[tophcfa]

Originally Posted by OrangeBlossomBaby

The tiers have changed a LOT since the ACA was first passed. Also medical needs of subscribers change from one year to the next, especially as we get older. As of January 1, my new plan will be BlueSelect Bronze 2139.

I'm expecting to need hip replacement surgery next year. The customary cost, for operation, facility fee, doctors and anasthetics, pain meds, follow up visits, scans and xrays and whatever the heck else they do, will be somewhere around $25,000.

Under my CURRENT plan - BlueSelect Silver 1443A, I pay $436/month just to be on the plan. It has a 7000 per person deductible and a 8500 per person out of pocket expense. Having the procedure at the hospital instead of a surgical center is only covered to something like 40%, leaving me with having to pay 60% of the balance. Certain other parts of the surgery aren't covered at all, though I'll get some kind of schedule of fees discount. It's pretty complex, lots of things that are and aren't covered, covered only partly, with a bunch of exclusions.

The tl;dr is I'll likely be on the hook for around $15,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.

For the NEW plan, it's a $9100 out of pocket max, 0 deductible. That basically means I pay for all my expenses as I go, and once it hits $9100 total payout, everything else is covered at 100 or with a reasonable additional copay (like $50 for a doctor's visit for a sprained ankle or whatever else).

This new plan will cost me $146/month, for myself and beloved spouse.

The tl;dr of the new plan is I'll be on the hook for around $10,000 total for the surgery, assuming I have no other medical issues all year, and including my premium.

I hear ya, I have essentially the same insurance except I pay a crap load more in monthly premiums without the tax credit subsidies. I got really sick in 2021 from an infectious disease from a tick bite and had to spend 8 days in critical care in a Gainesville Hospital before they finally figured out was was wrong with me and how to treat it (basically the same treatment used for Malaria). They ran just about every imaginable test on me trying to diagnose what was making me so sick. The billable expenses from that episode ran close to a quarter million dollars, but I only had to pay the max out of pocket, which was close to 10 grand. Now I need a second knee replacement (too many years of pounding ice moguls in Vermont), but I’m going to suck it up a little longer until I turn 65 because it will be way cheaper once I am on Medicare.

Best of luck with the hip.