That doesn't sound right - What is your maximum out of pocket?
Also, those numbers include only in-network providers. If I am given out-of-network care - which isn't always under my control - then I could potentially be on the hook for tens of thousands more dollars.
- An out-of-network providers gives you medical attention at an in-provider facility - maybe your ER doctor, surprise, is not in-network, even though the hospital is in-network. [1] [2] [3]
- Maybe you have a medical emergency and the closest facility at the time is out-of-network. (In some states and with some insurers under some circumstances, you can get them to pay the difference for emergency out-of-network care.)
The biggest risk factor is the "normal" <= $7500 medical bill from an in-network provider, but inadvertent out-of-network care is still something you have to be concerned about.
Also, I'm not sure if I'm reading you right, but "in-network" does not necessarily have anything to do with geography - sure, there exist in-network providers for my insurance throughout the country, but the second-closest hospital to me is still out-of-network.
[1] http://justcareusa.org/beware-of-out-of-network-er-bills/ [2] http://www.consumerreports.org/cro/news/2014/10/protect-your... [3] http://www.realclearhealth.com/articles/2017/01/09/in_throug...
EDIT: The HN backoff must be crazy high - 40 minutes later, and I still can't post, and I'll be offline the rest of the day.
Because the ACA didn't fix it. From my perspective, it was largely a giveaway to private insurance companies with some fortunate side effects.
The total cost for my health insurance premiums are 20k a year.
My in-network deductible is $4500.
My in-network out of pocket is $7500.
My out-of-network out of pocket is $20k.
Those are not hypotheticals, and because of those costs, I avoid medical care unless it is absolutely necessary. I'm afraid we're getting into the weeds - my main point is that the ACA's preventative care provisions are really quite weak and don't mean what we might think they'd mean; the preponderance of high deductibles and out-of-pocket maximums mean that people will continue to avoid getting prompt medical care until their condition becomes serious. The preventative benefit, mainly, is that everyone gets a yearly physical and a few other narrow types of preventative care.
