I tried to come up with a worst case scenario and see how all this applies. Say we have someone getting older, has kidney disease and has been cutting back on work, so they are making $10,000 a year (about 100% of Federal Poverty Level). Say the person is on a individual silver health care plan (one set of calculations above mentions using the silver) and is thinking about a transplant. However, first the person wants to see what it is going to cost.
Our friend sees the following:
Premiums: $200 a year (2% of income - from above)
out-of-pocket per year(co-pays, deductibles): $1983 (above post)
Transplant surgery: $30,000 (insurance pays $70,000 - silver plan)
The person is looking at paying $2183 a year for health care though (premiums plus out-of-pocket). I'm hearing the $30,000 for surgery is considered a co-pay, so the person doesn't have to worry about paying their surgery share after hitting the $1983 cap - and also may qualify for Medicaid (it has 0 co-pays, Medicaid kicks in if below 133% of the Federal Poverty Level). Head hurting yet?