I have been an independent consultant for over three years and after a few months on a COBRA plan have had ACA plans on two exchanges. My answer is that it is a mixed bag depending on your state's demographics, provider availability and regulatory climate.
Initially I had a plan on the District of Columbia, which saved me a lot of money over a COBRA plan and was not terrible in terms of out-of-pocket cost. But DC is a strong exchange with a large and diverse risk pool that includes members of Congress, their staffs and a lot of independent consultants in a variety of industries.
After I moved to New Hampshire last year, I had the option of auto-enrolling in my DC exchange plan or switching to a NH exchange plan. I reluctantly selected the latter, but have seriously regretted it. NH is dominated by one, for-profit health insurer, which has effectively colluded a few large health systems to make it difficult for unaffiliated providers. State level regulation in NH is haphazard and seems to be primarily concerned with generating revenue, so there is nothing done about this anti-competitive behavior. Also, NH is one of the oldest states in the country, so the exchange is likely populated by a lot of middle-aged people and families. I have had some difficulty finding providers outside the hospitals and one I have to pay entirely out of pocket. I have been unable to get a couple of recommended prescriptions because the insurer refuses to cover them. My deductible is huge although it does not apply to most expenses.
I recall ASCE members having access to a private exchange with Pearl Insurance a few years ago. I think I checked it out before selecting a DC exchange plan a few years ago. It looks like that exchange is no longer available and Pearl is selling members supplemental plans only.
I will also note that comparing the total cost of plans is essentially futile. My first time shopping for plans on the DC exchange, I talked myself into a 'gold' plan by setting up a spreadsheet and assessing the higher premium with the lower deductibles and copays and anticipated use compared to other plans. It turned out my assumptions about how the deductible would be applied was totally wrong; Instead of having to pay it fully before coverage kicked in, I never had to pay it. So I took on a higher premium for no reason. The exchange's estimate of total cost is probably the best estimate you are going to get.
I hope some of this helps.
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Richard J. Driscoll P.E., M.ASCE
Lebanon NH
rjd@...www.richardjdriscoll.com------------------------------
Original Message:
Sent: 11-27-2018 13:38
From: Natalya Sokolovskaya
Subject: Medical insurance for independent consultants
Medical insurance is one of the major considerations when leaving a company and starting one on your own. I'm lucky to have insurance for the entire family through my husband's job. I'd be interested to hear about people's experiences. Without getting too personal or political - are people able to find an adequate coverage at satisfactory prices through various available insurance markets?
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Natalya Sokolovskaya P.E., M.ASCE
Wynnewood PA
(323)382-6176
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