Photo : Getty

Last week, we asked you to send in details of the insurance plans you purchased on the Affordable Care Act exchanges. We received more than 70 messages, mostly all with the same theme: This shit is too expensive, and it sucks.




Although some people felt their plans were pretty affordable, the vast majority did not. We heard from many people who knew they had to buy something, but also knew the plan they could afford wouldn’t provide enough coverage if they actually needed it. We also heard from people who had to choose a worse plan this year to be able to afford it, and people with serious health problems who were terrified of how to pay for their care.

All premiums noted are monthly. Entries edited for length are marked with brackets, and the names of the respondents have been removed. Otherwise, each entry appears as it was received.


The Highest Premiums

Premium: $1,300, for two people

State: Iowa

At this point we’re just relieved we can (barely) afford insurance again. My wife & I had to go uninsured last year because we couldn’t afford insurance *plus* the hospital bills from when our son was born (when we had insurance). We are of course still paying down those bills.

State: New York

Job: Freelancer

The bottom line is that quality health plans are ONLY available through a corporate employer - even if you had all the money in the world, you could not buy a health insurance plan comparable to what corporations offer their employees - it’s simply not on the market. How is that fair? Why should you be forced to sacrifice your health in order to engage in entrepreneurial activity, which is supposedly what America is all about? This is yet another aspect of corporate control over our lives. I can’t wait for the day that this embarrassing excuse for a healthcare system goes down.


State: Virginia

I actually ‘saved’ about $50 switching from a Silver to Gold plan and dropping the Health Savings Account option. But the premium increase is still a 33% increase in cost over the prior year. To put this in context, in 2016 I was paying $283 a month. Now $664 a month. If I had kept the same plan, I would be paying $716 per month. The overall quality of the product isn’t 230% to 250% better now than it was in 2016.


Premium: $860 a month

Was laid off after 9 yrs with same company a few years ago. Am unable to find employment again. Age 60. Had same marketplace insurance and provider for 3 yrs. First year it was approx 250 dollars a month. Next year went up to 560 dollars a month with same income (approx 20,000 dollars social security from spouse). This year made about 23000 dollars. Now paying 860 dollars a month. Made call to health insurance broker that was non obamacare. They said nobody would sell insurance to me because i am overweight.


The Worst Deductibles

State: New York

Job: Freelance writer

Starting 2019 I’ll be paying $450 for Oscar’s bargain basement bronze plan. Based on my 2018 freelance income I don’t qualify for any ACA subsidy, and will probably owe the government a couple thousand in fines for lowballing my income when I signed up for Oscar’s silver plan last year (and got a $200 subsidy). This year’s silver rates are too high for me to afford without a subsidy. My plan doesn’t cover shit until I hit a $6,000 deductible, so I’m strategizing with my psychiatrist (who doesn’t take insurance) ways to get less-expensive meds for the upcoming year. Might do like my mom and buy meds in bulk from Bangladesh (like, actually).


State: Utah

Job: Seasonal park ranger & freelance journalist

I’m 30 years old, and I haven’t been to the doctor in three years. The last time I went for a physical, I had insurance but still had to pay $150 for a checkup, even though it was ‘preventative.’ So I haven’t gone back since. For 2019, the absolute cheapest plan I can get on the marketplace in Utah is $347.81/month, $4,412/year, or one quarter of my gross earnings as a ranger. And that’s for a $6,600 deductible! The price has gone up $45/month since last year. Insanity. If a free-at-point-of-service M4A system were to raise my taxes by $5,000/year, I would consider it a better deal.


I am JUST over the income line, so this is completely unsubsidized. The exchange plan is fucking garbage ($7900 deductible), but this is actually going to be a huge improvement over my current work-sponsored medical plan, which has a $5900 deductible, but a $355/month premium. It’s baffling that they’re offering something that awful to employees.


Premium: $324.17 for two people

Deductible: Nearly $16,000 for two people

This is the Catastrophic level, $324/month. NOTHING is covered, except for a flu shot. $7900/pp deductible, nearly $16k for both of us. The Bronze plan would cost us $791/month, which is out of the question financially. [...] His old employer-provided bronze plan was nearly $500/month and had a $6k/pp, $12k total deductible. It was the same coverage level as the catastrophic plan we’re signing up for now - nothing was covered, and we’re in medical debt paying off hospital bills. I was charged $150 for two aspirin during a hospital visit. One of us had a seizure this year and skipped medical attention because we were scared of the cost. When I fractured my elbow, I almost didn’t go to the hospital and was gonna cure it “on my own” with rest and ibuprofen, but my husband convinced me to go to the ER. On top of the $3k hospital bill, we had to pay an orthopedist $600 for less than five minutes of consultation time.


