Paging Oregon FIRE Residents Who Use ACA!

[iluvzbeach]

Hi fellow Oregon MMMers,

My question is specific to FIREd folks who live in Oregon and use ACA for coverage OR others who are familiar with ACA in Oregon and can help answer my questions.  I am looking to FIRE a bit earlier than I'd originally planned, which leaves me needing answers on the following:

• If I leave my employer in July and sign up for COBRA through the end of this year, will I be eligible for ACA subsidies in 2020 (provided income falls within subsidy limits?)  Or, would I be ineligible for ACA subsidies because I'd be terminating COBRA before it ran out?  I've read different answers on this and cannot seem to get a straight answer from the folks at the 800 #.  I'd really like to avoid needing to pay COBRA for all of 2020 (or using ACA without subsidies in 2020) if I can.
• If I'm understanding what I see on the healthcare.gov website, it appears the Oregon plans do not cover "out of network" care.  Am I reading this correctly?  Does this mean I would not be covered if I were traveling elsewhere in the U.S. and needed to see a doctor?
• As a follow-up to the second bullet point, are there any other insurance offerings you're aware of that do cover "out of network" care?

I feel fortunate to be in a position to FIRE and had hoped to wait until late this year to leave the job but current circumstances are making me feel like I should cut out ASAP.  Any knowledge you can share that will help me pin down answers on these important questions, would be really helpful.

TIA!

[secondcor521]

Regarding your first bullet point, you do have the option of signing up for ACA in August, because losing your employer coverage in July is a qualifying event that allows you to sign up outside the normal enrollment period in Nov/Dec.  You would qualify for subsidies this year based on your income this year.  Of course, if your income this year puts you above the ACA subsidy limit of 400% FPL, then you would not receive subsidies.  In that case you'd still qualify for ACA coverage, you'd just pay the full price.  And if you do this option, you'll also qualify to reenroll (i.e., continue your ACA plan, or switch to a different one) for 2020 in Nov/Dec and receive subsidies in 2020 according to your 2020 income.

Regarding your other two bullets, most ACA plans do not cover care out of network unless it is emergency or urgent care.  Emergency or urgent care is usually covered at a lower level than in-network care (so you might have to meet a higher deductible, or have a higher copay or coinsurance for emergency/urgent care).  I don't know of any that do cover you fully out of network.

[seattlecyclone]

Regarding your other two bullets, most ACA plans do not cover care out of network unless it is emergency or urgent care.  Emergency or urgent care is usually covered at a lower level than in-network care (so you might have to meet a higher deductible, or have a higher copay or coinsurance for emergency/urgent care).  I don't know of any that do cover you fully out of network.

The ACA only requires out-of-network coverage for emergency care. Urgent care is optional. When I looked at the plans available here in Seattle, only one of the four companies offering coverage through the exchange (Kaiser Permanente) chooses to cover out-of-network urgent care. Not sure what the situation is in Oregon. My concern with this practice is that it gives insurance companies every incentive to argue that your care wasn't enough of an emergency to merit coverage, and even if you had a genuine emergency when you entered the hospital there comes a point where the emergency has passed. Any further care past that point might not be covered.

[iluvzbeach]

Thank you @secondcor521. We will not be eligible for subsidies for this year but COBRA would be cheaper than an unsubsidized ACA plan for the remainder of the year. What I really want is the best of both worlds, COBRA through the end of 2019 and an ACA plan with subsidies in 2020. I also don’t want a change in plans mid-year as I don’t want to start deductibles over under a new plan.

[iluvzbeach]

Thanks @seattlecyclone for taking the time to respond. I need to look at whether any of the Oregon plans cover urgent care out of network. I don’t believe they do.