Even before seeing the narrow premium differential, I would have suggested Gold for the remaining half year b/c your D has surgery planned and that always runs so much higher than projected. Her six month premium difference is low compared to the gap in coverage between the two metal levels.
Each state’s marketplace site seems to vary, so no way to guess how WA will operate vs. CT. In CT, I can easily plug any provider’s name into each carrier’s site to see if the provider participates. The names each carrier gives to each type of plan are very close to each other, so you really do need to read carefully to confirm that a provider participates. I have found that providers’ office staff do not always know which plans are accepted, and I do not blame them, given the wide array of plans.
One word of caution about going OON, assuming the plan even allows OON care: Even after satisfying the unique OON deductible, the plan will only reimburse at the OON level up to the carrier’s allowable fee, which may be half the amount the provider charges. $400 office visit, $200 allowed, but reimbursed at OON level of 70% of the $200 allowed means patient still has to pay $260. Also, in-network and OON deductible amounts are separate and in-network charges do not accumulate toward OON deductible.
The Gold plan may still make sense for her next year. I find that young people should either elect a Catastrophic plan or the Gold plan.
Income cap on subsidy has been altered significantly until the end of 2022. If I plug $50K for 26 year old into CT’s Access Health, I see a monthly subsidy of $160 and a monthly premium difference of $200 between Bronze & Gold.
I found that brokers do not sell the Marketplace plans. They sell other plans, but they price out higher even before considering the premium subsidy she may receive.
Best of luck to her!