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.