$400,000 Surgery for $10,600?

March 3, 2026

Can a U.S. expat living abroad use ACA insurance to cover a $400,000+ cancer surgery? I'm a 50+ year-old U.S. citizen living in Portugal with a cancer diagnosis that requires CRS+HIPEC surgery — one of the most complex abdominal procedures performed anywhere. At a major academic cancer center in the United States, the uninsured cost runs $200,000–$400,000+. The goal: legally obtain U.S. health insurance through the Affordable Care Act (ACA) Marketplace, cap out-of-pocket costs at $10,600, and…

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Finding the Right Surgeon

March 2, 2026

Where I Am Right NowStage IV colorectal adenocarcinoma. The short version: diagnosed, completed 12 cycles of FOLFOX, recurred in the liver nine months later, reclassified as Stage IV. Now on FOLFIRI — with a measurable response. My latest MRI came back better than expected. The cancer deposits — subcapsular implants on the liver surface and two pelvic implants — have all shrunk significantly. One liver implant went from 28×21mm down to 15×3mm. That is not a rounding error. The chemotherapy is…

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