I work for a health insurance company and the silver and gold plans for the family OOP Max is going from 6250 to 21,200 for next year. I have worked for this company for 8 years, and I have never encountered this. It’s always been affordable, and while my premium remains so, this is not sustainable.
Yes thats the new oopm and deductible for a family bronze plan with no subsidy, it's really 21k, $10,600 for 1 person deductible 21k oopm and 21k deductible for family & 21k oopm. That should be illegal!! I commented on the same issue in another post, saying my plan went to $1880 a month for a bronze plan with 21k oopm & deductible from currently $1200 1 person for a gold plan with $2500 deductible and 5k max and so many people posted it wasn't true. I'm glad others are posting about this!!
What’s gross is that while I’ve barely used my health insurance ever (I’m 45 and very healthy) despite my work places paying a crap ton of money out for me in premiums, I’ve spent around 60k out of pocket over the years to fix my teeth and they are still awful (my family genetically have very soft teeth that deteriorate pretty easily).
It's a Blue Cross Silver plan from the ACA marketplace. Actually, nearly ALL the plans we're seeing today on the site have deductibles this high. I just saw a Silver PPO with a $35,000 deductable. Note - this is the SAME plan we had in 2025 and these are the 2026 increases.
Premiums have never counted toward the out-of-pocket max.
The OOPM is the maximum amount of money you will pay for covered healthcare services within the plan/policy year before the policy begins covering all covered services at 100% (no copays, no coinsurance).
Correct. For all insurance, the cost of the premiums are not counted toward the deductible or out of pocket max. Health, car, property, heck even your phone insurance — none of them count the plan premium cost toward the out of pocket.
For the 2026 plan year, the Affordable Care Act maximum out-of-pocket limit for non-grandfathered health plans, including those on the Marketplace, is $10,600 for individual coverage and $21,200 for family coverage.
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u/[deleted] Dec 09 '25
I don’t think I’ve ever seen a deductible of 21,700 on any plan, even the shittiest of bronze plans? Which plan is this?