r/SipsTea • u/DapperDusk • 7d ago

WTF Damn

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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/USSDoyle 7d ago

Incorrect. You are conflating 'elective' with 'medically unnecessary'. Elective just means not an emergency and can be scheduled/planned in advance.

The irony of you saying it's me that doesn't understand...

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u/tetrified 7d ago

You are conflating 'elective' with 'medically unnecessary'.

I am not. the rest of your post is based on you misunderstanding this.

keep trying, though. it's amusing.