Thanks for the info. When we "lost" employer health care insurance there was talk about COBRA but we were sent nothing. The insurance was from the wife's employer and getting answers was not easy. We were told it was very expensive by everyone who had the same situation.
COBRA is expensive because you start paying the full premium for the plan you already had. People in employer-based plans are generally only paying about 25-30% of the cost of their plan; when they actually get exposed to the full premium they're usually surprised at how high it is. That premium is very likely higher, perhaps significantly so, than the options you're looking at in the open market.
Am I wrong but since the state didn't set up exchanges does that not mean that the navigators are actually federal? One problem I had with calling the number my rep gave me is that it was PP. You may not believe this but if you call PP you hear a lot of options and the majority concern abortion. Then you get to the navigator and they cheerfully tell you to go to healthcare.gov and that is about it. That was my experience I am sure there has to be better experiences.
The federal government is funding navigators in states that don't set up their own but the programs are smaller and they serve fewer people. They're better than nothing but they're not as effective as when the state gets involved and takes ownership. I would be surprised if PP doesn't have some people on staff whose job is specifically to walk you through your options and talk about this.
OK, say it is July 4th and I have had 500 dollars in out of pocket. I go for the 33,500 knee operation. So what do I pay? I pay 3000 up front then the HC provider pays the rest? Or do I pay the 3000 then the HC provider pays part of the rest? My father has the same HC provider I signed up with except his is HC medicare. He had a total knee replacement and I am guessing he didn't pay over 1000 dollars. And his premium is zero as far as I can see. Except for what SSA takes, which I think is around 110/ month. So I was happy with that. Same with the wife. We had her HC insurance and it seems to me we didn't pay more then 1000 for the whole deal.
Every plan has an out-of-pocket maximum. That's the most you could possibly be asked to pay out of your own pocket in a given year (this doesn't include your monthly premium expense). What that is will depend on your plan, but next year that number legally cannot be higher than $6,850. It may be lower based on the plan you choose but it'll never be higher.
Plans usually have some kind of coinsurance after you've paid your deductible (unless you buy a low-end bronze plan where the deductible is the total out-of-pocket maximum--in which case once you've paid your deductible you've hit your legal limit). That's a percent of the bill you share in above the deductible. I don't know what the case is with your plan but let's imagine you have 20% coinsurance.
So let's say your provider's allowed amount for this procedure is $33,500 (which, by the way is likely a discount--an important thing you're buying when you buy an insurance plan is access to the negotiated prices they have with the health care providers in your area). That gets split up between your share and your insurer's share.
So your share is going to be your remaining calendar year deductible plus your coinsurance (with the caveat that your share can't be higher than the OOP max).
So: $3,000 + 0.2 * ($33,500 - $3,000) = $9,100. That's above your OOP max so the actual amount you're responsible for would just be your OOP max. Let's say you have the highest OOP max legally allowed: that means your share of the procedure's costs is $6,350 (since you're already paid $500 toward your OOP max in this scenario).