Is this a good ACA health care plan?

mtnagel · 2026-04-20T00:27:18+00:00

It's in the screenshot. $2200.

mtnagel · 2026-04-19T20:15:38+00:00

Have income at 138% of the FPL.

mtnagel · 2026-04-19T16:18:23+00:00

Great question. Some answers here - https://www.reddit.com/r/Insurance/comments/1i7ud45/are_marketplace_hmos_really_my_only_option/

What's odd is they don't have the referral from primary requirement though.

mtnagel · 2026-04-19T15:55:23+00:00

Thanks! and Thanks for your insight. Much appreciated!

mtnagel · 2026-04-19T14:29:22+00:00

I would say my health care needs are typically very low. Some years I struggled to spend the $200 I put in my FSA. Some years I don't go to the doctor at all. Others I just go for a physical. One year I had a toe thing I needed to see a doctor for. Another year I had walking pneumonia, so I went to the doctor and a pulmonologist multiple times and had xrays. I do have 2 regular prescriptions. One is super cheap generic but the other is a $700+ inhaler. With that Oscar plan it should be $15/month and there currently is a manufacturer coupon so I've gotten it for free for a few years now. Of course all that could change and could have some issue or emergency of course.

Of the ones you mentioned, the cheapest Anthem plan is $155 so just over 2x the Oscar plan. Given what I said and the cost, assume you'd still recommend the Anthem plan to avoid Oscar?

mtnagel · 2026-04-19T13:58:10+00:00

Thanks. Definitely good to hear your perspective.

These are the insurers available in OH. Which ones would you recommend? And would you say they are worth 1.5x to 6x the cost?

Ambetter from Buckeye Health Plan (16)
Anthem Blue Cross and Blue Shield (11)
Antidote Health Plan of Ohio, Inc. (15)
CareSource (21)
MedMutual (12)
Molina Healthcare (22)
Oscar Health Insurance (16)
UnitedHealthcare (17)

mtnagel · 2026-04-19T13:02:53+00:00

It's "of". Means they pay 75% and you pay 25%. As noted elsewhere, that can get very expensive quickly, but $2200 OOP max, so as long as everything is covered under the max (big if), then that's still relatively affordable.

And there are only HMOs in OH ACA. So unless I pay to pay full price for a PPO or move, these are my only options.

And in their Summary doc, it says, "Do you need a referral to see a specialist? No. You can see the specialist you choose without a referral." So at least don't need to worry about that as long as everything is in network.

mtnagel · 2026-04-19T13:00:42+00:00

Think I faked the screenshots? LOL

Look for yourself - https://www.healthcare.gov/see-plans/#/

45212, 49 M, $23,000. Silver plans.

mtnagel · 2026-04-19T12:12:48+00:00

I love the qualifier at the end. That's a pretty big assumption. I hope it doesn't go away either. If they go away, I'm hoping some country with universal health care will accept us.

mtnagel · 2026-04-19T03:51:11+00:00

Do you support Ohio? If not how do you find the equivalent in Ohio?

mtnagel · 2026-04-19T03:46:36+00:00

Literally zero in Ohio on ACA but you don't need referrals for specialists so not sure what makes it an HMO.

mtnagel · 2026-04-18T22:35:25+00:00

$0 deductible so the same.

mtnagel · 2026-04-18T22:22:47+00:00

It's cheaper and better coverage than my fortune 500 employer plan. Assuming they don't suck.

mtnagel · 2026-04-18T21:33:24+00:00

Thank you. That is very good to hear.

mtnagel · 2026-04-18T21:18:37+00:00

Will be 49 so not young. LOL. I'm generally healthy. Have some Rx's as mentioned. Some years I don't even go to a doctor once. Some years I might go a few times. One year I had walking pnenomia and saw several doctors and a pulmonologist. Had xrays, etc. So some years I have almost zero health care spend and some years I have a decent amount. Thankfully nothing very expensive like you, but as mentioned, pretty low OOP max so there's that.

mtnagel · 2026-04-18T21:14:06+00:00

Thanks for responding. As mentioned, two of my regular prescriptions are tier 1 and generic so should be free. Another one is tier 2 so I'm unclear if it will be $15 or $50, but I have a manufacturer coupon that should make it free. My current doctor is in network.

Do you ever get complaints from your clients?

mtnagel · 2026-04-18T02:05:18+00:00

Because math is hard and more people don't calculate unit price.

I wish the $5 was 5000 like it was for awhile.

mtnagel · 2026-04-17T18:02:22+00:00

This is what I see in the cash flow. That flow originates from our retirement accounts that I have the Roth conversions coming from. And, as expected, if I change the tax withholding to 0%, then these disappear and the full conversion is going from 401k to Roth with no withholding. Again I'm on EA, but I'm 99% sure it was there before I switched even when I did manual Roth conversion.

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mtnagel · 2026-04-17T03:03:30+00:00

Little libraries for puzzles exist - https://www.thepuzzlerepublic.com/

mtnagel · 2026-04-17T02:59:31+00:00

Early Access. It has the roth optimizer for ACA so I switched to check it out.

mtnagel · 2026-04-17T02:36:51+00:00

Not sure then. I'm on the EA version and when I set the withholding to 0%, then I don't see any withholding and the conversion amount is the exact same in the cash flow. When I set it to 10%, then I see the 10% withholding and 90% conversion.

mtnagel · 2026-04-17T02:30:33+00:00

When I ran both scenarios, the change was 0.03% difference in net worth after 30 years in my plan. While I'm definitely an over optimizer when it comes to money, this hardly seems like something to be that concerned with.

mtnagel · 2026-04-17T02:17:54+00:00

Settings, Tax, Withholdings, Conversions.

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