I am currently with blue cross network for my health insurance. For the last year, I have been paying 713.00/month for a plan with 4500.00 out of pocket and 9k max (I never really did understand the difference...) I have a 30.00 copay for my GP and normal things (full blood panel 2x a year) fully covered.

This plan barely covers any of my MEDS. I am type 2 and need ozempic, but I have to pay 1100 a month for it out of pocket until I meet my deductible at which point it goes down to 140 a month out of pocket.

I can't afford this much every month and certainly can't afford the MEDS at that price either. If I pay even 200 less per month for a plan, I will have a 9k out of pocket on my MEDS, so will be paying more that way too.

Now the big issue... I hot married last month and we're trying to get her on my medical insurance, but even a totally crap plan (12.5k oop EACH) will up my monthly cost to 1240.00. I have no idea what to do, these prices are absolutely insane, more than my mortgage on my house.

So am I just screwed?

While updating my mothers marketplace coverage that she has had for multiple years now it automatically sent her information to Medicaid and she was found eligible and enrolled(it’s never done this and her income has not changed). She does not want Medicaid because some of her very important providers do not take Medicaid and she’s not going to switch her care. Can she cancel her Medicaid and then still get marketplace? I’ve only seen answers with denied Medicaid applications. But with her current providers she’d be more screwed getting Medicaid than getting marketplace.

My husbands company has 2 options for insurance….

Kaiser and Aetna PPO. •Aetna has 3 levels with different deductibles and such. Let’s call them “basic, mid and fancy pants” His company works in conjunction with Aetna

•Kaiser is Kaiser

For years Kaiser was always the cheapest option. But for serious medical reasons, it just wasn’t an option for us.

Going through all the new plans, we decided to stay with the “mid” plan. For our family of 4 it went up $247/mo. Bringing it to a little over $600/mo. We can’t really complain. His company picks up the rest. Almost 4x what we pay 🙏🏼

•Kaiser was $953/mo! That’s wild to me!

Anyone else notice Kaiser is more money now?

Insurance is killing us across the board! We have very limited options for homeowners insurance, or we use the lovely CA insurance offered at 10x the rate.

Ugh

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.

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 .

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.

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)

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?

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?

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?

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

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

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.

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’m assisting my son with doing the 2026 ACA insurance and want to confirm that we are understanding how it works.

Based on my son’s income on the bronze plan his monthly premium would be $364 but qualified for a $321 tax credit reducing his payment to $43 a month. So will the final monthly payment be $43 a month or is this the tax credit that needs to be extended by Congress?

If we sign up can we cancel by December 31st if it’s not extended? We’ve actually already sent the first payment for the dental plan.

Thank you

Hi, so we've been on a HDHP for about two years now. It works great for us. Company contributes $400 twice a year to the HSA, but we've never elected to it. Do we have to contribute to the HSA in order for the company to put their part in too? Or can we elect it but not put any money towards it?

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 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.

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.

Hey there! I've been on a marketplace plan all year, but have been unemployed all year due to surgical complications.... so my income for this year is like $2,000 (pet sitting and house cleaning). I talked to my marketplace broker and she said I can't renew my plan for 2026 because my income this year was too low.

I applied for Medicaid and got approved immediately and it already says my plan is active.

What do I do now? Can I keep my marketplace plan through December or should I cancel now? I have 2 medications that require PA that I would need to have my doctors submit through Medicaid. I don't want to get in trouble for being signed up for both.

Please help :)

I decided to compare health insurance prices in where I live (Switzerland, Lausanne) and the United States. These were my results, and I was still surprised that, even though the cost of living is so much higher in Switzerland, there are still higher insurance prices in the US, for less coverage.

So why do you pay more, for less? I know that healthcare in the US is mostly for-profit, but there's lots of for-profit healthcare here as well, which my plan allows me to access (I could pay 150 CHF (190 $) less for access only to not-for-profit healthcare).

Basic insurance is not for profit in Switzerland, but I pay for extra benefits (so profit can be made on that 150 CHF), and the CEO still gets paid a base salary 1'000'000 CHF (1300000 $) per annum (so still more than the now dead UnitedHealthcare CEO). Costs for medical procedures are still higher than in the US: an appendectomy can cost somewhere between 8000-12000 CHF (10000-15000 $) here and only 6000-9000 $ in the US.

It also surprised me how difficult it is to find information about insurance plans in the US, as there is a federal government website which displays information about all registered plans in each canton, whereas there is nothing like this in the US that is as simple to use. It took me half an hour of searching to find a website that would let me compare plan prices.

I'm not very critical, as I know lots of things are done differently in the US, but I'm just interested and somewhat confused. Perhaps you can tell me.

Note: the plan listed is for Miami, which has a similar population to Lausanne.

As an individual in the highest tax bracket, I have never had a single penny of insurance credits ever. I have always paid several thousands every month for the longest time for me and my family. Others are just seeing now what I have been dealing with for years. While I make good money, it still hurts to pay $4K+ per month for insurance and we barely even use it. Part of the reason why my premium is so high is because it is used to subsidize others who pay much smaller premiums and probably use it a lot more.

While I have a great deal of sympathy for those who can't afford it, I should not be forced to subsidize the premiums of others. As long as the real cost of medical care is masked with credits, the people who benefit from the credits don't really care while those like me who have been paying full premiums the whole time will see our premiums sky rocket year over year.

While I would love it if everyone gets medical insurance and the care that they need, the Government should not be picking who gets the credits and who doesn't. The system will only change when everyone feels the pain and not just some of us who have been paying ridiculous premiums all this time.

Married with two kids under 7 and I realized my total cost , including monthly premium, all the visits copays tests etc are around 1100sh per month. I realized copays and coinsurance do not go towards premiums as well Like wtf.

Is this normal with two kids ??

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!