At the end of this year I am planning to leave my current job, for at least a "trial run" at early retirement (meaning taking a few years off until the kids get through high school, and then will re-evaluate based on market conditions & boredom whether it makes sense to go back to work ). Which means that for 2022 and part of 2023, we'll have the option of COBRA from my current job, or ACA coverage.
The ACA premiums will be _much_ less expensive because of subsidies assuming we manage our taxable income well (which seems pretty easy). So, on the face of it, ACA would be my preference. Likely about a $1500/mo difference between ACA and COBRA premiums.
But the "in-network" provider networks, at least in my area, are VERY limited on all ACA marketplace plans, with most having no coverage at all for out-of-network. And for the last number of decades I've had typical megacorp group insurance that covers many/most providers nationwide. So, I'm trying to understand what this difference means in practice, and how to select the coverage (i.e. provider network) we'd want to go with, if we go with ACA. Some comments / questions:
- It's pretty obvious that for routine checkups and preventative healthcase, my family and I would have to go to providers in the "in-network" list, or else be prepared to pay cash prices (and not file with insurance) for out-of-network providers. (For example, my kids' pediatrician is not "in-network" with many of the policies, but since we just have a few years left before they leave for college, and they have no major chronic health conditions, maybe we just choose to pay out-of-pocket for the small number of routine office visits so they can keep their pediatrician.) This is an inconvenience but not a major one, and is well understood.
- If we are traveling (vacation, etc.) outside of our area, where there are no in-network providers, that's probably okay - the only coverage we'd typically use on a trip would be emergency coverage (i.e. major car accident, taken to ER), which I believe is covered at in-network rates by all ACA plans.
- When the kids go off to college, if they attend away from home, is the idea to purchase student insurance coverage through their university, and drop them from the ACA plan, so that they can seek non-emergency care on/near campus? But what if they want to see a doctor when home for summer/winter breaks? So maybe keep them on the family ACA plan _and also_ purchase student coverage? Not sure how that would impact the ACA subsidy or if that's even allowed? Or just choose to pay out of pocket if/when they need non-emergency care away from school/home, depending which plan they are on?
- My biggest concern would be if, God-forbid, one of us is diagnosed with a critical condition which requires specialty care - a specific type of cancer, perhaps, or specific neurological condition or whatever, where we'd want to be treated at a specialty medical center with expertise in that specific condition (without knowing a priori, of course, what the condition is!). Is it correct that this is the major drawback of tiny provider networks?
Or of course, I could bite the bullet and pay for COBRA which will allow me to postpone this decision for 18 months.
Am I thinking about this the right way? Interested in anyone with first-hand experience with these issues, or who has gone down a similar decision path.
Thanks as always!