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"The out-of-pocket limit for a Marketplace plan..." It's capped for 'in network' stuff. But 'out of network' - the infamous phrase that... you can hardly ever
by lowercased 4y ago
"The out-of-pocket limit for a Marketplace plan..."
It's capped for 'in network' stuff. But 'out of network' - the infamous phrase that... you can hardly ever really know ahead of time... it's 'no max'.
This is a plan purchased directly from the ACA marketplace, so either they're all in violation of their own rules or... the "in network" is all they mean.
And that 'out of pocket' is still sort of crazy because "premiums" don't count. Our premiums would be around $12k year, but then we can have another ~$18k of fees on top of that before. $12k PLUS another $7k of 'deductible' before there's any insurance kicking in (beyond 'negotiated discount rates').
Had an ER visit last year - $4k. Miraculously, with all the insurance I have (earlier, before the ACA plan), we still owed over $2k of that... Insurance 'negotiated rate' brought things down some, but $2k (plus another $600 for ambulance ride).
I really fear getting sick or injured here the older I get