Unfortunately that’s not exactly how it works. We don’t have a marketplace plan, so our insurance has no responsibility to pay for anything really.

The link you shared says this.

“All Marketplace health plans and many other plans must cover the following list of preventive services for children without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible.”

Maximum out of pocket only kicks in once you’ve hit the deductible on 2+ family members, at least for our plan. So for us, the max is $20k.

By purchasing insurance not compliant with marketplace regulations, one chooses to pay less in premiums in exchange for accepting the risk of paying more at point/time of care.

>Maximum out of pocket only kicks in once you’ve hit the deductible on 2+ family members, at least for our plan. So for us, the max is $20k.

Out of pocket maximum has nothing to do with deductible. Copays/coinsurance “kick in” after deductibles are reached.

If you had purchased ACA complaint health insurance, then OOP max is simply OOP max, a single number that once you reach, you do not pay further for in network services (and now for out of network emergency services also).

Edit: note that a “Marketplace” (or ACA complaint) plan explicitly transfers wealth from young and/or healthy to old and/or unhealthy, where healthy and unhealthy mean “does not need healthcare” and “needs healthcare”. So by choosing to go with a non Marketplace plan, they are placing their bets on not needing healthcare…which is probably not a winning bet for people birthing and raising young children.

> note that a “Marketplace” (or ACA complaint) plan explicitly transfers wealth from young and/or healthy to old and/or unhealthy, where healthy and unhealthy mean “does not need healthcare” and “needs healthcare”. So by choosing to go with a non Marketplace plan, they are placing their bets on not needing healthcare…which is probably not a winning bet for people birthing and raising young children.

The unfortunate reality is that paying $2000/month to an employer managed health plan is cheaper than going through the federal government ($5,000/month for a family of 4 the last I checked). If marketplace plans had lower premiums and lower deductibles that would be the ideal option.

I would not believe an ACA compliant plan healthcare.gov was $5k for a family of 4.

Here is NJ’s prices, which is a relatively high cost state:

https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...

For a silver level Horizon BCBS plan (Omnia Silver HSA, pretty broad coverage, never seen a provider not in network), you would be looking at $300 to $700 per person, calculated using the age rating factors at the bottom. And I know from experience the max OOP was $10k or a little less.

Even if you were older parents, the total would come in under $3k per month for a plan that covered 70% of expected healthcare expense, which is what qualifies it to be labeled silver.

I know priced in California were not too much more than NJ. There is a Kaiser pdf showing a detailed breakdown of premiums nationwide, but pretty much everywhere scales from $300 to $1k per month from age 20 to 65 for a silver level plan.

And this is all for buying via healthcare.gov. I would bet all big employers provide far more subsidized ACA compliant health insurance, so if you are employed, I would budget for employers to pay 70% of the premium, so individuals would pay 30% of $2k for family coverage = $700 per month and be subject to $5k per year deductible, and $10k oop max per year.

Basically, you can expect to insure your whole family for unlimited (in network and out of network emergency) healthcare expense for $20k per year if you work for a big company, and $40k per year if you are paying yourself, maybe $45k if you’re over 50 years old.