ACA enrollment is down about 5% in 2026 from the previous year. In addition, 1-in-7 enrollees in 2026 have not made their premium payments. That suggests nearly 3.3 million people enrolled in an ACA plan before the open enrollment window closed even though they were not yet sure if they planned to maintain coverage. Many apparently are letting their plans drop.
Obamacare is a boondoggle for those who need medical care. As I have stated before, somewhere between 80% to 90% of enrollees do not surpass their health plan deductible in a given year. Nearly three-fourths of ACA plans are Silver or Bronze plans. Health plan deductibles for Silver plans average $3,727, while Bronze plans average $5,304. That means most people are paying the bulk of their day-to-day medical expenses out of pocket regardless of whether they have coverage. Some people are questioning the need to buy coverage and prefer to use their premium dollars directly for medical care.
The Wall Street Journal discusses what uninsured patients can do to lower their medical bills. This could also be what underinsured patients can do since Obamacare is the epitome of underinsured, overpriced health plans. From WSJ:
Contorno is one of a small cohort of people who opt to buy healthcare largely on a cash basis. His family of six hasn’t had conventional insurance in eight years. He is keeping his bills down using services that he promotes to others through his business as a health-benefits consultant.
Among his secrets: He pays a monthly membership fee for constant access to a primary-care doctor, scores cheap prescriptions by using discounts and manufacturers’ coupons, and negotiates with hospitals and doctors’ offices for deals.
Reread the first quoted paragraph. Contorno is a health benefits consultant who does not think health insurance is a good buy. He presumably sells health insurance, but his family does not use it. From WSJ:
After back surgery a few years ago, Contorno was billed at around $20,000. “I just called up and said, ‘I’m willing to pay today. What can you do for me?’” His payment dropped to around $4,000.
I am a little skeptical that it was that easy but after significant negotiations I can see it happening. Something that millions of people are doing (and I have often considered) is joining a direct primary care (DPC) practice. DPC is similar to what was once called concierge medicine, but with a more affordable monthly fee. Month fees vary, but often for $70 to $150 a month you get same day appointments and unlimited visits. DPC physicians know their patients are price sensitive and act accordingly. They can also make referrals to specialists who take cash and have transparent pricing.
Patients should also shop for services when needing care. We have used some of these. More from WSJ:
A growing array of websites promise shoppable cash prices on certain procedures, including Green Imaging, MDsave, ColonoscopyAssist, RadiologyAssist and UberDoc.
We used RadiologyAssist last year and they literally gave us an insurance card for the imaging center so it worked just like health coverage with no copay. If comparing prices without a service (like above) mention you are uninsured and inquire about cash discounts ahead of time, do not wait until after the service is done.
Drugs are another example of ways consumers can compare prices. My wife and I use GoodRx. I went to pick up my dog’s medication at CVS a few years ago and they announced a special program for pet medications, and said I owed only $53 for the prescription I was picking up. I handed them a GoodRx coupon for $15 and it worked. Mark Cuban’s Cost Plus Drug Co is another valuable resource. The best advice, however, is to ask your doctor about a generic drug. Free samples are always costly name brand drugs.
Another piece of advice not mentioned in the WSJ article is to negotiate prices ahead of time if you are uninsured. There are numerous prices for the same services. There is a cash price that is the highest price (called the chargemaster). Then there is the cash price if negotiated ahead of time, which is often the lowest price. Let your doctor know you are price sensitive. My physicians have always helped me when I let them know I had a high deductible or was uninsured. The most important piece of advice is to never, ever get services from a hospital campus if you can avoid it. Hospital prices are higher than elsewhere.
For more information see WSJ: Losing Health Insurance? Here Are Ways to Cut Medical Bills
Good information; bookmarked for future reference.