The Biggest Problems with the ACA Marketplace (and How to Avoid Them)
The Biggest Problems with the ACA Marketplace (and How to Avoid Them)
4/30/2025
Let’s be honest: navigating the ACA Marketplace can feel like trying to read a medical bill in Latin. Confusing, overwhelming, and often followed by the phrase, “Wait, I have to pay *what*?” I’m Jo Hutchison, a health insurance broker with Founders Life and Health, and today we’re diving into the most common complaints I hear about ACA (aka Marketplace aka Obamacare) plans—and what you can do to dodge the biggest headaches.
1. “My plan doesn’t cover anything!”
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Yep, I hear this one all. the. time.
Here’s the likely issue: You probably enrolled in a plan that doesn’t offer any benefits until you hit a high deductible. That plan might’ve looked tempting—low monthly premium, right? But when you see things like “$20 copay *after deductible*” or “50% coinsurance *after deductible*”... that’s your red flag.
👉 Pro tip: Look for plans that list copays up front—*before* the deductible kicks in. Paying an extra $20 or so per month can save you hundreds down the line when you actually need to use the plan.
2. “My doctors aren’t covered!”
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The struggle is real. Network limitations are a legit downside of many ACA Marketplace plans.
If your favorite doctors are non-negotiable, make sure they’re in-network before you enroll. Use the Marketplace tools (or better yet, work with a broker—hi, that's me!) to check. And if there’s a doc you only see once a year, it might be worth paying out-of-pocket just to keep that relationship going.
And remember: Open Enrollment is your chance each year to shift plans and fix network issues. Mark your calendar!
3. “This isn’t affordable!”
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It’s literally called the Affordable Care Act, right? So why is your monthly premium more than your car payment?
A few things to double-check:
- Are you including your *entire* household size when applying, even if only you need coverage?
- Are you using your adjusted gross income (line 11 on your 1040), not your total income?
- Has your income changed (job loss, retirement, etc.)? You might be eligible for more help than you think.
And if your income is too low or too high for Marketplace subsidies, don’t panic:
- **Too low?** You may qualify for Medicaid in your state.
- **Too high?** Private PPO plans designed for self-employed folks might be a better fit—often with lower premiums and deductibles.
4. “My prescriptions cost a fortune!”
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This one’s a beast, especially if you’re taking specialty meds. Tier 4 and 5 prescriptions aren’t always well-covered on Marketplace plans.
If you’re stuck:
- Check with the drug manufacturer for copay assistance programs.
- Talk to your pharmacist—especially if it’s a specialty pharmacy. They know their stuff.
- Consider switching to generic versions (with your doctor’s blessing) when possible. Marketplace plans are usually more generous with generics.
Personal note: My son takes Humira for Crohn’s. I get it—these meds can be crazy expensive. But there *are* ways to make them more manageable.
Final Thoughts: Don’t Settle, Get Help
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The ACA Marketplace has its flaws, sure—but many of the biggest issues come from people not knowing how to work the system. That’s where a good broker can make all the difference. (Psst: our services are free!)
Have a complaint I didn’t cover? Want help picking the right plan? Hit me up! I’m here to make health insurance suck less.
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Jo Hutchison | Founders Life and Health
jo@founderslifeandhealth.com | (800) 651-2577
www.founderslifeandhealth.com