Premium: $617.83 for two people

Deductible: $13,000 for two people

This year will represent an improvement, not in price, which continues to climb, but in that there was only one non- Kaiser Permanente option last year, a company called Ambetter that no provider accepted. The process is just as awful as ever, with no real way to discern what the difference is in various plans, and a general lurking feeling that if we get sick we’ll still lose everything. My mom died of breast cancer when I was a teenager, my brother of leukemia 5 years ago. They both had employer provided plans, but it didn’t avert economic ruin, so I stay terrified of not having health insurance and simultaneously sure it won’t be enough.


The Most Pissed-Off People

In 2017, I ended up repaying part of my tax credit because I ended up making ~$2,000 more than I anticipated due to income from my side-gig. Due to this, my tax bill was $1,300, even after retirement plan and student loan interest deductions. In 2016, my automatic-payment was declined one month due to non-sufficient funds in my checking account and I was subsequently dropped by my insurer; I did not realize this until the two months later when I cut my finger washing dishes and was billed $400 for the ER trip where I received three stitches. Oh, and because of the individual mandate, I was penalized around $75/month for each of the four months that I was uninsured (which happened because I was broke). Great system! [...] Oh and fuck small businesses too. Each of my bosses are on their spouse’s health insurance and I’m left to go fuck myself.


I don’t have a screenshot to share b/c I pay zero dollars for health insurance. I’m a veteran who gets all of my healthcare through the VA system, and it’s absolutely fantastic. I’ve had a few bumpy times initially getting in to the system, and again some admin difficulties when I moved to a new area and had to get set up with a new primary care physician and mental healthcare provider, but the actual quality of care has been fantastic. [...] When I look at the healthcare system in America and see how totally fucked up it is, with people having to have GoFundMe’s to pay for fucking cancer treatment, or young people dying from diabetes b/c they can’t afford insulin, it makes me absolutely sick. Sure, I served in the military, but that doesn’t make me any more special or my life any more important than anyone else in America.


State: Washington

We’re a deep blue state. We have our own insurance market and everything and this is the best they can do? This is the health care reform I’m supposed to be grateful for? This plan only fully covers routine appointments but I can walk into a clinic and get that for $150. [...] I’m so sick of this too clever by half pick your plan horseshit. I spend all day working for people who are constantly taking vacations and drive new cars and I’m trying to wonder if I’ll be able to buy a house before I’m 45. Shit like this is why.


State: Pennsylvania

Despite making pretty decent money, between rent, healthcare, and student loans (which had to be deferred for a year while caring for my mom), there’s not much left for just living. I purposefully moved to a city so I could forego a car and for lower rent. I haven’t traveled in years. I go out once or twice a week for happy hour beers, but other than that exorbitant expenditure of about $20, there’s not much left to buy much-needed clothing or take an Uber to the doctor to check out the latest health issue, much less catch a movie, travel, or save for the future. I also have about $1000 worth of dental work I’ve been putting off because every time I save up a few hundred dollars, the dog needs to go to the vet, or I need to chip in for a relative’s medical expense, or I get sick and need to visit a doctor myself. I’m drowning, I don’t particularly enjoy life, and it feels like this will never end.


Premium: $0 after subsidies

I am a high-school computer science teacher, working with a very small non-profit. I make $32,100 per year there, plus $6,500 in additional income from a second job. Until taking this job, I had good health insurance that allowed me to get the proper care for my chronic, but manageable with care mental illness. Now, I can’t afford to pay the $100/mo+ premiums (after the substantial tax credit) a comparable plan would cost, especially since I have like $40,000 in student loan debt from getting my teaching degree. Instead I have this bullshit, worthless plan because even without the individual mandate I am too afraid to go without some kind of health insurance. This means I can’t afford to get treatment for my mental illness, which makes maintaining a stable life in terms of both work and home very difficult. I spend my days teaching teen moms how to use Word to make resumes and helping 17 year-olds with MS13 tattoos learn to code and I’m damn good at it. But it’s quite possible I’m going to have to quit and go back to my college gig of being a barista because at least Starbucks gives you FUCKING INSURANCE.


