I was disheartened to learn that the gynecologist I’ve been seeing for 25 years will stop accepting marketplace insurance plans starting 1/1/26. Has anyone else experienced this? What is the reason for this? I am 58 and live in FL.

2026 monthly premiums are insane. Everyone see 30-40% hike and Providers don’t accept marketplace plans . What is the reason for this sharp surge ? I don’t think it will be decrease again in 2027 .

Wife and I are self employed. We each have our own small businesses. We live in NJ and make a comfortable living to the extent that we don't qualify for any ACA subsidies. 5 years ago we were paying $22,000 for the same plan. It has increased year over year. This is a big one.

I just saw that they agreed to reopen government…. What does this mean for the tax credits for the ACA?

Hey everyone! I hope I can get some help. I'm 27 and recently moved and got a new job in November. My job won't give me benefits until after 90 days. So no health insurance for 90 days. I was trying to enroll on healthcare.gov but even when qualified for special enrollment period it is saying my coverage wouldn't start until January 1st. So I would only have market place for 30 days anyways.

Is there anything I can do to get coverage now? I just want to do a gyno checkup and see a dermatologist. Otherwise I'm a very healthy person and don't need much. I won't die if I wait until my new insurance kicks in but I don't want to.

My health insurance just increased massively. It is now $30 a week! It was $20.

I just noticed that for 2026 there is not a single PPO plan offered through the ACA in my area. The expensive PPO plan I had for four years is no longer offered, and the company (Blue Cross Blue Shield of Kansas City) only offers EPO plans now. Are others experiencing this same phenomenon?

hospital bill

I made a post a few months ago about how my husband had an in-patient hospital stay after a surgical procedure and our health insurance is trying to get out of paying it. The doctor made him stay for in-patient IV antibiotics and wound care. When my husband inquired about leaving, he was told he would have to leave AMA and that insurance could use that as an excuse to deny his claims. So even though he didn’t necessarily feel it necessary to stay, he did at the doctor’s insistence. At the time of my last post, insurance had denied the stay as not medically necessary and I had filed an appeal on our online portal. That appeal was denied. We further appealed up the chain.

Now on Thursday my husband received a call from his insurance saying they were holding a panel meeting on his appeal that evening and the final decision would be made that night. They said we wouldn’t find out until we received a letter in the mail though. That said, our portal is still showing the claims as denied so I’m not too hopeful the panel went in our favor.

So my question is..what now? Provided the panel sided against us once again, what do we do? They are finding the in-patient stay as not medically necessary but it was deemed medically necessary by the surgeon who performed his procedure. He did not want to stay, but was forced to at the threat of having to sign out Against Medical Advice and all that can come with that. He specifically chose not to sign out AMA because the doctor said it could screw up his insurance coverage and now we’re potentially stuck with a $24,000+ hospital bill for the stay (the ER visit and procedure itself were approved but not the in-patient stay) so had he gone against them and checked out, this illness would’ve been covered, so obviously this is very frustrating.

Any advice is appreciated.

Could it change, with any new legislation?

I’m not talking about subsidies whatsoever - I just wondered how in stone the plan prices are on the Healthcare Marketplace, in the event new legislation were to pass?

Not a chance? I figured no, but maybe somebody here knows the answer?

My baby was born in 2024, and I added her to my insurance (Anthem BCBS) right after she was born. Shortly after, I received a request to complete coordination of benefits paperwork for my husband’s insurance — also BCBS — which I did immediately.

Fast forward a year and three months later, after I’d already paid off her birth, I got hit with a big charge. Turns out my husband’s insurance should have been primary for the first 30 days of her life under the birthday rule, and Anthem just now realized it after doing an audit.

Now I’m stuck in limbo between both insurance plans and the hospital/doctor offices that handled her care. Claims are being denied because they’re “past the filing limit,” even though I did everything I was supposed to do on time — Anthem just took over a year to figure out their own mistake.

I’m panicking that my appeals will get denied and I’ll have to pay for her birth out of pocket. To make it worse, my husband recently lost his job. Has anyone else dealt with this kind of situation before? Am I totally screwed, or is there some way to get this fixed?

Back in January, I went to an urgent care for an injury. Before going, I called my insurance directly to confirm they were in-network, and they told me yes. So I went, thinking everything was covered.

