ACA plans in my state expose you to over $20,000 in annual risk, for a family plan. That's assuming you don't end up with a huge "out of network" bill by accident (and their networks are terrible, so that's very possible). I think the "gold" plan is a little better (though a much worse deal if you're having to pay the full premium, overall) but I'm not sure how much income-based help you get for the top-tier (and still quite bad, compared to group plans at employers around here) plan.
Not sure what you mean by "annual risk". Do you mean out-of-pocket costs?
> That's assuming you don't end up with a huge "out of network" bill by accident
New laws mostly take care of that. No more out-of-network doctors walking by your hospital bed while you're sleeping and sending you a $5000 bill. Also if you have an emergency while out of state your insurance takes care of it.
The "metal" plans all have the same network. The only difference is how much you pay vs. insurance.
> Not sure what you mean by "annual risk". Do you mean out-of-pocket costs?
Yeah, max out-of-pocket per year. Something like ~$24,000 family / $12,000 individual on our ACA plans. Gold and Silver ACA plans are basically identical in this state, you're just guaranteeing you pay more in premiums with Gold (so, in a bad year, the totals work out about the same, but in a good year the Gold is more expensive). We have exactly two ACA plan providers here, and their plans are nearly identical except that they have very different (both terrible) networks.
So if you get cancer you'll be paying $12,000/yr, on top of premiums (another $20,000 or so, for a family silver plan, if you're not getting assistance) until you're cured or you're dead. Two people get very sick, about $24,000 per year that they remain very sick, on top of premiums.
But that's still on top of premiums. My last year on an ACA "Silver" family plan (2019) was just shy of $20,000 in premiums w/ a $13,500 family deductible.
Health insurance premiums are a tax, not actual insurance premiums priced to one's own health risks.
The Affordable Care Act stipulates various terms which result in young and/or healthy people explicitly subsidizing old and/or unhealthy people:
1) only age, location, and smoking status are able to be taken into account for pricing. And everyone must be offered insurance (i.e. no exclusions for pre existing conditions)
2) age rating factors - premium for costliest person (64 years old) must be at most 3x those of least costly person (21 to 24 years old)
The tax credits are the same regardless of your plan, and for modest income the credits are substantial: even for $100k, the credits are $500/mo for a family of 4. Not that healthcare still isn't a significant expense, but the assistance is meaningful.
