employer KYP coverage and creditable coverage

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I’ve bought health insurance on the marketplace for a number of years now as my employer didn’t offer coverage. I’ve enjoyed getting to pick the best plan for myself (very high utilizer of healthcare, usually choose a plan with higher premiums and lower out of pocket max as I usually hit my out of pocket max in Feb/March) I’ve also been eligible for a subsidy the pay few years which is nice. Now I’m changing jobs and one place I’m considering offers a plan that’s been grandfathered in. Turns out this plan does not have an out of pocket maximum, just copays for everything and a few things have coinsurance. I see this a being potentially a large problem for me, especially because I probably have 2 or 3 medications that are likely tier 4 w/ a $100 copay, plus 4-5 that would be a $35 copay and 4 that would likely fall under $10 copay… I mean prescription out of pocket costs alone would likely cover the costs of my premium for my usual marketplace plan. Especially once you add in copays for doctors appointments!

The SBC says this qualifies as “creditable coverage” and that I may not be eligible for premium tax credits if I decline this plan. I guess I’m wondering how it can be defined as creditable coverage if it doesn’t have an out of pocket max? I guess maybe for the majority of people that doesn’t matter but for someone like me it could get really expensive!

The plans SBC’s examples of yearly costs for diabetes/pregnancy/broken leg are also misleading and confusing because all state the members yearly cost for treatment to be $0… but I’m failing to see how that can be when all office visits have a copay, hospital admission has a copy, prescription drugs have a copay? Every scenario/example they have had an instance where a copay would be applicable per the SBC. Am I missing something?

State: WI

submitted by /u/dreamingjes
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I’ve bought health insurance on the marketplace for a number of years now as my employer didn’t offer coverage. I’ve enjoyed getting to pick the best plan for myself (very high utilizer of healthcare, usually choose a plan with higher premiums and lower out of pocket max as I usually hit my out of pocket max in Feb/March) I’ve also been eligible for a subsidy the pay few years which is nice. Now I’m changing jobs and one place I’m considering offers a plan that’s been grandfathered in. Turns out this plan does not have an out of pocket maximum, just copays for everything and a few things have coinsurance. I see this a being potentially a large problem for me, especially because I probably have 2 or 3 medications that are likely tier 4 w/ a $100 copay, plus 4-5 that would be a $35 copay and 4 that would likely fall under $10 copay… I mean prescription out of pocket costs alone would likely cover the costs of my premium for my usual marketplace plan. Especially once you add in copays for doctors appointments! The SBC says this qualifies as “creditable coverage” and that I may not be eligible for premium tax credits if I decline this plan. I guess I’m wondering how it can be defined as creditable coverage if it doesn’t have an out of pocket max? I guess maybe for the majority of people that doesn’t matter but for someone like me it could get really expensive! The plans SBC’s examples of yearly costs for diabetes/pregnancy/broken leg are also misleading and confusing because all state the members yearly cost for treatment to be $0… but I’m failing to see how that can be when all office visits have a copay, hospital admission has a copy, prescription drugs have a copay? Every scenario/example they have had an instance where a copay would be applicable per the SBC. Am I missing something? State: WI
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