We're currently paying Cobra rates (ouch), but I've been keeping an eye on the ACA site just in case we need it next year (our Cobra will run out next January). The rates are lower via ACA, but the benefits outweigh the cost of Cobra (for us) at this time.
I keep seeing people mention that the cash price is lower, but I personally haven't found that to be the case. Looking at a recent EOB for labs, the charge was $258, the "adjustment" (due to carrier agreement) was $235.30, and the total left to go toward my deductible was $22.70. An ultrasound was $288.25, the adjustment was 177.50, so I paid the other $110.25, which went to my deductible. The one time I had a lab test that was not covered (deemed experimental), I had to pay the full price. Just my experiences.
Vision "insurance", though, if you have to pay for it yourself, isn't worth it, IMHO, after adding up the monthly charges and comparing it against the discount they give you off cost of an exam and glasses. Any expensive stuff your eyes need is generally covered under medical.
I shudder when I see 20-30 year olds include incredibly low expenses for medical in their post FIRE budgets. Not gonna happen, people, at least not over time.