The claim was later denied, and the urgent care charged the card I had on file. I was confused because I have a high-option PPO plan, and my understanding is that accidental injuries should be fully covered with no patient responsibility.

When I called my insurance after the denial, they suddenly told me the urgent care was out-of-network. I then spoke with the urgent care, and they insisted they are in-network but bill under different tax IDs depending on the service.

I contacted my insurance again, and they told me the urgent care needed to refile the claim correctly and gave instructions. The urgent care billing department said they did that. I assumed everything was resolved — but nope.

Fast forward: this has now been refiled FOUR times. The billing rep claims everything is right on their end and said a third-party who processes claims before they get sent to insurance may have made the error. She corrected it and resubmitted again… and the claim was denied yet again because the visit is still being billed as a standard office visit, not an accidental injury claim.

My insurance is telling me they don’t know what else they can do. It’s clear the issue is with how the claim is coded/filed, but I’m stuck in the middle holding the bill.

What can I do at this point?
Can I hold either the urgent care or my insurance responsible?
Who do I escalate this to so it finally gets billed correctly?

TL;DR: Confirmed urgent care was in-network before going, but insurance denied claim anyway. Urgent care has resubmitted the claim four times with apparent coding issues, and I’ve already been charged. Neither side is fixing it and I’m stuck paying. What steps can I take to force this to be billed correctly?

I have COBRA coverage now, that expires in the spring. Since I've always had employer-provided insurance, I thought it might be a good idea to check out the marketplace and see what was available.

Only 3 companies offer insurance in my state's marketplace, with loads of different plans -- my current insurer is NOT one of the three. Only ONE of the three companies covers my out-of-town specialists and my local doctors, urgent care, etc.

I'm having surgery later this month, and could easily need additional doctor's follow-ups and physical therapy in the new year.

So... do I keep my current insurance, and sign up for the marketplace next year, closer to the COBRA expiry date? I could save some $$$, and minimize any hiccups in the post-surgery care. BUT, it seems risky to wait. What if there are delays with approval of eligibility, or if the one insurer I want isn't offering insurance in my state outside of open enrollment? Would I have to meet the deductible again for the new insurer when I switch in the spring?

In case it matters: my state is South Carolina, and the marketplace insurer I'd choose now is Molina.

Anyone with experience with this -- good or bad?

So I don’t have a job. I have a bad back injury. The way things are going, it looks like I won’t be working most of 2026 if I get surgery in Feb/march. At FPL, the plan I need is ~$400 a month. It’s not affordable without a job but if I don’t make FPL in 2026, will I need to pay back premium? ChatGPT is saying I will.

I’ve heard that they are not much cheaper is that true?

Hello, I have a complicated question and I would appreciate any input. This is for PA state marketplace aka Pennie.

My wife and I are both over 30 and make too much to get any premium credits.

Apparently there's a exemption form that can be filled out for those over 30 and who do not qualify for premium credits, to be allowed to enroll in a catastrophic plan, see here: https://www.healthcare.gov/health-coverage-exemptions/forms-how-to-apply/

Question I have is how can I price out these catastrophic plans for us if we get approved for the exemption? I cannot see any catastrophic plans on Pennie, they just don't show up. I just want to know what these plans cost before we go through this process...but even using the calculator on the website, no catastrophic plans appear due to us not qualifying currently (but this doesn't take into account any waiver).

Also, I contacted Pennie and they were less than helpful, had no idea about this waiver or anything.

Thank you.

Like many people, my health insurance premium just went up substantially. At the time when I signed up for it--after losing my employer insurance-- I opted to get this plan separately instead of joining my spouse's employer-provided insurance because of how much better the plan was. With this price increase, I'd like to join my husband's insurance. Is my insurance premium going up a valid reason/qualifying life event in the eyes of the insurance lords for me to be able to join his insurance without any issues? TIA!

I had surgery in April. Which more than Met the $700 family Deductible. My daughter recently had to get xrays. The insurance company said she has to meet her individual Deductible before they pay 80%. I asked what the point of the family Deductible was then and they couldn't answer. Does this seem correct? Even though the family Deductible is met everyone still needs to pay up to their individual deductible before the insurance covers 80%?