The People Who Just Said No

State: Michigan

Here’s the lowest premium available to me - $215/month, which I can’t afford in the first place, for the privilege of fronting nearly $8,000 (lolol) before anything else kicks in. Unless something crazy happens before tomorrow night I’m looking at another year without insurance. I don’t know wtf else to do.

[...] I live in metro Detroit. I have 2 contract jobs with no benefits. Husband works for a small business that subsidizes his plan, but adding me would be full price. Our combined income puts us over the limit for any ACA subsidy.


State: Texas

2018 was the first year I was penalized by the IRS for not having insurance, even though I paid for my healthcare. It’s been WAY cheaper for me to just pay my doctor & pharmacy when I need an appt or meds—& only when I need them. As a cash paying customer I pay $120 to see my doctor (an avg of four times a year) & in 2018 I’ve paid $749.27 for meds, also as a cash paying customer. I use CVS because they’ve consistently had the lowest prices every single month for almost 3 years now. This has been the cheapest marketplace premium I’ve been offered since the ACA was enacted ($697.97) but it’s still much more expensive than what I pay for my needs. I don’t know how they come up with these monthly premium prices but they made me input my household income info so they know damn well that $700/month & a $15k deductible is more than I can afford. If(when) I ever get really sick, I’m gonna be really fucked.

The People Who Aren’t (Too) Mad

Premium: $270 for two people

State: Vermont

For 2019, we were able to upgrade to a much better Gold level plan for only a small bump in premiums. If we’d kept our current plan, our premiums would have risen to $249 per month. In contrast, a gold plan is only $270 per month with unlimited primary care visits for $15 (this tends to be all we use) and 30% coinsurance for hospital services (as opposed to 50%). We are absolutely delighted with what we’ve been able to get this year! [...] Our child, like most Vermont children is on Vermont’s wonderful single-payer program for kids “Dr. Dynasuar.” We pay $60 per month in premiums and all of our kiddo’s health care (including vision and dental) is free at the point of service.


State: New Jersey

I’ll be 39 next year, smoke, and after leaving an awful ad agency job, been stuck paying $901/month for dental and health coverage through Cobra with my former employer, which is fucking outrageous. [...] These were the least worse choices for me, as I’m lucky enough to not have any serious health problems, and the trade off with these premiums results in a less batshit deductible.


State: California

I rarely go to the doctor, and I know that as an American, I am being massively ripped off at every turn but I do believe that participating in an exchange makes the system stronger for other people. That might not be true, but it feels true? I know that I’m fortunate I can afford to pay such a high premium, and I would prefer Medicare for All, but within the range of fucked-up options open to me, I sort of don’t hate buying through a state exchange. When I was employed full time, it wasn’t uncommon for employers to totally change insurance options on a yearly basis, so I actually feel like I have more control over my coverage by getting it through Covered CA.


The Least Improved Plans

Premium: $234.70, up from $12 last year

State: Tennessee

Up from $12/mo last year. Not pleased. I’m right around the income eligibility cut-off for any subsidy, like last year.


Premium: $86.89, up from $4.84 last year

State: Pennsylvania

I was probably just being cheap when I chose the four dollar plan when I moved to a new city which ended up being to my detriment. I couldn’t afford therapy since every appointment would be 40 dollars. I fortunately still get medication refills once a month. The deductible was extremely high. PCP visits were 30ish dollars and I wanted to get blood work done, I just assumed I would either be quoted something before they did it, or it would be included as a regular procedure but it ended up costing me 250 dollars. Now, with insurance I chose for 2019, my premium not only went up, but instead of quoting actual prices for specialty or even PCP visits it just says “no charge after deductible” which means even though my premium is much higher I’ll probably still be paying more for doctor visits and I still can’t afford therapy. I’ve been on a months long wait list for sliding scale clinics since summer and I still haven’t heard anything back.


State: South Carolina

Single male 54 yrs old and saw my insurance go up $50 a month for the least expensive plan. I’m a freelancer that every year has to ask myself, will I have enough work this year to pay for health insurance? Sadly that answer is not always yes.


State: Virginia