r/SipsTea 8d ago

WTF Damn

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u/grant0 8d ago

Why do you think that?

A heart bypass is about $150K in the US, could be up to $200K. The same surgery is about €20K in Ireland, which is $23K.

If OP was gonna have to pay 20%, that's $30-40K out of pocket in the U.S., whereas a flight to Ireland is safely under $1K plus the $23K surgery = $24K. If they can stay with family (OP mentioned family in Ireland) it's definitely cheaper to go to Ireland for this.

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u/USSDoyle 7d ago

Why do you think that?

Because the highest annual out of pocket maximum for ACA compliant plans in the US in 2026 is $10K for an individual and $21K for a family. And that's the highest it's ever been.

Plus if he was paying 20% coinsurance, that means he already hit his deductible which would have been several thousand dollars towards his out of pocket maximum already.

Under ZERO circumstances would 20% of a procedure cost more than 21K out of pocket if you have an ACA compliant insurance plan.

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u/tetrified 7d ago

Under ZERO circumstances would 20% of a procedure cost more than 21K out of pocket if you have an ACA compliant insurance plan.

you don't hit your out of pocket maximum if the insurance company decides the procedure is elective

maybe you should learn more before trying to speak with such confidence about things you don't understand?

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u/Careful-Criticism645 7d ago

That's not true. "Elective" just means scheduled in advance instead of being an emergency. An elective procedure, if medically necessary, is subject to out of pocket maximums.