Posted: 7/21/2026 4:57:56 PM EDT
|
For those who are on ACA plans under 65yo is there a downside to getting separate ACA plans with your spouse in this scenario? The main consideration I'm thinking of is the max OOP is almost half as a single, and odds are both people won't hit the max OOP in a given year. So in years a person hits the max OOP that could save ~10k assuming the other person doesn't use their insurance. Let's make assumptions of no dependants, couple in their 40s or 50s, no W2s or employers, and if one spouse is in good health. I know hitting the deducible is a different comparison but has anyone run detailed numbers for similar scenarios? |
|
I'm on a grandfathered plan, wife is ACA, and every year I do this calculation to see if it makes sense. (Wife is a fair bit younger which is a factor in the cost, but not the dominant issue.) Your proposal hits the nail on the head -- the net of it is we're always better with separate plans due to one of us being far more likely to hit the deductible limit than reaching the family deductible. The other thing is when you add up the cost of separate policies the juice isn't worth the squeeze. Real numbers from AZ BCBS with me (60s) and wife (30s) using BCBS' "medium" health care use which is premiums + a few appts. For AZ Blue AdvancedHealth Bronze Neighborhood plans: Couple $32,629/year. $20K deductible. Me - $22,549, 10K deductible, 10K OOP. Her - $10,080, 10K/10K. Note that the above adds up to the exact same price as the Couple plan. The only difference is you hit the single plan deductible sooner, just like you noticed. FWIW the last few years one of us (usually me, but sometimes her) hits the deductible and at no time would we have on the couple plan. |
|
Thanks, I'm glad to hear someone's been putting this into practice IRL. It just seems odd how even with both of us fully employed now it's still the same situation where separate plans are better. The healthcare volatility has been the hardest thing for me to plan for in pre Medicare retirement. |
|
Given the pricing it's pretty clear the insurers are setting the system up to work this way (separate policies.) I'm sure there's some financial motivation for doing so. FWIW, the last several years when I've hit my deductible it has been for surgical procedures, hospital stays, etc, and I got cash prices for the work that was done for comparison purposes. Even with a rotator cuff repair and a gallbladder removal, I'd be better off paying cash by a wide margin -- about half of what is being paid for insurance between my wife and I (over 30K, not counting deductibles paid on top of premiums.) So literally I could do a major surgery a year and come out ahead by $20K once deductibles are factored in. The only reason I still have insurance is for the unpredictable very large bills (e.g. auto accident, cancer, etc.) If they still did catastrophic policies that's where I'd be. As you well know this whole system is f'd. |
