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Comment by floating-io | Hacker News Reader

Employer-offered plans tend to be extremely good value, so the vast majority take advantage of them.

I was paying <~$300/mo on that plan. I now pay over $700 on a directly-acquired plan. So that's problem one.

The bigger problem, IMHO, is that quitting means changing your insurance, which isn't just a financial change. It can also end up requiring you to change medical providers, which is no small deal!

This adds massive friction and stress to the act of quitting/changing jobs, a major source of leverage on the employer's side.

And that's to say nothing of the fact that it's effectively an overly burdensome tax on new entrepreneurs. It's a reinforcement of the concept, "you have to have money to make money".

JMHO on the topic; for reference, I'm a new entrepreneur very early in the process. I'm just lucky enough to be able to risk the attempt.

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> I was paying <~$300/mo on that plan. I now pay over $700 on a directly-acquired plan. So that's problem one.

This is relatively small pickles. Your employer paying a few hundred, maybe a thousand dollars on your behalf if you are old, per month. You can buy the same on healthcare.gov

You actually can’t. There are off market and on market plans. Even though it’s by the same insurer, on market insurance is only taken by 50% of the places that take the off marketplace plans. Been down that road a few years ago and it was a disaster. Ended up getting a great plan for my company through the state chamber of commerce.

In my experience in west and northeast coast states, the plans are the same assuming they are ACA compliant. The employer even shows the same gold/silver metal level labels when you select a plan, and I’ve always had BCBS plans, which has the same networks via employer or via healthcare.gov

They only things that I expect to change are total premium, deductible, out of pocket expense, copays, and network. Otherwise, the coverage itself is dictated by the same law.

I can see right now that the BCBS gold HSA premium from my employer (total, including employer portion) is the same as the BCBS gold HSA available on healthcare.gov.

Reimbursemenet rates are not the same. Some doctors will accept 1 and not the other.

I used a hospital for a new baby birth. Because my plan was on-market, the provider doing delievery didn't accept it (Despite it being on the in-network list). So I got to be stuck with a ~13k bill. Was super cool.

This was back ~8 years ago, so perhaps it's all been sorted.. but I have such a bitter taste in my mouth after having to pay this out of pocket, I won't touch on-market plans with a 100 foot pole.

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