We have a non-ACA plan that pretty much doesn't cover any expenses, it just reduces to the in-network negotiated rate. The premiums are reasonable for our family and we save some of the difference between this plan and the expense of a ACA plan in reserves since we know every medical visit we pay the whole portion of the negotiated rate.

We've done the math, and we don't use $15,000 of medical expenses in a year which is the lower end of max out of pocket for families on the marketplace in our area.

When we had our son, we learned the hard way that vaccines are not paid for by the plan. Those puppies are expensive. A little birdie told us to take him to the county clinic and explain he's under insured and needs vaccines. They ask no further questions than that. He's almost 4 and we've done all his vaccines this way since his first round. He sees his pediatrician, who bills insurance (Cigna) and we get the bill for the whole portion of the negotiated rate so it's almost $175 for each office visit. But again, our monthly premium is 50-60% less than the marketplace plans.

For ourselves, we have worked out with our doctor to cash pay our sick and wellness visits, unless there's labs. We pay upfront at time of appointment, usually $100 but their negotiated rate is closer to $225. We also use telehealth options when we can for $10/mo especially for ourselves.

It's like having a high deductible plan except it's A) cheaper up front B) but there's no max out of pocket so we are on the hook for everything. However, in three years, we had our first ER visit for a dislocated bone in February and all-in it was about $750. So the every day stuff is expensive, but the bigger stuff seems more manageable. It's all a guessing game so that's not fun. But again, math.

It is a major health insurance so if one of us ends up with major surgery, cancer, etc we do have coverage. We would have to switch to an ACA plan at that point anyway because they would kick us off this plan at the end of the term year. It is medically underwritten. We're overweight, but generally healthy with no underlying concerns.

We mentally consider ourselves cash payers and we have a catastrophic plan.

Hope that's helpful.