How can I get the Health Insurance I want?

[Zoid]

We officially reached FIRE-dom back in 2013 and didn't find this community until just recently. So good to see others out there stepping off the treadmill early and sharing ideas about how to get other there! On to our question, for the last 3 years we have been traveling abroad so we were covered by traveler's health insurance (Seven Corners, they were great). Now that we are back in the States I am struggling with our options under ACA. Ideally what we want is to self-insure for everything except the big stuff (cancer, etc.), let's say medical issues that could run $50,000 or $100,000 and up. I realize under ACA the health plans are required to cover things that I would rather self-insure, so I'm not going to find my ideal scenario. The problem I have is this, if one of us does get cancer or something big and expensive, I am going to want the best doctors and/or specialists. All the plans I see require me to be stuck in their provider network. So I'm not sure any of the insurance plans are offering me anything I want. If I do get cancer and then choose to work with a specialist outside of the network, then the insurance doesn't help. I'm now starting to wonder why I would pay for insurance at all if all it does is cover the small things I don't need it to and then if something big happens not cover me for the type of treatment I might need. Anyone else having this issue? Anyone have any suggestions?

Thanks in advance!

[Fishingmn]

I'd just pick the ACA plan that's the closest fit. Probably an HSA Bronze plan that comes closest to the doctor network you think is best. If you choose no plan and have lots of assets that possible cancer diagnosis will wipe you out. With a plan at lease you'll have a choice of some doctors at the time before deciding if getting wiped out in order to choose your own doctor is worth it.

ACA as we know it will almost certainly be radically different in 1-3 years given the political environment. Just hope you don't get cancer in that time period as pre-existing condition coverage may go away. Continuous coverage in that case may be even more important.

[Zoid]

Good points. I'm looking at Bronze plans and will probably pull the trigger on one of them. Just frustrating that I can't get what I want from the system in place somehow. I had no problem getting what I wanted while traveling abroad. Was hoping there was some little known mustachian way just have catastrophic coverage.

[mskyle]

If you do have some serious medical problem you can always pay out-of-pocket to see the fancy-pants doctor until an open enrollment period (or life event) then change to a different plan (assuming ACA stays as it is, which it probably won't). And honestly, the restricted network is going to be good enough for almost anything. I admittedly live in an area with a ton of great hospitals, but I would happily give up access to the most expensive hospitals in my city for lower premiums.

[Mr. Green]

If you do have some serious medical problem you can always pay out-of-pocket to see the fancy-pants doctor until an open enrollment period (or life event) then change to a different plan (assuming ACA stays as it is, which it probably won't). And honestly, the restricted network is going to be good enough for almost anything. I admittedly live in an area with a ton of great hospitals, but I would happily give up access to the most expensive hospitals in my city for lower premiums.

Data collected by the Feds over the last few years, now that they're forcing hospitals to reveal financial data, has shown that the most expensive hospital doesn't mean the best care. An example in the article I read a while back looked at heart surgery in the New England area and the hospital that was known as the best heart center in the area was actually cheaper than other hospitals, yet the data showed cases where people chose other hospitals because they assumed the better hospital would cost more.

[jim555]

If all the plans are "unaffordable" then you can get a hardship exemption for a catastrophic plan.

[Jammu]

You don't have to buy on the exchange. There might be other individual plan options open to you that are not on the exchange, so you might want to research those.

[Arktinkerer]

One other option is to buy the plan you want (or the closest thing to it) and then pay the penalty.  May still cost less than buying what you don't want.  Just be aware the numbers and penalties change every year.

[Spork]

I'd just pick the ACA plan that's the closest fit. Probably an HSA Bronze plan that comes closest to the doctor network you think is best. If you choose no plan and have lots of assets that possible cancer diagnosis will wipe you out. With a plan at lease you'll have a choice of some doctors at the time before deciding if getting wiped out in order to choose your own doctor is worth it.

ACA as we know it will almost certainly be radically different in 1-3 years given the political environment. Just hope you don't get cancer in that time period as pre-existing condition coverage may go away. Continuous coverage in that case may be even more important.

FWIW: this ^^^ is what we went with.  In year 1 of FIRE, there was only one insurance provider in our area and... well, precious few of the local doctors seemed to be in their network.  In year 2 of FIRE, a second insurance provider popped up.  They had a much better doctor network *AND* were significantly cheaper. 

Your mileage is going to vary wildly, I suspect, by location.  And just because it is good/bad now doesn't mean it won't change.