It's true this cap only applies to in-network, approved care. But that's the same under any health plan, whether universal, or not. For instance, Sovaldi and Harvoni are curative for hepatitis C, but it costs $50,000 for a 12-week course of treatment in the UK. There are 210,000 people with hepatitis in the UK, but the NHS only furnishes 10,000 courses of treatment per year. If you're not approved, you can't get it from the NHS, but you're free to buy it yourself, of course.
First, every dollar you pay does not count towards the insurance company tally of "out of pocket". Often it is a tiny fraction. I've personally had years where my true out of pocket was in the several thousands but according to the insurance company my "out of pocket" was less than $100. With that kind of multiplier you can see one can easily spend many tens of thousands before reaching the nominal limit according to insurance company. How do they do this? Because they can and there's nothing to stop them.
Also, insurance plans have caps on what they'll pay. End up in the hospital for months and exceed the limits and it's all out of pocket, which can be in the millions.
Also, these don't include things like prescriptions. A friend (working at a FAANG in SV) spends about $50K/year out of pocket on medicines for chronic conditions.
https://www.hhs.gov/healthcare/about-the-aca/benefit-limits/....
"The health care law stops insurance companies from limiting yearly or lifetime coverage expenses for essential health benefits."
https://www.healthcare.gov/health-care-law-protections/lifet...
I wonder what's included in "covered health benefits"/"essential health benefits" and what's not.
Medical underwriting is permitted for Traditional Medicare Part B supplemental/Medigap plans, so pre-existing condition clauses apply, even with the Affordable Care Act.
In other words: once you go on a Medicare Advantage Plan (an HMO) you can never truly go back to traditional Medicare.
If you have cancer or a rare disease (it's not uncommon to have a rare disease--about 7% of the general population collectively has some sort of rare disease) you likely cannot risk being on an HMO if you want to stay alive.
I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, and I have traditional Medicare. I require a blood product, called subcutaneous immunoglobulin (administered in that form--it is the only medication that has ever worked for me and has put me in pharmaceutical remission).
If I come back to the United States, I can expect to pay $50,000+/year for my healthcare (mostly due to the subcutaneous immunoglobulin) due to something called the Medicare Part D catastrophic coverage level.
A lot of people, and I mean a lot, get screwed due to the part D catastrophic coverage level. Actually, because of this "program" I never plan on living/working in the US ever again, unless things drastically change.
The parent is fearmongering for some reason. The real scenario is a 2-3 year illness that takes you out of work so long that your lose your employer sponsored plan, have to hoof it with whatever ACA plan you can find, and not have income in the interim.