<prompt> Human: My spouse and I are self-employed. Weve been purchasing insurance off the exchange for the past 2 years. The first year we had a Gold plan, and this year we have a Silver premium increases through BCBS. For our family of 4 including minor child with autismepilepsy and other minor child with ADHD and ptsd related issues pays 900 month with after 200 subsidy which was based on the prior years income, and we may have had to pay it back after we filed taxes, I dont remember at this point. Our family deductible was 3700 and 1750 individual. We have met our family deductible and have paid a total out-of-pocket 6,765.18. Including the premium, deductible and OOP, we have paid 21,265.18 for health insurance this year. This doesnt count dental because we self-pay for that.I was recently informed that BCBS is not selling in my state anymore. So when I went on to apply, I only have two options for providers. Also, this year, we dont qualify for a subsidy. My choices are between Cigna and Ambetter. A comparable sliver plan from Cigna is 1359 monthly premium with 9000 family deductible, and 14,700 OOP. I will lose all of my doctors therapists, pcp, psychiatrist, neurologist, all of who have been treating my family for the past 5 years.The AMBetter plan will allow me to retain some of my former doctors. Monthly premium would be 1500.28, family deductible 14,100, and OOP max 14,100.The Bronze plans look pretty awful and are not much cheaper 900 premium 14000 Deductible, but the benefits are terrible.My husband and I do not get child-support for my two step-children, and we pay for 100 of all expenses while they are with us, which is 23 of the year well, 100 of the year for my stepdaughter bc her mother no longer sees her. This is per our court ordered agreement. Bio mom has a corporate job with great insurance, but has previously been unwilling to put the kids on her insurance unless we pay the entire premium including her insurance. We have asked her again to do this, and are prepared to pay her for their coverage and perhaps allow her to deduct one of them on her taxes. She is not reliable and we cannot plan on this working. We have debated taking her to court, however, because of the nature of the situation, it could possibly open pandoras box with other issues, and the last thing we need right now is a long and drawn out legal battle.Ive tried submitting minor child with autism for disability through medicaid, but they say that we make too much money. I need go down there personally, but they intentionally make it difficult.My question is: should we just start self paying for doctors and buy a catastrophic plan or do I get one of these plans off the exchange? My husband and daughter each go to the doctor once every three months for med checkups--they have ADD. My husband takes Vyvanse which is 300 OOP until we hit deductible, and then it is still 150. He is going to get an appt before we lose coverage to try to switch to a cheaper drug Even though hes been on others that dont work as well. Daughter takes Concerta generic, and its not costly.Husband also has high cholesterol for which he takes lipitor generic. He does from time to time have pain from tendonitis and will get a cortisone shot. Hes looking to have some pins removed from a previous injury before we lose coverage this year.I go to the doctor a couple times a year. I have an IUD and am not planning to get pregnant. I see my GYN twice a year. I see a psychiatrist for anxiety twice a year, and a therapist weekly. Both my meds are generics. Ive already talked about paying her out of pocket and reducing visits to once a month.Stepson has epilepsy but it is under control. He sees neurologist 2x per year for med check up. He gets benefits and ABA from school and department of mental health. He sees psychiatrist every 3-6 months for med checkup. He takes oxcarbazepine and risperidone. Both are pretty cheap. We are going to try to continue to get him on disability hes low functioning, but hes only 15, so SS is not yet an option either.I know many doctors work with you if you self-pay. Im wondering if it would just be best to do it that way, and buy a catastrophe plan for big emergencies? But what do catastrophe plans cover? Broken arms? Car accidents? Serious illness? Ive had precancerous cells removed before, would that count or would that be OOP?I cant fathom paying 1500 month with a 14000 deductible. It sounds insane. Any advice would be greatly appreciated.  <response>: Also, this year, we dont qualify for a subsidy.Being self-employed, you can reduce your income by contributing to a deductible Traditional IRA andor a SEP-IRA. Your spouse can do this as well. This could make you eligible for subsidies. 