Having had both, this is not my experience. My experience is that employer plans have fewer choices and similar or higher rates. They're cheap because my employer is paying most of the bill.
Just a note for those who may not know, either because they've grown up under a different regulatory regime or they never shopped for private insurance before the ACA:
Pre-ACA, I was once a much healthier early-twenty something applying for private coverage. I have a genetic condition that has never manifested in a health consequence that has required treatment, and technically it was illegal even at the time to reject someone based on their genetic information. Despite that, I was denied coverage by every private insurer in the market because I had a preexisting condition. The only reason the private market functions at all for anyone with so much as a history of a sprained ankle is because of the ACA.
Insurance companies would routinely (and retroactively!) deny coverage and payment based on preexisting conditions. They would accept premium payments for years, then when you came down with breast cancer would dig up an old photo of you with a cigarette in your mouth and refuse to pay for your treatment because you claimed to be a non-smoker when you applied for coverage. This was considered normal.
Varies a lot state-by-state. Ours has no individual plans offered outside the "marketplace", which most years only has a couple companies offering plans on it, all with bad networks, bad coverage, and terrible rates. A fairly bad employer plan is a much better value than the marketplace plans while a middling employer-provided group plan will be way better than the best plans on the marketplace, and there are, I repeat, no other providers that will sell you an individual plan in this state (I've checked, both with brokers and with major providers around, all said the same thing: "no-one sells individual plans in this state anymore, your only options are whatever's on the marketplace")
Is it available off-market? That's how I bought my insurance (in another state). My state has a marketplace too, but I found better plans directly through the insurer's website.
>I haven't had insurance for five years because the (major, national) providers who cover what I need aren't available on my state's marketplace (NY).
As someone who purchases insurance from the NY marketplace, that hasn't been my experience.
Initially, I had a plan from one of those (Anthem/BCBS), which provided pretty good coverage because they increased my premiums by more than 50%.
Now I have a local (New York State) provider (Fidelis Care) which costs less and has a (fairly) low deductible through the state's marketplace.
That said, many providers are actively hostile to marketplace plans. Back when I still had an employer-based plan, my company changed insurance providers. I called up my GP to make sure they accepted insurance from the new company, but before I could even describe the scenario, the office person at my doctor's office raised her voice and said, "We don't take any Obamacare plans!"
Which was quite interesting, since back then many of the major national insurance companies were offering such plans, including the companies (both old and new) my employer was contracting with.
All in all, I've been fairly satisfied with Fidelis Care, although I wish I could do database queries of their "Explanation of Benefits" records rather than having to wade through PDFs for each visit to a provider.
All that said, I don't know your circumstance (none of my business) so you may have needs that I don't. I wonder what those might be that a "national" insurer might offer than an in-state provider doesn't, especially since the ACA specified requirements for all health insurance plans, not just those on marketplaces.
Although I'm not sure how no insurance could be better than some, unless you're against medical care in general. But my use case isn't yours and I'm sure you make decisions that are best for you.
Edit: Added a few thoughts to address parent's issues, clarified my point about coverage to be more clear that I'm emphatically not calling anyone a liar.
> As someone who purchases insurance from the NY marketplace, that just isn't true.
So have I, and I stopped purchasing insurance because I cannot find the coverage I want. I need a specific variant of a certain operation which is only performed by a few surgeons in the country, and the one surgeon in New York who offers it only takes Aetna for that operation. Aetna reentered marketplaces starting 2022, but I'm moving and the operation has a year-plus waitlist, so I'm SOL. It has made a ton of sense for me to have no insurance because I'm fairly young and in fantastic health, making it cheaper to just pay out-of-pocket for primary care once or twice a year. Please don't call people liars.
>So have I, and I stopped purchasing insurance because I cannot find the coverage I want. I need a specific variant of a certain operation which is only performed by a few surgeons in the country, and the one surgeon in New York who offers it only takes Aetna for that operation. Aetna reentered marketplaces starting 2022, but I'm moving and the operation has a year-plus waitlist, so I'm SOL. It has made a ton of sense for me to have no insurance because I'm fairly young and in fantastic health, making it cheaper to just pay out-of-pocket for primary care once or twice a year.
That seems reasonable. As I said, "my use case isn't yours and I'm sure you make decisions that are best for you."
>Please don't call people liars.
My intent wasn't to call you (or anyone else) a liar. My apologies if you felt I was attacking you. Nothing could be further from the truth. I've edited my comment to explicitly reflect that.
I'd also add that I had a similar experience with physical therapy (PT) after surgery. When I changed insurers from BCBS to Fidelis (just a month or so after surgery), I found that the PT group I was using didn't accept my new insurance.
It's sad that we have to jump through all sorts of hoops just to get the medical care we need. Which is often the case even when it isn't an edge case like yours (or mine with my PT -- my situation was, of course, much less consequential since there are many PT providers out there).
