What an ACA insurance policy costs

The typical annual premium for job-based coverage in 2020 was $7,470 for individuals and $21,342 for family coverage, according to the Kaiser Family Foundation.

Source: The government will fully cover laid-off workers’ COBRA premiums

Compare that to the cost of unsubsidized ACA plans in my market for 2021:

  • the cost of a Bronze plan ($17,000 family deductible) was $18,000 for two adults.
  • the cost of a Silver plan ($5,000 to $7,000 deductible) was $24,000 for two adults
  • the cost of a Gold plan ($1,500 to $3000 deductible) was $30,000 for two adults.

According to a health policy adviser to a Governor, the typical individual market plans are up to+40% higher cost than “small group” ACA plans. The reason for this is that pre-ACA, 35 states ran their own “high risk” insurance pools – but post ACA, all of these people – and their high risk/high cost – were merged into the small individual market pools (which are half the size of what Gruber modeled them to be by now). Separately, an estimated 27% of the pre-ACA uninsured had pre-existing conditions and some portion of those higher risk patients ended up in the small individual market ACA risk pools.

The result was the individual market was turned into the new high risk/high cost pools and the result was skyrocketing insurance premiums. Ours went up by 3x over 5 years before we had to drop out of having ACA insurance.

I’ve had people insist that ACA insurance is affordable and is just like corporate group plans – which is the effect of a mind control game played by Democrats for a decade.

There are other ACA issues – All plans but one in our ACA marketplace have no coverage for major medical emergencies outside the local area. While they cover ER treatment, subject to the deductible, if you need to be hospitalized or have surgery there is NO BENEFIT, not even as an “out of network” provider. Literally, you have no insurance coverage for major medical expenses while traveling within the United States. I’ve had Democrats argue with me and insist this is not true – sorry, it was confirmed by my insurance broker and the insurance company.

Thus, the ACA turned the unsubsidized individual market in to over priced, unaffordable “junk policies”.

The “Covid-relief” bill acknowledged that ACA policies, outside the subsidized group, were unaffordable and that many of us were forced to go without insurance. Under the new law, for the next two years, premiums for a “standard” plan will be capped at 8.5% of household income.

I feel vindicated – the political idiots finally admitted what they refused to admit for ten years: ACA polices were unaffordable, and for the reasons I described in a 52 page paper written back in 2016-2017. That paper was read by insurance industry staff, economists, several state legislators and public health staff in my state, which led to some fixes within my own state.