If I have a chronic condition and know I will need surgery, is a $0 deductible health plan with $1800 OOP max and 20-25% coinsurance a good idea? It is $43/month for me. A few questions in the post. TIA.

the plan I am referencing

Hello

I have a suspected labral tear and severe pelvic floor dysfunction. This plan covers 35 physical therapy visits a year, which is 15 more than my current employer healthcare plan that I am losing due to having to drop to part time.

I receive FAFSA in January so I am not concerned about an $1800 OOP max at the moment, if I’m assuming I will be putting it down for a surgery. I will need to activate this plan at the beginning of December, however. Is that even possible? I lose my current plan on 12/01.

I know this means I will be paying 80% of the visit price off the rip – so if a specialist says it’s $400 to see them, I’d be paying $320 up until $1800. But this also means that within a month or two, I will not be spending anything for the rest of the year, correct?

What is the likelihood they deny me? Should I avoid getting the MRA imaging done until I am already on the plan? I am in a lot of pain but now that I’m part time and still in PT, I can probably push through another two months without the imaging and surgery talk visits.

If I get the imaging done and the Ortho I am seeing this week puts surgery on the table for sure, will this new insurance plan I’m looking at deny me to avoid paying for a surgery?

I will also need a few other diagnostic procedures and imaging tests for pelvic floor dysfunction. I am planning on having my tonsils removed before my insurance changes, but the order for that is already in as well. I’ve seen about 10 or 12 different specialists this year and am just now breaking into the actual diagnostic process, but I’m worried it’s bad timing.

Thank you so much for reading!!

Edit: I forgot to mention that I am disabled due to all of this and have all that paperwork and everything on file so I’m sure they will see it. Does this affect things?

Edit 2: Could I theoretically bridge during December with cheap marketplace insurance? I was hoping to get a head start with any new specialists I need to see due to insurance changes while avoiding any potential major costs for ER visits as I’ve had 8 to 10 of those this year prior to my prolapse diagnosis and physical therapy.

I also have a Cardiologist, Rhuematologist, Gyenecologist, Urologist, and Urogynecologist that I need to see. I’m currently with an ENT as well but as I said I believe I’ll be done with those visits after the tonsillectomy – I am doing allergy shots but I’m sure I can find any ENT office that can do this for me. The plan definitely covers my Urogynecologist and PCP which are the most important to me. I’m okay with switching the rest aside from maybe my Rheumatologist as it’s very hard to establish new care with those as people tend not to leave them until they die.. lol.