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$396 (if un-subsidized) probably means you are on a bronze tier plan. And yes many of those are hot garbage. However, if you are paying that for a crap plan and getting a subsidy too, you're probably getting ripped off. Most people on healthcare.gov or a state exchange who sign up for bronze tier are getting a subsidy, so the premium is reduced to near zero in some cases. Still often a bad plan, but a cheap bad plan.

I pay ~$400 but the government kicks in ~$350 too due to my low income. Its a Silver PPO plan and not bad, though, I haven't used it for anything serious yet. The Silver plans have extra subsidies so are usually better quality than bronze.

It also can be helpful to switch insurers if the plan is bad. My insurer up until last year was once decent but has gone downhill. They are also the dominant insurer in my area. The one I switched to this year is trying to gain market share in my area, so they seem to be a better deal, the plan is more generous and has less red tape.



When I was on the marketplace, I couldn't tell much difference between the metals. I'd pick a network, all the tiers covered only the mandatory stuff as best as I could see; really same deal with all the networks, but different providers. Higher tiers had higher premiums and lower deductables... for me, I just went with bronze because premiums + out of pocket max was lowest; I'm sure there's portions of the curve where care would cost less with a higher tier, but I figured lower cost with minimal use and lower cost with maximal use is pretty good.

IMHO, health insurance makes it hard to do cost control of healthcare. Patients can't do it, because they won't know how much stuff costs until 6 months after service, so they can't really make decisions on cost. Providers can't do it either, they have even less idea of what things cost for patients, and they have an interest in providing more billable care. Insurance companies could do it, but denying care for economic reasons is hard, so they just go with denying care for beuracratic reasons; also, ACA insurers have revenue limits based on ratios to covered care, so covering more things allows them to get more revenue. Even government paid healthcare has trouble because everyone gets grumpy when they can't get all the care available.


The maximum you can make and receive any subsidy is absurdly low. I don't qualify for any government subsidies yet I'm the one actually paying real income tax.




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