Health insurance for DV winners

[seanjoe 1]

Hi all,

Tried doing a search on health insurance for DV winners on entry to the US, but struggling. Right, so I entered on the 30th of Jan and am now in Texas. I keep getting emails about the Feb. 15th being the deadline for applying.

When I spoke to Healthgov, they told me that since I have no job at the moment, I should just apply, but most probably will not have to pay anything as I do not have any income. No low income either, so no chance of tax credits. My question is whether I need to apply before Feb 15; has my "life changing" time lapsed now?

Also, can anyone explain the difference between deductible and out of pocket exp. I understand copay. An eg. would be brialliant.

Also, in Texas, what is the UK equivalent of emergency medical care? Or do they start hunting you after you get out? I presume I would have to pay in the region of $100+ if I had to go see a doc. for a simple visit?

Help please.

thanks

[kzielu 1,147]

The equivalent of emergency care is a bill you get in mail, some places - if you don't have insurance - will ask you to pay upfront. No free healthcare in US of any kind.

[LORIEandPHIL 123]

Hi all,

Tried doing a search on health insurance for DV winners on entry to the US, but struggling. Right, so I entered on the 30th of Jan and am now in Texas. I keep getting emails about the Feb. 15th being the deadline for applying.

When I spoke to Healthgov, they told me that since I have no job at the moment, I should just apply, but most probably will not have to pay anything as I do not have any income. No low income either, so no chance of tax credits. My question is whether I need to apply before Feb 15; has my "life changing" time lapsed now?

Also, can anyone explain the difference between deductible and out of pocket exp. I understand copay. An eg. would be brialliant.

Also, in Texas, what is the UK equivalent of emergency medical care? Or do they start hunting you after you get out? I presume I would have to pay in the region of $100+ if I had to go see a doc. for a simple visit?

Help please.

thanks

There is no UK equivalent, healthcare in the UK is free. In the US you pay for treatment.

[seanjoe 1]

Ok, so how much do we have to pay at the start? Any providers anyone knows?

[NigeriaorBust 4,087]

A deductible is sometimes also called maximum out of pocket. This is how much you will pay before the insurance covers at a higher rate. If you have a $100 co pay for hospital stays and have a $500 max annual out of pocket after you go to the hospital 5 times you will no longer pay anything to go the 6th and more time. Out of pocket in general is things you pay for above your premium such as co pays and ?? ( crutches may be something not covered and you pay out of pocket )

There is a deadline of Feb 15th for everyone , if you don't get covered by then you pay a tax penalty next year.

[SusieQQQ 11,585]

A deductible is sometimes also called maximum out of pocket. This is how much you will pay before the insurance covers at a higher rate. If you have a $100 co pay for hospital stays and have a $500 max annual out of pocket after you go to the hospital 5 times you will no longer pay anything to go the 6th and more time. Out of pocket in general is things you pay for above your premium such as co pays and ?? ( crutches may be something not covered and you pay out of pocket )

There is a deadline of Feb 15th for everyone , if you don't get covered by then you pay a tax penalty next year.

The deadlines don't apply to those who have undergone "life events", of which immigration is one. I have heard it is either 3 or 6 months after immigrating that one needs to be covered by - not sure, we got covered almost immediately - but with the cost of healthcare there is no rational reason to delay getting insurance.

[Nich-Nick 3,353]

Deductible -

$250 deductible example--You pay for everything until you reach $250 spent. Then insurance will start picking up a percentage of the tab, usually 80%. You do still get the negotiated rates your insurance has worked out with the doctors or hospitals. For example, if a doctor charges $100 for an office visit that's what he would bill a person with no insurance. But your insurance has negotiated that an office visit is only worth $52. The doctor can only bill you $52. If you had not met your deductible, then you pay the full $52, but that's better than $100. Once you hit the deductible with doctors and medicines, then insurance pays part of each procedure. There are some no cost things outside of the deductible that the Affordable Care Act mandates. You get a yearly health exam, mammogram...I forget what else...paid for by insurance even without meeting your deductible mark.

Out of pocket--

$3000 example. Once you reach your yearly out of pocket number, insurance pays $100%, so let's say you got cancer and had a lot of treatments, CT scans, and hospitalizations. You pay everything until you hit the deductible mark. Then insurance starts paying 80% of the bill. Once you have spent $3000 out of your pocket (for the deductible part, and then your 20% part of the bills) then insurance pays everything for the rest of the year. You could get bills totaling $500,000 but would not spend more than $3000 a year paying for your treatments, scans, and medicines. Those figures are from actual experience and not an exaggeration. My former husband died of cancer. We reached our out of pocket max in January each year and Feb-Dec was free mostly. There's a few small co-pays sometimes that wrangle their way in.

When you shop for insurance, the small deductible and small out of pocket amounts will have a high premium to pay every month. If you pick the lowest premium, you may get a $6000 deductible which pretty much means you are going to pay for all your doctor visits for the sniffles and such. But if you have a heart attack, cancer, surgery, etc then you will reach that point easily. I spent a week in the hospital and the bill was $42,000. That did not include paying the doctors for their services. It included the room, medicines, blood tests, IV fluids, monitoring devices, etc.

