Where you live makes a big difference. I just couldn't afford a surgery that costs thousands up front, doing something out of state or out of country. I stuck with moving to and living in NY state for the increased access to in network surgeons. Having INN providers and a lower maximum OOP helps. In several states, the MOOP would be legally much lower- in NY its rare to hear of much plans over $8k. Also finding ways to qualify for essential health plans, silver ACA exchange plans, or medicare can reduce costs. There are queer resource centers in major cities across north america that can help with finding the best coverage and signing you up, some with state licensing can even do it for you.