Health Insurance in the U.S.

[Aker 26]

I am a bit confused as to what health insurance I need to get before I move to the U.S. or after I move.  Does anyone know what to do?  I will be leaving Canada October 30th and am just barely learning about open enrollment.   Would anyone kindly explain insurance options?  Or who you've used? Obamacare vs Outbound insurance, etc>

Any advice or information would be greatly appreciated.

[mcdull 474]

34 minutes ago, Aker said:

I am a bit confused as to what health insurance I need to get before I move to the U.S. or after I move.  Does anyone know what to do?  I will be leaving Canada October 30th and am just barely learning about open enrollment.   Would anyone kindly explain insurance options?  Or who you've used? Obamacare vs Outbound insurance, etc>

Any advice or information would be greatly appreciated.

To make it simple for you, Obamacare equals mandatory private insurance. So the conclusion is, you need to buy private insurance, through the market place or not.  

[NikLR 13,227]

Does your future spouse have insurance through work?  Generally the easiest is to be added onto theirs after marriage.  However it can be cheaper to buy individual insurance.   I have found most often that you need to be a full-time employee to qualify for insurance through work.   

 

The hard part, IMHO, is choosing a type of plan and provider.  Some plans allow you to see any doctor but give you a discount if you see their "network providers."  Other plans charge extreme amounts unless you only see their doctors.  Some you pay more per month but have a lower deductible and lower out of pocket total cost.  Others ask you to pay out of pocket (deductible) but then cover most of your costs after that.   Some allow you to have a health saving account that you can use for medical expenses (co-pays or against your deductible) and sometimes they rollover and sometimes you have to use it up each year.  So you have to make a choice on how often you get sick, vs how much you want to spend per month, vs choice you want to have to see certain doctors, and also if you want to have to be referred to a specialist or not.

 

It's really quite complicated.

 

I will give you an example:  We have a nationwide plan that changes depending on where you are in the country.  Here in Colorado we use a specific network and if I stay within that network, I get charged less for anything that needs to happen (preventative is always covered.)  I have a $3k deductible because we are self plus one.  (it would be $1500 as a single.)  After that they cover 95% of the cost.  The out of pocket limit is very high, like 10 or 12k.   But this plan comes with an HSA (health savings account) in which the employer puts $1500/year in and it rolls over every year.  We could add more too. 

What this means is:

I pay until the $3k is met

I pay until the out of pocket limit is met as well but I am only paying 5% of the total cost. 

I can use the HSA to pay for any costs but obviously it doesn't cover the full deductible.

I get to choose my providers, but in network ones cost me less.

I don't need a referral. 

As long as I go to an in-network provider (aka doctor) I don't have to do any paperwork except the main health questionnaires if I see someone new or it's been over a year, giving over my insurance info, and paying the bill.

I have a hugely reduced rate on prescriptions if I fill them at a certain pharmacy.  My BC is free. 

(And when I say hugely reduced I mean I've spent over $150 in Canada on antibiotics and painkillers due to an infection.  I've had the EXACT same product down here and it cost me $18 TOTAL.) 

 

However know that no matter WHAT provider you have, emergency rooms are EXPENSIVE.  There is very little wait here because of that.  Don't go to one unless you NEED it.  There are urgent care centers and they are like walk in clinics.  They're not cheap but they're fast compared to trying to find a GP.  I don't know the price comparison to a GP since I don't have one. 

 

Edited October 15, 2017 by NikLR

[Aker 26]

Just an update because someone asked: my husband is on disability and will lose his coverage from his employer in a month.  He with either continue with his employer but pay full premiums but we do not know yet if I can get added after we get married.  Unlikely.  Or he will have to be covered through Cobra.  So I figure I will likely need to have my own insurance until I get a plan through an employer.  Thanks to all that have responded so far.

 

[NikLR 13,227]

I highly suggest making sure you do not get pregnant until you have decent insurance. 

 

edited to add:  The cost of a baby out of pocket down here is like 8-10k provided there are no complications.  Even with insurance it can be expensive.  So when you arrive and are married check the marketplace for insurance until you can maybe get it through work.  It may be 3-12 months before you become eligible however.  Once you have it through work it may be cheaper to have both of you through your work. 

Edited October 15, 2017 by NikLR

[jle2234 68]

I have insurance through my husband's employer but also have the option to get insurance through my school.  I actually joined my husband's insurance prior to my immigration being approved and had surgery in the U.S. while my immigration was still pending.  My immigration status did not affect my insurance eligibility in any way, or vice versa.

 

As mentioned above, there are also options to purchase insurance privately, which sounds like the route you will need to take.  It is important to understand that you will be penalized on your annual income taxes if you do not have at least the minimum required insurance coverage.  And, of course, you want good insurance so you can receive proper medical care.

 

I agree with NikLR that insurance can get quite confusing.  That said, I find the health care here far superior to what I was receiving in Ontario, so there is a bright side to switching to U.S. medical care (in my opinion).

