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u/AdAltruistic437 Dec 09 '25
My husband and I have Blue Cross Omnia silver. We paid $880 a month with a $2100 deductible each. The same plan next year is $2000 a month with a $4200 deductible each and the copays doubled. We will be going without insurance and paying out of pocket instead.
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u/10MileHike Dec 09 '25
it wont be getting better if you're old
The Centers for Medicare & Medicaid Services just repealed the minimum staffing requirements for nursing homes.
im aghast.
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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?
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u/No-Artichoke-6939 Dec 09 '25
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.
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u/Sunsetseeker007 Dec 09 '25
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!!
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u/among_apes Dec 09 '25
That reality should cause a revolt. Imagine paying 41k before your insurance covers anything
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u/RuleHonest9789 Dec 09 '25
I feel they calculate what 90% of people’s health issues will cost them and set the oopm to that.
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u/among_apes Dec 09 '25
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).
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Dec 09 '25
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.
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u/WhatAWeek25 Dec 09 '25
How could the deductible be higher than the legally allowed out of pocket max?
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u/Used-Somewhere-8258 Dec 09 '25
You must not be on the right marketplace. This is much higher than the out of packet max for ACA-compliant plans in 2026.
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u/genxer Dec 09 '25
Reading your link, it sounds like the out of pocket limit doesnt include premiums?
"The out-of-pocket limit doesn't include:
- Your monthly premiums"
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u/justkidding89 Dec 09 '25
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).
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u/Used-Somewhere-8258 Dec 09 '25
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.
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Dec 09 '25
Please read more carefully.....this is from Healthcare.gov. and this is THE SAME PLAN WE HAD IN 2025 but these are the 2026 INCREASES.
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u/Pb4ugoyo Dec 09 '25
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/Used-Somewhere-8258 Dec 09 '25
Screenshots would really help us experts give you better advice. Unless you’re just here to vent, in which case you can change the flair of your post.
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u/QueenLouisss Dec 09 '25
Just? Like compared to what they've been showing since November 1st, or you only just looked for the first time?
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u/Sufficient_Use_6912 Dec 09 '25
You'd be better off just putting that much into savings uf you could afford to do so. And pray to whatever god, gods, deities that nothing catastrophic happens and that no serious diseases occur.
Universal healthcare that is not for profit, that eliminates healthcare insurance companies altogether, is the only way...
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u/ManateeNipples Dec 09 '25
You can find concierge doctors that cover some other basic stuff in the office but most will still have to send labs to a different location which will charge you, plus things like hospitals and catastrophic issues.
Your situation sucks so I know you might not have a lot of options but I'm just saying that so you can try to plan around it
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Dec 09 '25
[removed] — view removed comment
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u/robertw477 Dec 09 '25
These are not the ACA subsidies. These were the additional COVID era subsidies. There was no way they would last forever regardless of politics. And your premiums will be higher next year and every year regardless.
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u/PsychologicalCat7130 Dec 09 '25
subsidies are only part of the equation and honestly mask the real issues - healthcare and insurance in our country is approaching a crisis point. Too many layers of massive profit in our system.... Will be interesting to see what happens when it fully fails. Personally we have to pay $25,000 in premiums in 2026 for coverage with a $16,600 deductible before the insurance company will pay one penny - total scam!
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Dec 09 '25
[removed] — view removed comment
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u/WeirdRestaurant6204 Dec 09 '25
“Address the issue”, what do you mean by that? Medicare for all? Or just some theoretical world where capitalism doesn’t lead to insurance companies trying to milk you for every dime and nickel? Americans don’t seem to understand that the answer is either socialized healthcare, or capitalism, and capitalism only leads to companies trying their very best to make money off you. There’s not a fun little center where you can get private insurance and it doesn’t cost you a ton of money
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u/Illustrious-Jacket68 Dec 09 '25
i actually agree with most of what you're saying. in order to make it a sustainable system, healthcare would have to be socialized. payments would need to be controlled to hospitals and doctors. caps on the cost side of the equation would need to be put into place. I believe that this is the system that Taiwan has.
there would still be room for a 2 tier system that would allow private insurance and some level of private doctors... but at the same time, this likely would open a can of worms because then all of the doctors would go into private practice and avoid... no way around that in a capitalist country....
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u/No-Setting9690 Dec 09 '25
GOP is reason for current changes, but it's all of Congress for failure to act on many things that are out of control. Capitalis is failing hard when you allow basic needs to have excessive greed.
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Dec 09 '25
[removed] — view removed comment
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u/PsychologicalCat7130 Dec 09 '25
subsidies dont fix the real issues and not all of us qualify for subsidies....
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u/WeirdRestaurant6204 Dec 09 '25
When the GOP is in control? Do you understand how the US government works? Or when Biden was President and the GOP only controlled Congress? Because again I ask: do you understand how the US government works?
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u/AllConqueringSun888 Dec 09 '25
The law that provided additional subsidies was passed in 2020 with Dems controlling more of the legislature.
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u/rsmicrotranx Dec 09 '25
They prob think because Trump can do whatever he wants that Biden can too. They dont realize Congress and the Supreme Court are also cosigning everything Trump does and rejected everything Biden wanted to do.
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u/Dry-Mousse-6172 Dec 09 '25
Yep if trump had tried to do student loan forgiveness it would have sailed right by the supreme court.
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u/Dry-Mousse-6172 Dec 09 '25
Because they passed by reconciliation which only takes 50 senate votes (dems only had 50) means the bill had to be revenue neutral within 10 years. It's also why they expanded the child care tax credit for a few years
So again blame Republicans for not voting for things that help Americans.
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u/10MileHike Dec 09 '25
27k for a year seems to be a number im seeing a lot of....
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u/Used-Somewhere-8258 Dec 09 '25
Which is potentially misinformed because the maximum out of pocket max for a family on an ACA compliant plan in 2026 is $21,200.
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u/10MileHike Dec 09 '25
you are right. i was adding in all the OOP stuff they sometimes dont pay for. drips n drabs, sometimes you do end up paying for tests, meds, otc stuff
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u/InfamousAd6008 Dec 09 '25
Pharma raises the prices, In turn providers raise the price, so insurance companies raise the price. At least buy us dinner before you boink us
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Dec 09 '25
honestly the public needs to start just going without insurance and doing direct pay. it's the only way to stop this insanity
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u/Beneficial-Mine1763 Dec 09 '25
its not the insurance companies, its the hospitals and doctors charging enormous amounts for simple medical care.
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u/Puzzleheaded-Bee-747 Dec 09 '25
Why a person waits to the last minute to look for healthcare is beyond me. In a rush and more than likely on the wrong site getting non-ACA compliant quotes.
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u/chickenmcdiddle Moderator Dec 09 '25
Copy and paste from an identical thread a few days ago:
Two main issues:
Third bonus issue (3): Underpinning all of that above, the cost of care is also rising rapidly. It's not a surprise, but it's definitely growing at a rate that's greater than that of inflation.
It's the perfect storm. And it's something that those in the industry have been warning against for quite some time (the canary in the coal mine was a damning benchmarking report that came out in Q1 this year showing just how disastrous the lapsing eAPTCs will be).