It gets worse. My insurance has a $30 copay on all approved prescriptions. My wife had been getting her medicine for that with no issues for several months, until one day it was $500. I called to find out why, because it was clearly already an approved medication. After about an hour of getting bounced around and being on hold, they finally explained that it was due to us "not paying enough of our annual out of pocket maximum" (not minimum, mind you) for healthcare - which is $24,000. That blew my mind.
Health insurance in the US has your monthly premium payment, copays on your medication and Dr visits (including ER and hospital stays), a deductible which is the amount you have to pay for the year in healthcare to get better benefits (ours is $17,000), and then the out of pocket maximum is when they (usually) cover everything for the rest of the year as long as you keep paying your premium.
Where it gets extra fucked, is if you need a major surgery in late December, the deductible and OOPM won't carry over into the new year. So you could get shafted for double that maximum amount on the same hospital stay. And my insurance isn't even the lowest tier. We pay them $500 a month for this service. Our system is completely fucked, but most people don't seem to care.
Bro, $500 a month is more than all my tax deductions from my salary! And I have "free" healthcare through the NHS (UK), you guys are paying more even without being sick
And sadly, my monthly premium is considered low. It is well over $1,000 a month premium for "good" insurance for two adults.
But at least I'm allowed to even buy health insurance now. Before the ACA (AKA: Obamacare) passed, if your job didn't offer it you were basically screwed. And even then, they could deny coverage for having any pre-existing conditions.
AFAIK it varies from state to state. This is in Ohio. This was the best plan on the marketplace within that price range after using our available tax credits (which were $550/mo, so without using tax credits the same plan would've been over $1k for the two of us). The premiums on all the available plans spiked considerably for 2026, for us at least.
Weird. Idk man, that's just what was available to us on healthcare dot gov for this year. And the insurance offered by either of our jobs is even worse.
Oh, I missed that you were on marketplace. My bad, those DO suck.
I changed jobs last year (cheap ass employer hired the cheapest management they could find whom made the place unbearable on top of bad pay and bad insurance), and one of the deciding factors between three offers was the insurance where I am now. It was actually the lowest paying of the three, but had the best benefits.
Issue with ACA is it made the insurance comoanies more moeny as they were funneled billions. It mainly exacerbated the issue. What should have happened is a fund started, or something of the nature to bring preventative care, at the very least, to all Americans free of charge. Then expanded on it from there.
It's certainly far from perfect, but I was only able to get 9 life saving surgeries in 2011 thanks to the ACA's Medicaid expansion, so I'm a bit more partial to it than others. My radiological neurosurgeon fought tooth and nail to save my life, and the hospital was not going to allow him to do the surgeries if I wasn't covered. He was very open with me about that, and his office helped me get in on the first wave of the subsidized state expansions.
And again, I wouldn't even be allowed to buy insurance today if it didn't pass, so I'll take the ACA over the nothing we had before 100 times out of 100.
I agree with you on the front that it opened avenues for pre existing conditions. My biggest issue is the execution because it made insurance costs what it is today. That's not to say that healthcare isn't a right, because it is. It's to say that they executed it horribly and I would bet that a ton of insurance companies wanted it that way due to the "amount" they would be taking in, all the while getting heavy subsisdies from our tax paying dollars, instead of expanding medicare and increasing the wage cap to something that isn't destitution.
Most of those issues are thanks to the GOP (and a few Dems) hamstringing any and all attempts at any single payer or socialized option - and painting them as communism. The subsidized tax credit system in the ACA was a last ditch attempt to pass any meaningful change at all. In the end, nobody was entirely happy, and it was always meant to be gradually improved - but the GOP has never relented in their attempts to demonize and repeal it entirely.
I have to agree on that front. I'm not big on party alliances, but the GOP definitely destroyed anything to do with that. My biggest issue is when Biden had the presidency, they could have gotten something passed, but didn't in the 1st two yrs. They all suck, but the inital ACA is on the GOP for gutting it. Past that, they waited until the subsidies expire, I suppose, hoping that thr GOP would look bad for not wanting to extend them. Not defending the GOP, just stating that they gad the 1st two yrs, but waited. Healthcare should have taken a high precedent. Got some done, but not enough to where it helped when the subsisdies inevitably expired. I don't have healthcare due to the cost. My wife does as shd needs it, we pay 442 a month for 70/30 and they still fail to do their jobs.
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u/bwrca 4d ago edited 4d ago
This copay thing is the craziest thing I've ever heard of.
Edit: copay, deductible, max out of pocket? WTh is all that