my pocket.

by koolba 7y ago

tptacek 7y ago

I had ACA coverage before we offered group health insurance to our employees and did not find these things to be true: the network for my ACA silver plan was the same (fine) network as we get now, the deductible options are the same (but I was opting for higher deductibles to go with an HSA on the ACA plan, which is what I think most startup employees should do), and the out-of-pocket costs were the same. I suspect that a lot of people alarmed by ACA costs are really just observing that their employers were subsidizing a lot of stuff for them. That's true! Employers who give you group coverage directly are usually giving you a shadow pay raise in the background to make the numbers look better! But for startups, the difference between the individual market and the small group market probably aren't usually that big --- as you'd expect, since a small startup isn't really aggregating much risk.

runako 7y ago
My POV (from GA) is that this is going to be highly state-dependent. For example, the first couple years of the ACA there were N vendors providing ACA plans materially similar to small group plans. Today, most of those vendors have abandoned the individual market. So the quality of plans/carriers available to ACA purchasers vs small groups is vastly different today. In 2015 it was the case the $500 in the individual market was roughly equivalent to $500 in the small group market. Today, $500 (or $1000) spent in the individual market won't buy you the same coverage as $500 in the small group market.
simmons 7y ago
As a sibling comment points out, the value of ACA plans may vary quite a bit from state to state. I don't know how it is elsewhere, but here in Colorado the major insurance companies only provide a special, lousy version of their product on the marketplace. It's not uncommon to find health providers that claim to take Anthem or Cigna insurance, for example, only to show up and be told that "Anthem Pathway" and "Cigna Connect" don't count. Astonishingly, they don't seem to be willing to sell regular plans to individuals for any amount of money. (Source: self-employed.)
- tptacek 7y ago
  That's common in the small-group market too: the insurers have a network they advertise, and then smaller subset networks they offer for a lower price. So, I know it's true that you have to be careful not to accidentally subscribe for the small-network version. It's definitely not the case in Illinois that the large-network plans aren't available on the exchange; they are. Couldn't tell you about California or New York, though.

lotsofpulp 7y ago

My healthcare.gov options were easily better than employer offered options. Especially if an employer doesn’t offer an HSA plan, that’s tens of thousands of dollars out of my pocket.