[ryandrake]

Barring the few lucky people with those platinum-plated insurance policies, American workers with normal insurance are one random cancer diagnosis away from total bankruptcy. You can have a great salary, do everything right, be frugal, save in your 401k invest well——it all goes poof when you get sick. Honestly, I’d trade half my salary to not have to avoid the doctor because his diagnosis might ruin me.

[jlmorton]

There's an $8,500 annual maximum out-of-pocket per individual under ACA. That's a lot over several years, but it's not going to be retirement-destroying for most SV workers.

[geofft]

This is only true of Marketplace plans (which are, increasingly, very bad deals is you're not actively using your insurance - even back in 2015 when I was looking for Marketplace plans for myself, I could easily spend close to that amount on the premiums of plans that had high deductibles/coinsurance/etc. and it's not like the Marketplace has gotten more competitive since then), and I think it's only true of expenses that the insurance company is willing to cover - if you get treatment out of network, or if you get treatment beyond what's insured (e.g. you get "elective" surgery on the medical advice of your doctor to avoid a bigger problem later), I don't believe those are covered by the out-of-pocket max.

[jlmorton]

The out of pocket maximum also applies to non-grandfathered group insurance plans. There were some plans allowed to be grandfathered, so the plans wouldn't terminate as non-compliant, but in practice the vast majority of plans terminate every year, and essentially everyone with health insurance now has an $8,500 per individual annual out of pocket maximum. I'm sure if you look at your own insurance, you'll find $8,500 or less.

It's true this cap only applies to in-network, approved care. But that's the same under any health plan, whether universal, or not. For instance, Sovaldi and Harvoni are curative for hepatitis C, but it costs $50,000 for a 12-week course of treatment in the UK. There are 210,000 people with hepatitis in the UK, but the NHS only furnishes 10,000 courses of treatment per year. If you're not approved, you can't get it from the NHS, but you're free to buy it yourself, of course.

[camhart]

Don't most policies have a max out of pocket? Everyone I've seen/had did.

[jjav]

Out of pocket does not mean what normal people think it should mean. Your actual out of pocket can be far larger, up to unlimited.

First, every dollar you pay does not count towards the insurance company tally of "out of pocket". Often it is a tiny fraction. I've personally had years where my true out of pocket was in the several thousands but according to the insurance company my "out of pocket" was less than $100. With that kind of multiplier you can see one can easily spend many tens of thousands before reaching the nominal limit according to insurance company. How do they do this? Because they can and there's nothing to stop them.

Also, insurance plans have caps on what they'll pay. End up in the hospital for months and exceed the limits and it's all out of pocket, which can be in the millions.

Also, these don't include things like prescriptions. A friend (working at a FAANG in SV) spends about $50K/year out of pocket on medicines for chronic conditions.

[camhart]

"The current law bans annual dollar limits that all job-related plans and individual health insurance plans can put on most covered health benefits."

https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/....

"The health care law stops insurance companies from limiting yearly or lifetime coverage expenses for essential health benefits."

https://www.healthcare.gov/health-care-law-protections/lifet...

I wonder what's included in "covered health benefits"/"essential health benefits" and what's not.

[disabled]

Well, wait until you get on Medicare. There are no maximum out-of-pocket limits with Medicare, unless you get a Medicare Advantage Plan (which is almost always an HMO).

Medical underwriting is permitted for Traditional Medicare Part B supplemental/Medigap plans, so pre-existing condition clauses apply, even with the Affordable Care Act.

In other words: once you go on a Medicare Advantage Plan (an HMO) you can never truly go back to traditional Medicare.

If you have cancer or a rare disease (it's not uncommon to have a rare disease--about 7% of the general population collectively has some sort of rare disease) you likely cannot risk being on an HMO if you want to stay alive.

I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, and I have traditional Medicare. I require a blood product, called subcutaneous immunoglobulin (administered in that form--it is the only medication that has ever worked for me and has put me in pharmaceutical remission).

If I come back to the United States, I can expect to pay $50,000+/year for my healthcare (mostly due to the subcutaneous immunoglobulin) due to something called the Medicare Part D catastrophic coverage level.

A lot of people, and I mean a lot, get screwed due to the part D catastrophic coverage level. Actually, because of this "program" I never plan on living/working in the US ever again, unless things drastically change.

[thehappypm]

Yes. Out of pocket maxima are extremely common—basically the reverse side of high deductibles.

The parent is fearmongering for some reason. The real scenario is a 2-3 year illness that takes you out of work so long that your lose your employer sponsored plan, have to hoof it with whatever ACA plan you can find, and not have income in the interim.