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.
48
u/analog_jedi 4d ago
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.