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Comment by lotsofpulp | Hacker News Reader

Yes, the ACA made it so everyone can go to healthcare.gov and buy health insurance.

Health insurance and healthcare is NOT tied to your employer in the US.

However, many employers pay 50% to 70% or even 100% of the health insurance premiums for their employees, and employees can use pre tax income to pay health insurance premiums if purchased by their employer.

The problem has always been this tax advantage of your employer purchasing it, AND most Americans opting to not purchase it due to cost.

Note that there are significant subsidies available if you earn less than 400% of the federal poverty level, although that may still leave many unable to purchase it (or the deductible/oop max is so high it would not make any difference).

https://en.wikipedia.org/wiki/Premium_tax_credit

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The other problem is that ACA plans are garbage compared to group plans, with no out of state or out of network coverage available. If you end up needing a hospital stay, you could be in trouble if the "wrong" doctors do a drive-by.

I have been able to find equivalent plans in 3 states, usually BCBS ones that are the same as any self insured or employer group plan. Might not be as good as the employers with especially high portions of young, healthy, higher paid office workers, but for most people, it should be comparable.

> If you end up needing a hospital stay, you could be in trouble if the "wrong" doctors do a drive-by.

This is not true since the No Surprises Act went into effect Jan 1, 2022. Everything is considered in network in an emergency, and if a doctor works in an in network hospital, then the doctor is considered in network too.

Interesting. In the few states I looked, there were no PPO plans (including by BCBS). As for hospitals, I guess it's important to know which hospitals are in network near home and anywhere you might be traveling?

Usually in an emergency I don't have the presence of mind to direct the ambulance to the right hospital (in case the emergency turns into an overnight stay), and it's all the more important if the plan doesn't have good (or any) out of network benefits.

In an emergency, all hospitals/doctors/facilities are treated as if in network, so you would not have to direct the ambulance to the in network hospital.

But can't a doc insist on a hospital stay following the emergency, which then isn't covered by insurance as an emergency?

By "insist," I mean that leaving would be against medical advice -- and I know some insurance will refuse to pay for the preceding stay.

I wish this stuff weren't so hard to make sense of.

I don’t think so, if you get discharged from the hospital under your own recognizance, you are no longer in an emergency. If you are not discharged, then how could they argue it is not an emergency?

Who knows how well it works in practice.

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