ACA Post Fire Experiences?

[swagster]

Hi- I'm new to the board and somewhat new to FIRE.  My wife and I are both 46 and are considering retiring early.  We have the amount we would need for early retirement but our biggest concern is healthcare / ACA.  We are in Texas so we have only the Federal marketplace (I have run some scenarios on their site).  I should also add we have two teens and my wife tends to have a healthcare issue about 1-2 times a year.  Nothing life threating but a knee surgery or gastritis type issue would be two examples.

My question is what experiences have others had who have FIREd early?  I have looked through the forums here and at other information sources and we could qualify for the subsidy by controlling income, which is discussed in great detail on other posts.  We are more concerned with what life is actually like on the other side.  We have "good" insurance now through our employers and I would like to know what your experience has been like with ACA insurance. For example:

Have you had to change doctors?
Is it hard to get appointments?
Is it hard to get seen by a specialist?
Are some drugs not covered?
Bronze vs Silver vs Gold?
Any good or bad surprises?

I would really appreciate any input on these questions plus the many more I'm probably not thinking to ask.  I would also greatly appreciate any guidance to other sources of this kind of information.  I'm usually pretty good at finding what I'm looking for, but most of the experiences discussed elsewhere relate more to those who were without insurance when they got coverage.

Thank you in advance.

[jim555]

Every state and county can be different when it comes to plans and networks.  So unless you can find someone in your immediate area on ACA I don't know how useful someone in another state will be to you.

My state has its own web site and enrollment period which differs from most other states.  I have been on a Medicaid Managed care plan for many years which has been very good.

[geekette]

We've gotten an ACA silver plan since (almost) the beginning (May, 2014).  Things change.  Doctors and insurance carriers come and go.  Even when we were on company insurance that happened.

That said, we haven't had much in the way of problems, even though we've gone back and forth between BCBS and United Health care.  We did lose our primary care doctor after 2015, but we found a new practice we like about the same.  No problem with specialists here.  We're in a very saturated health care area, though. 

From our experience, you can find out which practices participate for the current year and the current crop of plans, but there are no guarantees things won't change the next year. 

[Goldendog777]

I quit my job at the end of December to go back to school.  Our investments cover our basic living expenses.  I had great insurance with Aetna through my mega Corp with only a $500 deductible and I could see any doc I wanted.  We chose a silver plan on the exchange through Health Plan of Nevada (HPN). We only had 2 insurance companies to choose from and both are HMOs which I’m not used to.  We had a really hard time finding a PCP that would take it and the docs on the list that are accepting new patients do not get the best reviews.  I’m disappointed with what is offered but didn’t have a choice unless I wanted to continue to work at mega Corp until I’m 65!  I believe TX is also one of those places you can only buy an HMO plan as well.  No great solutions. 

[secondcor521]

Have you had to change doctors?
Is it hard to get appointments?
Is it hard to get seen by a specialist?
Are some drugs not covered?
Bronze vs Silver vs Gold?
Any good or bad surprises?

For context, I'm in Idaho, I'm 49 with three kids, two of whom are in high school.  FIREd and have had an ACA plan with SelectHealth for 3 years.

I haven't had to change doctors, but I do check each year to confirm that my primary care doc is on my plan.  He's been on my plan every year so far.  I am relatively healthy and as long as the doctor is board certified I don't really care much.

Not hard at all to get appointments.  Being retired and having a relatively wide open schedule helps with this too.  Tomorrow at 2pm?  Sure.

Not hard to get seen by a specialist.  My plan is a PPO, though, so I don't need to clear it with my PCP.

I've never had a drug not covered.  I've had antibiotics covered for me, and ADHD meds covered for my son, and allergy serums covered for my daughter.

I like Silver with CSR 87, which IIRC means an AGI between 150% and 200% of FPL.  When my kids graduate off the plan I'll consider a Bronze plan which would probably be with $0 premium if I'm still in good health then.

Overall I've been pleasantly surprised.

[Frankies Girl]

I'm in a major metro city in a state that did not do a state exchange or expand medicare, spouse w/no kids, FIREd about 4 years ago and been on ACA ever since. We control our $ so I get the sweet, sweet subsidy and cost sharing and my insurance is right at $175 for two adults in their 40s with a platinum-plated silver - been both EPO/PPO plans - and they both aren't an issue. No dental because we don't mind paying OOP for the occasional toothy needs.

Have you had to change doctors?
Only if I wanted to. Our main doctors group (small husband/wife team of family practitioner/internist) took one type, decided to step on level up onto a slightly higher cost plan to go into a closed EPO network with EXCELLENT surgeons for a minor day surgery one year, then stepped back down to the one we currently carry and back to the husband/wife team of doctors. 

Is it hard to get appointments?
Why would your insurance make a difference in getting appointments? I've never had any issues whatsoever. My insurance was once BCBS, and then a non-profit company well known in the city.


Is it hard to get seen by a specialist?
No? See above. Unless you're going for the bottom of the barrel "Crazy Juan's Insurancepalooza Company, LTD." I have no idea why seeing any specialist would be dependent on your insurance in a basically decent area that normally takes different insurances. If you have a small town where the specialists are not plentiful, then you likely would see a wait but that shouldn't have anything to do with insurance and has definitely not been my experience.


Are some drugs not covered?
Nothing I ran into that are any different than when I had work insurance. Most generic every day stuff is not even worth submitting through insurance for me anyway considering you can get them for like $4/30 days or $10/90 days. I also use things like GoodRX and RetailMeNot's script discounts and get things SUPER cheap even more than most insurance anyway.


Bronze vs Silver vs Gold?
We're basically healthy, but I worry so we did Silver. Again, we control our income tho, so it's like having a platinum level with the perks for the cost savings/subsidy.

Any good or bad surprises?
Our current insurance company gives us 10% off our monthly premiums just for taking a 2 minute health assessment survey (it's laughably easy and not at all intrusive). They are SO MUCH BETTER than just about all the companies I'd been with in past like BCBS, Humana, Signa, etc... nicer people, helpful people, and coverage has been so easy even for things like surgery. Hardly any paperwork or balanced billing garbage or runarounds with miscodes and all sorts of quibbles I used to have to untangle in the past. And I hadn't realized they were non-profit when I first went with them (literally just decided I was sick of BCBS BS) but they have been really amazing. They have had to increase prices slightly (under 5%/year) and they reduced a few coverages since I started with them but it's been really modest and you can tell they're trying to keep things as fair and evenly priced as they can.

Something to consider: since insurance is now state/region based, you may want to get traveling coverage if you vacation far outside your network area. You still get basic emergency coverage no matter what, but some insurance companies might be right bastards and try to stick you with out of state bills if they deem your emergency "not really an emergency emergency" or you linger longer than they feel is necessary in an out of network facility.

[secondcor521]

The above post reminded me...I joined a gym about a year ago and my insurance company will now reimburse me for my membership as long as I meet a few basic requirements (that I have already met).  So that's pretty nice.  I belong to a cheap gym at about $150 a year, but still better than a kick in the pants.

[Mr. Green]

Once you select a plan, you're just like any other person who has insurance with that company. You're not treated differently because it was purchased through the ACA. So it's all about the details of that particular plan, which really isn't any different than if you were getting insurance through an employer. You definitely want to do your due diligence on plans available to you for things like how big the doctor networks are, if they offer out of network coverage, etc.