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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Maximum Cost be for a Knee Replacement with Obamacare?

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Question: What will my maximum Out of Pocket expense be for a knee replacement surgery? I am 64 years old. I have Covered CA Blue Shield Silver Level health insurance. My deductible is $5,000.00 I look forward to your answer. thank you.

Answer: You can figure about $6,400, which is the maximum-out-of-pocket expense. Once you have paid out $6,400, your covered medical expenses are 100% paid by the plan. One thing to watch out for is extra charges for durable medical devices. In the case of a knee replacement, you are advised to go home with a device that flexes the repaired knee automatically. Make sure that the device you choose is covered by your plan.

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On a silver level Blue Shield plan your deductible for in-network is only $2,000 and your Out of Pocket Max is $6,250.

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