 

When enrolling in our insurance, we had to choose between three tiers of coverage.  Tier 1 was the most expensive but provided the most extensive coverage.  We opted for Tier 2, which is serving us quite well.  We have low co-pays ($30 for doctor's appointment, $10 for prescriptions, no charge for imaging, blood tests, etc.).  We also have significant coverage in the event of more serious illnesses or rehabilitation needs.

 

I would definitely recommend considering your future plans and outlooks when choosing insurance, as many insurance companies only allow you to change your coverage once per year (or similar).  So if you choose less-expensive health coverage and become pregnant, ill, etc., you may not be able to immediately opt-in to more comprehensive coverage.

 

Prospective insurance plans also come with a lot of paperwork, fine print, etc.  As tedious as it is, make sure you read and understand all of it to ensure that you have the coverage you need.

[amicablebride 25]

On 10/14/2017 at 10:23 PM, NikLR said:

Does your future spouse have insurance through work?  Generally the easiest is to be added onto theirs after marriage.  However it can be cheaper to buy individual insurance.   I have found most often that you need to be a full-time employee to qualify for insurance through work.   

 

The hard part, IMHO, is choosing a type of plan and provider.  Some plans allow you to see any doctor but give you a discount if you see their "network providers."  Other plans charge extreme amounts unless you only see their doctors.  Some you pay more per month but have a lower deductible and lower out of pocket total cost.  Others ask you to pay out of pocket (deductible) but then cover most of your costs after that.   Some allow you to have a health saving account that you can use for medical expenses (co-pays or against your deductible) and sometimes they rollover and sometimes you have to use it up each year.  So you have to make a choice on how often you get sick, vs how much you want to spend per month, vs choice you want to have to see certain doctors, and also if you want to have to be referred to a specialist or not.

 

It's really quite complicated.

 

I will give you an example:  We have a nationwide plan that changes depending on where you are in the country.  Here in Colorado we use a specific network and if I stay within that network, I get charged less for anything that needs to happen (preventative is always covered.)  I have a $3k deductible because we are self plus one.  (it would be $1500 as a single.)  After that they cover 95% of the cost.  The out of pocket limit is very high, like 10 or 12k.   But this plan comes with an HSA (health savings account) in which the employer puts $1500/year in and it rolls over every year.  We could add more too. 

What this means is:

I pay until the $3k is met

I pay until the out of pocket limit is met as well but I am only paying 5% of the total cost. 

I can use the HSA to pay for any costs but obviously it doesn't cover the full deductible.

I get to choose my providers, but in network ones cost me less.

I don't need a referral. 

As long as I go to an in-network provider (aka doctor) I don't have to do any paperwork except the main health questionnaires if I see someone new or it's been over a year, giving over my insurance info, and paying the bill.

I have a hugely reduced rate on prescriptions if I fill them at a certain pharmacy.  My BC is free. 

(And when I say hugely reduced I mean I've spent over $150 in Canada on antibiotics and painkillers due to an infection.  I've had the EXACT same product down here and it cost me $18 TOTAL.) 

 

However know that no matter WHAT provider you have, emergency rooms are EXPENSIVE.  There is very little wait here because of that.  Don't go to one unless you NEED it.  There are urgent care centers and they are like walk in clinics.  They're not cheap but they're fast compared to trying to find a GP.  I don't know the price comparison to a GP since I don't have one. 

 

My plan is about the same as this. I stupidly went to an Urgent Care center when I had a flu / cold a few months ago. My employer needed a doctor's note. In Canada, we'd generally just hop on over to the closest Walk-in clinic. I did the same thing here... I even asked them if they accepted Blue Cross insurance. They said yes. My mistake.. you're not supposed to ask the urgent care center, you're supposed call your insurance company ahead of time and make sure the place you plan on going to is covered through them. At least in CT that's how it is. 

Also, just to add to this, I found out today that most insurances don't cover chiropractic care / massage or anything similar. You have to have it approved by your doctor as a "necessity".  I haven't been to a chiropractor in almost a year.. my neck and back all out of whack. Reallllly missing Manitoba Health and the insurance I had back home. 

[NikLR 13,227]

I make sure online to pick providers within my network before going anywhere.  They always accept insurance, but if it's not within the network, they may charge you more.  

 

2 years ago I had a really bad abscess as a complication of tonsillitis.  As I know dr's cost money, I was avoiding going even though I've never made it through tonsillitis without medication.  I don't think I've ever taken so much tylenol or advil.   The 2 urgent care visits wanted to charge me over $700 and over $400 respectively and my insurance "disallowed" their charges and it ended up being only $300 total.  I ended up at the ENT anyhow and paid them about $450.  Last year, I had the same thing happen, but I made an appt right away at the ENT (which still took a few days) and the payment was again about $450.  To get my tonsils taken out will be over $3800 ($3k deductible plus 5% of the hospital visit) so we're looking at changing our insurance next year just to get this procedure done.   Either that or I have to take out a loan, or dole out $450 a year if my throat decides to continue on in this manner.   I miss being able to go to the Dr if you're sick or need something and not worrying about dollar signs.  No wonder people in the USA are crazy about their safety labels!!