Anthem BCBS COBRA -> ACA; out-of-pocket max, prior authorizations

[u/UnknownBowser]

Our family has been on an Anthem BCBS high deductible PPO plan via a former employer for 17 months. We lose access to it at the end of September.

There is an ACA Silver 73 Anthem plan which appears to have similar terms at a similar price. We have on the whole been happy with Anthem and are inclined to switch to it.

Because we've been on an employer's Group plan, we would be switching to an Individual Member plan through the ACA and would this seems to be a big jump within Anthem. When I call the question line for our Group plan they route me over to Sales to talk about an Individual Member plan.

So I have two questions for anyone who has done this:

1. With group plans at open enrollment in July each year if we switch plans, any money we've spent out-of-pocket so far that year counts toward the out-of-pocket maximum on the new plan. So if we spent $1000 before Open Enrollment, the new plan which starts after July will count $1000 toward the out-of-pocket max. Is that also the case if we switch from a Group plan to an ACA plan? I'm afraid we'll reset to $0 and end up paying a lot out of pocket.
2. Will prescriptions which required a prior authorization on the Group plan need a new Prior Authorization on the ACA plan? I assume yes. Are they more likely to be denied on an Individual plan?

I've tried asking these questions of Anthem, but I get routed to their sales department who focuses on trying to sell us on a non-marketplace plan. I didn't get answers to the questions I most wanted answered.

Edit: Family of 5, parents in our 50s with three teenage kids, in California. About $70k gross income right now.

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[u/BaltimoreBee]

1) your deductible and OOP max will reset at $0 when you switch to an individual market plan.

2) you will need a new prior authorization. At the company I worked for, no more likely to be denied than group.

[u/ILoveLemonHeads]

I’m not sure I understand your first question. With your employer sponsored plan, what is the actual benefit year? When open enrollment is doesn’t really matter. Your deductible and OOP max resets for every benefit year. If your benefit year is the same as the calendar year, open enrollment would not reset your deductible. It only resets when the new benefit year begins.