This article below about ACA deductibles is so important for you to read, and you may be shocked when you are finished…but don’t keep it to yourself. Please remember to share this article with everyone you know including non-RVers!
Can You Afford the “Affordable” ACA Plan?
What could you buy for $18,200? That could be a healthy down payment on a new truck, a year’s worth of camping at $50 a night, a brand-new Coachmen camper, or your 2023 ACA plan yearly family deductible! Are you and your family prepared to pay the out-of-pocket expenses that the plans on Healthcare.gov contain? Is there a better option available out there?
Plan Now During Open ACA Enrollment
With 2023 Open Enrollment upon us, it’s important to evaluate the changes in the plans available on Healthcare.gov and state exchanges. Many Americans are lured into purchasing these ACA plans by the appeal of government subsidies lowering their monthly premiums, but are they prepared to accept the financial vulnerability that comes along with that reduced monthly premium? Before answering that question, it is necessary to understand what costs are included in that total financial vulnerability.
Pay Attention to the ACA Summary of Benefits
To see all of the costs a policyholder may be responsible for, it’s essential to view the plan’s “Summary of Benefits”. This is a document located under “plan details” and then “plan documents” on Healthcare.gov. The Summary of Benefits explains what costs the policyholder will be responsible for, and what benefits are covered under the plan.
For RVers, this document also holds an imperative chart that shows the out-of-network benefits for the plan! Most RVers are not spending the entire year in their resident/domicile state, with the vast majority of ACA plans, they will be outside of the plan network for most of the year.
Even with the few PPO plans that are available on the ACA, it’s important to consider that in an emergency situation you may not have the ability to search your plan network, and might be rushed to an out-of-network hospital without having a say in the matter.
Most RVers are not spending the entire year in their resident/domicile state, with the vast majority of ACA plans, they will be outside of the plan network for most of the year.
Understanding Financial Vulnerability
The financial vulnerability of a plan is important to calculate, because it can help you understand what you may have to pay in the event a major health condition/injury arises while you have the plan. The financial vulnerability would include the plan’s yearly premium costs, in-network deductible, out-of-network deductible, and out-of-pocket maximum. Notice that the word “deductible” is listed twice… that’s because even if you reach your out-of-network deductible, with most plans that money does not count towards meeting your in-network deductible!
As Scary as a Heart Attack
So if a policyholder had a heart attack outside of the plan network, they would be responsible for the out-of-network deductible. Let’s say that a policyholder is discharged from the hospital, but has regular doctor’s appointments and medications they must take to monitor their cardiac system. They would probably want to return to the plan network, and when they get there, they will be greeted with a nice surprise: a whole new deductible to pay into!
One of the aspects of the ACA plans that folks like the most is the concept of an out-of-pocket maximum, which effectively caps your financial requirements to healthcare in one year. But behind every curtain, there’s another catch! You won’t see this in the plan advertisements, but the vast majority of ACA plans do not contain an out-of-network out-of-pocket maximum. That means you cannot calculate how much money you might spend on medical expenses with an ACA plan in one year. If something catastrophic happens, and you are not in your plan network, your requirement to pay a percentage of medical expenses would be unlimited.
A Frightening Example of ACA Deductibles
So, let’s do our best to calculate the total financial vulnerability of one of these plans. We’ll base these numbers off of a household of two married 60-year old’s, and pull the example plan from my home state of North Carolina. I’m choosing a bronze plan offered by one of the “brand name” insurance companies, as most people who purchase ACA plans buy a policy from the “brand name” insurers. With a monthly premium of $1,789.62, that would equate to an annualized premium of $21,475.44. In addition to that monthly premium, policyholders would also be responsible for paying an in-network deductible of $7,500 per person, or $15,000 for a family.
The deductible must be satisfied before the insurance company will pay many costs of services. Certain plans have copays for office visits and prescriptions prior to having the deductible met; we will discuss that in a bit. So, for a couple of married RVers, we are up to $36,475.44 on our vulnerability calculation. Next, we will add in the out-of-network deductible. With this plan, that is $37,500.00 per person, or $75,000.00 for a family. So, if both husband and wife experienced a major health event/accident out-of-network, they would be responsible for the first $75,000 of medical treatment, bringing up our vulnerability figure to $111,475.44. In addition to that 111k, if their medical treatment for whatever emergency exceeded $37,500 per person, they would be responsible for 80% of all bills going forward, to infinity with this plan.
Is this starting to scare you? Good, because it should. I would bet that knowing the real numbers these plans may cost might make folks second guess taking that government premium subsidy, as well. In our above example, even if the couple qualified for a premium subsidy that reduced their monthly premium to $0, they would still be liable for $89,982.00 plus 80% of any additional out of network costs.
Ok, I’m Scared – What Are My Options?
Now the real question; is there a better option? For most people, yes there is! There are off exchange plans available to most Americans that provide nationwide comprehensive coverage. At the RV Insurance Exchange, our insurance agents are well versed with many different insurance companies and plans that provide things like nationwide coverage, no network restrictions, lower monthly premiums, guaranteed renewability, and much more!
Custom Plans for RVers
Our most popular health insurance plan for RVers and travelers offers something called “first dollar benefits”, which means that the insurance company pays out benefits without policyholders having to first satisfy some outrageous deductible. What plan would you rather have? The nationwide plan that pays the first $150 of a Specialist visit and does not require a primary care referral, or the ACA plan that charges a $150 copay for a Specialist visit and requires you to get authorization from your primary care provider that the visit is necessary? The last time I went to a Specialist, the self-pay cost of the visit was only $120, which means had I had an ACA plan I would have paid a copay that was more expensive than the visit!
Protect Yourself from Scary ACA Plans
If you’re interested in your financial future, don’t have potentially hundreds of thousands of dollars to pay on yearly health care, and would like the ability to travel without losing your peace of mind, please give us a call at the RV Insurance Exchange. Our trained expert agents can send you no obligation quotes for plans that suit your specific needs. Our goal is to help RVers achieve freedom and peace of mind through our experience with health insurance – let us help you today!