There are many different forms of health insurance that exist in the health insurance market. The ACA Obamacare (or Affordable Care Act) market only offer traditional expensive major medical health insurance plans whereas the Non-ACA Obamacare (or Non Affordable Care Act) offer lower cheaper health insurance plans called Fixed Benefit (or Fixed Indemnity) health insurance plans.
Major Medical has a STOP LOSS GAP, where you would have to reach a deductible of some sort. Whether it's a $7,000 Deductible, $10,000 Deductible, or a $25,000 Deductible, that particular deductible is your cap. If you have a 100% co-insurance and not an 80/20 or a 70/30 co-insurance set up, then that particular deductible you choose, is your cap, so long as you seek medical providers that are in the contracted network of your health insurance plan.
Fixed Benefit plans (aka Fixed Indemnity) health insurance plans do NOT have a STOP LOSS GAP. Instead you receive a FIXED AMOUNT OF CASH or CREDIT to pay your medical bills. These types of plans are advertised as "Zero Deductible" which can attract a lot of customers, BUT is not be all end all, by any means. You as a consumer can receive anywhere from $25k to $50k for a particular surgery, for some fixed benefit plans. A heart transplant, which is a major surgery, can range at least $250k. IF you receive only a $50k credits towards your $250k medical claim, you'll still have a left over balance of $200,000!
So bottom line, make sure you know what you are buying or else you can get screwed and go upside down on your medical bills.
