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Just_Vote_Dem

(3,195 posts)
Tue Dec 24, 2024, 09:04 AM Tuesday

ACA Help needed please

So i signed up for an ACA plan I only need for 3 months, as Medicare is coming but I'm confused-
The plan says the most I pay out of pocket is 9K, but if I have a hospital stay, it's 40% coinsurance after deductible.
Wouldn't that be more than 9K if it's say, heart surgery? And if so, can I get a supplemental hospital insurance?
Any help will be appreciated, thanks.
And Happy Holidays!

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ACA Help needed please (Original Post) Just_Vote_Dem Tuesday OP
Surely whoever you signed up PoindexterOglethorpe Tuesday #1
Good point, thanks Just_Vote_Dem Tuesday #4
If max out-of-pocket is 9k, NameAlreadyTaken Tuesday #2
Thanks, that coinsurance stuff scared me lol Just_Vote_Dem Tuesday #3
You're welcome NameAlreadyTaken Tuesday #5

PoindexterOglethorpe

(26,847 posts)
1. Surely whoever you signed up
Tue Dec 24, 2024, 09:30 AM
Tuesday

with can answer those questions. Or you may need to read the fine print.

NameAlreadyTaken

(1,647 posts)
2. If max out-of-pocket is 9k,
Tue Dec 24, 2024, 10:06 AM
Tuesday

That's the most you'll pay out of pocket, period (in addition to your monthly premium). Once you hit that max OOP, the insurance company pays everything including copayments, coinsurance on covered services. I had surgery in August and after paying my copayments and coinsurances I reached my max OOP so everything since is paid 100% by the insurance until the end of this year.
But make sure you go only to doctors, clinics and hospitals that are in network for your plan. Ask each place to verify that. (In an emergency, the in-network requirement doesn't matter.)

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