Best states for ACA coverage

[Jinny]

One of my top concerns for early retirement is healthcare insurance. Any opinions out there about what states have the best ACA offerings? We will  be able to structure our retirement income to maximize subsidies so I’m most concerned about the quality of coverage not the before subsidy cost. Thanks for your help.

[Monkey Uncle]

I live in West Virginia and have ACA coverage through Highmark, which is a Blue Cross/Blue Shield affiliate based out of Pittsburgh.  Great provider network, not just statewide, but including many areas in neighboring states as well.  Plus it includes nationwide coverage through the BCBS network, thus eliminating the need for travel insurance when I'm traveling domestically.  I have one of the silver plans.  It is just as good as the BCBS insurance I used to have when I was a federal employee.  My wife had some very major health care issues last year, and our total out of pocket costs were around $2,000.

Like you, I'm crafting my income to maximize the PTC, so silver ends up being the best deal.  But even with the maximum PTC, I still have to pay a modest premium because the Highmark plan is undercut by a crappy silver plan offered by some insurance company I've never heard of.  That's a potential situation to be aware of.  The PTC is benchmarked to the second lowest cost silver plan, which may not be a plan that you want.  You can go with a better plan, but you'll pay the difference.

[bmjohnson35]

We moved from a medium sized city with relatively dense population to small town.  The ACA options was substantially less in the smaller town/county.  The point is, it's not just the state, it can vary greatly in the region you settle in as well.  Our area only offered an HMO.  We try to eat healthy and exercise regularly.  It has been fine so far, but we don't use the coverage much.  Our costs have been low and so far, it has been fine for our limited healthcare needs.

[Evgenia]

California's is quite good (Covered California). We've been on it for six years, since FIRE. California is not a great retirement choice for probably all other reasons, but I can attest that its ACA marketplace offerings and management are good and have only improved over the years.

[firestarter2018]

In general, the more insurers/health plans in an area, the better your ACA choices will be -- they really do compete against each other in terms of pricing, and in some years certain carriers will price their plans specifically to undercut others and gain market share.  I've looked pretty closely at Oregon and California's ACA sites and have been impressed by the offerings in terms of value (premium vs. deductible/max OOP, networks, benefits).  The Gold plans in particular seemed pretty affordable premium-wise when you consider how low the deductibles were.

On the other hand, I took a look at Texas' plan finder when my parents were shopping for plans and was kind of shocked at how bad the plans were - huge deductibles and extremely skimpy networks. Your best bet is to pick a handful of states you're considering for early retirement and create a spreadsheet of all the plans and their details (using the same age and income inputs) so you can compare.  Then pick a few and look more deeply into how broad their networks are if that's important to you (e.g. if you'll be traveling between two states frequently, etc.)

[Paul der Krake]

Hawaii has great options.

1) Kaiser HMO, or
2) HMSA PPO/HMO

HMSA is the local carrier and is accepted by virtually every provider in the state that isn't a Kaiser facility. Oahu hospitals can cover nearly anything. Neighbor island residents get flown to specialist appointments to Honolulu every day. Patients requiring cutting edge or very unusual treatments are typically flown to California.

Hawaii and Alaska are the only two states with higher subsidies. That's because the poverty line is higher than in the lower 48. Unsubsidized premiums are roughly in line with the country's average.

[DirtDiva]

I just shopped for ACA insurance in Colorado; deciding whether to switch over from COBRA.  The prices are standard (around $800/month for one person over 55) but the coverage is restricted to the state, except for urgent/emergency situations.  I want the flexibility to seek routine care in other states in case of extended travel.

(We currently don't qualify for income-based subsidies.)

[DirtDiva]

I just shopped for ACA insurance in Colorado; deciding whether to switch over from COBRA.  The prices are standard (around $800/month for one person over 55) but the coverage is restricted to the state, except for urgent/emergency situations.  I want the flexibility to seek routine care in other states in case of extended travel.

(We currently don't qualify for income-based subsidies.)

ETA: a close acquaintance makes around 20k a year and has great in-state coverage for $115/month.

[djadziadax]

I believe NY State also has a great plan if your income is above Madicaid, but below 40K. It is less than $100 a month for a couple.

[EricEng]

I'm not sure looking at as a state vs state comparison is very productive.  The ACA coverage quality in every state will vary dramatically across the state.  The more rural, usually the less options and lower quality. Like I could say the Denver area has great coverage and competing options, but other parts of CO have terrible options and medical care.

[Paul der Krake]

I'm not sure looking at as a state vs state comparison is very productive.  The ACA coverage quality in every state will vary dramatically across the state.  The more rural, usually the less options and lower quality. Like I could say the Denver area has great coverage and competing options, but other parts of CO have terrible options and medical care.

Yes, ACA plans are underwritten at the county level. In general, populous counties in or near large-ish metro areas is where you want to be.

You can see some cool maps about this here:
https://www.kff.org/private-insurance/issue-brief/insurer-participation-on-the-aca-marketplaces-2014-2021/

[Jinny]

Thank you all for the information. I have used the Kff.org site for ACA info in the past but had not looked at it lately - great map Paul! Monkey Uncle brought up the nationwide coverage through the BCBS network - would love to have that feature - didn't know it was a possibility with any ACA plans anywhere! Things are looking up!

[American GenX]

I believe NY State also has a great plan if your income is above Madicaid, but below 40K. It is less than $100 a month for a couple.

When I checked for myself a while back, the max income was about $25,000.  Otherwise, looked like a good deal.  I think Jim uses it.

[jim555]

New York, no age rating.  Also the Essential Plan, which is $20 a month or free for 200% FPL (25.5K) or lower.

[MMMarbleheader]

Massachusetts is good because they have been doing it for so long. They have 7-10 insurers.

They have "connector care plans" which are more regulated than your normal exchange plan for people not qualifying for medicaid

https://www.mahealthconnector.org/wp-content/uploads/Guide_to_ConnectorCare.pdf