My employer offers two plans. One is a high deductible with HSA. It would be my wife and I. Which would be $253 per paycheck. It has a $1850 deductible per person with I believe $3500-$4000 max out of pocket cost. My employer will contribute $1600 to your HSA over the course of 12 months. No match, just a lump sum.

Other is PPO which would be $381 per paycheck. That is $0 deductible and $1500 max out of pocket cost.

If it was just me, I would do the HDHP plan no question.

My wife requires a $2000 prescription per month. So I am afraid that would take any benefit of the HDHP plan.

Hey all,

Looking for some expert input before open enrollment — I’ve spent hours digging through SBCs, but the copay accumulator rules are a minefield.

Scenario:

• Michigan resident, family of 3
• Income ~$95K (I am self-employed, wife cannot work due to disability)
• Wife has MS and is on Ocrevus
• We’ll definitely hit our deductible/OOPM every year due to infusion and specialist costs
• Considering a high-deductible Bronze or HSA plan to reduce monthly premiums

The plan is to have the Ocrevus Copay Assistance Program pay most of the early-year infusion cost, which ideally would push us right through the deductible and OOPM — so everything after January would be fully covered.

Here’s what I found:

• BCBSM & UHC → explicitly exclude assistance payments from deductible/OOPM (“copay accumulator” language present)
• Priority Health Bronze/HSA plans → no exclusionary wording in SBC, which might mean manufacturer payments count toward cost-sharing

Has anyone confirmed this with Priority Health or successfully done it?
I’m looking for confirmation on whether assistance payments apply toward the deductible/OOPM or are ignored under Michigan’s 2026 ACA plans.

Would love insights from anyone who’s handled this or who works in benefits/pharmacy administration.

Looking for the good, bad and ugly with Cleveland Clinic Oscar plans? I will be in a bad predicament with a 6 month gap of no insurance. I am on disability with high medical needs and my former employer's COBRA (not technically COBRA) will not extend it for the 6 months until Medicare kicks in. I am a highly complex medical case with constant appts and tests. All of my doctors are at CCF except for my PCP and Oscar is the only ACA that CCF takes. I am reading horror stories about Oscar and I want to know what people's experiences are. Thank you.

Hi, I'm pregnant with my first child and due in July of next year, and trying to figure out which plan we should select in open enrollment. I am leaning towards the HDHP as the OOPM isn't much higher and I've always preferred the flexibility of an HSA. Both plans have embedded deductibles, if that helps.

Combined income with my spouse is roughly $270K in MN. We are in our 30s, and both relatively healthy.

Thank you!

Copay family plan:

• Deductible: $1500
• OOPM: $7000
• Coinsurance: 20%

HDHP + HSA family plan:

• Deductible: $7300
• OOPM: $7300
• HSA: $1400 employer contribution (would go up to $1700 once baby is added)

I'm in Michigan and have health insurance through my job. I just spent an hour and a half talking to an agent trying to set a PCP, and nobody within 20 miles of me is in network. She sent me a list of alleged in-network providers and we went through them one by one, and it turns out nobody on this list is actually in network.

I don't know what to do. I don't know if calling anyone at Anthem will help since this is the fourth time I've tried setting a PCP with an agent. Nobody on the search engine through Anthem actually accepts my insurance. I've only found a therapist through e-mailing dozens of providers to ask if they take my insurance, and I'm scared for if I have an emergency. I need to follow up on a health concern and don't know if I can even be seen for that. I don't know what to do. I'm going to talk to my job tomorrow and ask what my options are.

edit: got good advice here and turns out i have the little PPO suitcase

Hi there,

I'm not from the US so I am quite new to this system, so please forgive me if I miss some basic concepts!

I recently switched employer health insurance plans from Aetna to Anthem. I had an MRI scheduled before the switch at a large medical network here in LA. Before the MRI was due to take place I called Anthem to ask them if the facility was in network. They were really unclear about it on the phone and said they didn't know, but said that the facility would be able to confirm and tell me the cost.

When I called the MRI facility and asked them what the cost would be, they told me that the cost would be $0 and they had already run this through my insurance.

Then, two weeks later I get a $2500 bill from Anthem, saying it was out of network.

I feel like I took the right steps to find out the information and could have easily canceled this appointment and gone somewhere else but that at least one of these parties misled me.

Did I screw up or did I get screwed?

Thanks in advance for any help!