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>the annual maximum out-of-pocket payout is roughly $20,000,

https://www.healthcare.gov/glossary/out-of-pocket-maximum-li...

The annual max family out of pocket is legally capped at $18,200, but most plans will be less than that.

>Another issue with ACA marketplaces that I found was they churn a lot; every year when you have to renew coverage you can have an entirely different set of providers and plans.

This is not my experience, I have been able to purchase the same BCBS health plan from the same insurer for many years.

In NJ, I would budget $30k per year for premiums for a gold level plan for a family of 4, assuming you are not getting any premium tax credits. Of course, out of pocket maximum is up to another $18k.

https://www.state.nj.us/dobi/division_insurance/ihcseh/ihcra...

>Sadly, none of this is tax-deductible as far as I can tell.

It should be tax deductible if you are self employed:

https://www.healthinsurance.org/obamacare/self-employed-heal...

And if you are working for a small business that does not offer a group health plan, you should be able to get premiums reimbursed from employer with pre tax income:

https://www.healthcare.gov/glossary/qsehra/



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