If you get a job that offers group insurance, it will usually be a much better deal than plans found on the marketplace for insuring yourself.

Edited February 13, 2015 by Nich-Nick

[Boiler 43,790]

A deductible is an excess, think car insurance

If there are no other options then the Exchange is where most people would go. Each State is different.

As far as what is available for low income earners that is also very dependent on location. Texas is a big State, as a general rule look for those providers serving the Spanish speaking population.

[seanjoe 1]

The deadlines don't apply to those who have undergone "life events", of which immigration is one. I have heard it is either 3 or 6 months after immigrating that one needs to be covered by - not sure, we got covered almost immediately - but with the cost of healthcare there is no rational reason to delay getting insurance.

Thanks Susie!!! I googled it and it is 60 days from the event.

Link here: http://obamacarefacts.com/special-enrollment-period/

Specific sentence here: An individual, who was not previously a citizen, national, or lawfully present individual gains such status.

So 60 days from landing date and you will be fine.

[PeruvyandGringa 25]

A deductible is sometimes also called maximum out of pocket. This is how much you will pay before the insurance covers at a higher rate. If you have a $100 co pay for hospital stays and have a $500 max annual out of pocket after you go to the hospital 5 times you will no longer pay anything to go the 6th and more time. Out of pocket in general is things you pay for above your premium such as co pays and ?? ( crutches may be something not covered and you pay out of pocket )

There is a deadline of Feb 15th for everyone , if you don't get covered by then you pay a tax penalty next year.

The deductible is not the maximum out of pocket, my plan has a $1500 deductible and $5000 out of pocket maximum. What it means? The first $1500 in medical expenses in a year, I have to cover. I do pay the discounted negotiated rates negotiated by the insurer, but I pay it all until I reach $1500...after that, they cover a portion, (I believe it is 70%), of expenses over $1500 in a year (and I cover 30%). At some point in the year, between the first $1500, and paying the 30% for anything over $1500, I eventually might hit $5000 of my own money spent in a year. At that point, I don't need to pay anything else (that year). It's really not a great plan, since I typically spend right about $1000 each year (so I'm paying a lot to have a plan that i really don't get much advantage of, other than slightly lowered rates from the doctor, which i'm not even convinced are much lowered). It will only be beneficial if (hopefully not) I would be in need well in excess of the $5000 in medical expenses in a year, which would be easy if you end up in the hospital even once!

[PeruvyandGringa 25]

Deductible -

$250 deductible example--You pay for everything until you reach $250 spent. Then insurance will start picking up a percentage of the tab, usually 80%. You do still get the negotiated rates your insurance has worked out with the doctors or hospitals. For example, if a doctor charges $100 for an office visit that's what he would bill a person with no insurance. But your insurance has negotiated that an office visit is only worth $52. The doctor can only bill you $52. If you had not met your deductible, then you pay the full $52, but that's better than $100. Once you hit the deductible with doctors and medicines, then insurance pays part of each procedure. There are some no cost things outside of the deductible that the Affordable Care Act mandates. You get a yearly health exam, mammogram...I forget what else...paid for by insurance even without meeting your deductible mark.

Out of pocket--

$3000 example. Once you reach your yearly out of pocket number, insurance pays $100%, so let's say you got cancer and had a lot of treatments, CT scans, and hospitalizations. You pay everything until you hit the deductible mark. Then insurance starts paying 80% of the bill. Once you have spent $3000 out of your pocket (for the deductible part, and then your 20% part of the bills) then insurance pays everything for the rest of the year. You could get bills totaling $500,000 but would not spend more than $3000 a year paying for your treatments, scans, and medicines. Those figures are from actual experience and not an exaggeration. My former husband died of cancer. We reached our out of pocket max in January each year and Feb-Dec was free mostly. There's a few small co-pays sometimes that wrangle their way in.

When you shop for insurance, the small deductible and small out of pocket amounts will have a high premium to pay every month. If you pick the lowest premium, you may get a $6000 deductible which pretty much means you are going to pay for all your doctor visits for the sniffles and such. But if you have a heart attack, cancer, surgery, etc then you will reach that point easily. I spent a week in the hospital and the bill was $42,000. That did not include paying the doctors for their services. It included the room, medicines, blood tests, IV fluids, monitoring devices, etc.

If you get a job that offers group insurance, it will usually be a much better deal than plans found on the marketplace for insuring yourself.

I want your plan, it's much better than the one I have. And I pay plenty each week for my not fabulous plan, it's actually the best of the plans my company offers

[Nich-Nick 3,353]

I want your plan, it's much better than the one I have. And I pay plenty each week for my not fabulous plan, it's actually the best of the plans my company offers

That was only an example

The government has mandated my husband must have insurance. He has to buy an individual plan. $647/mo premium. $6000 deductible. $6000 out of pocket.

$7764 every year in premium payments plus $6000 medical costs before insurance pays. That's $13,764 a year.

I am not included on the plan. That is for one person. If he was single or quit his part time job, he would qualify for subsidy. But because he is married, my Social Security counts toward family income and puts him out of qualifying. I am personally not fond of Obamacare as it works out for us.

[Boiler 43,790]

That is why it is called the Affordable care act.