Obtaining Health Insurance

[TransplantUSA 167]

Hi everyone, 

 

So I'm really confused about the US healthcare system. I'm coming from the UK on a K1 visa and would like some advice.

 

1. My fiance doesn't have health insurance, or work at a job that provides it. He currently gets state funded healthcare if he needs it (which is very rare). I know I obviously cannot sign up to that, so I'm wondering should we get a plan for both of us once we're married, or would he be able to stay on the state plan and I just get healthcare for myself?

 

2. Where do I go to find out about all of this? I'm having a hard time understanding what I should be looking for. I'm confused about what a deductible and copay/coinsurance are? (I am so going to miss the NHS )

 

3. Until we're married, is there anyone that would offer me health insurance short term? I read somewhere that most providers require you to be an LPR or have been in the US for at least 6 months before you're eligible for coverage?

 

I know there's loads of healthcare posts, I've tried looking through them all but it's just overwhelming. Grateful for any information and advice!

 

Emily.

[Sarah&Facundo 577]

Following because my fiance is coming soon and I have NO idea what to do with him. Hopefully someone has more information!

[Noel194 53]

So you have some options.  You can purchase a short term policy (90days) from a website like this https://www.***removed***.com/new-immigrant-insurance/   This is short term catastrophic insurance in case of a major illness.  As a new immigrant you are eligible to purchase insurance off of the health insurance exchange  https://www.healthcare.gov/immigrants/immigration-status/   here is some information on the Oregon exchange as that is the state listed on your profile.  http://healthcare.oregon.gov/Pages/index.aspx  While you are single you will be eligible for premium support based on your income.  Once you are married you must include your husbands income for the purposes of figuring a subsidy if any.  The cost depends on your income and the choice of benefits you choose.  It can be free up to $1500 per month. 

[TransplantUSA 167]

9 hours ago, Noel194 said:

So you have some options.  You can purchase a short term policy (90days) from a website like this https://www.***removed***.com/new-immigrant-insurance/   This is short term catastrophic insurance in case of a major illness.  As a new immigrant you are eligible to purchase insurance off of the health insurance exchange  https://www.healthcare.gov/immigrants/immigration-status/   here is some information on the Oregon exchange as that is the state listed on your profile.  http://healthcare.oregon.gov/Pages/index.aspx  While you are single you will be eligible for premium support based on your income.  Once you are married you must include your husbands income for the purposes of figuring a subsidy if any.  The cost depends on your income and the choice of benefits you choose.  It can be free up to $1500 per month. 

Thank you so much! I appreciate it.  

[yuna628 9,532]

On ‎10‎/‎30‎/‎2017 at 9:52 AM, emylady said:

Hi everyone, 

 

So I'm really confused about the US healthcare system. I'm coming from the UK on a K1 visa and would like some advice.

 

1. My fiance doesn't have health insurance, or work at a job that provides it. He currently gets state funded healthcare if he needs it (which is very rare). I know I obviously cannot sign up to that, so I'm wondering should we get a plan for both of us once we're married, or would he be able to stay on the state plan and I just get healthcare for myself?

 

2. Where do I go to find out about all of this? I'm having a hard time understanding what I should be looking for. I'm confused about what a deductible and copay/coinsurance are? (I am so going to miss the NHS )

 

3. Until we're married, is there anyone that would offer me health insurance short term? I read somewhere that most providers require you to be an LPR or have been in the US for at least 6 months before you're eligible for coverage?

 

I know there's loads of healthcare posts, I've tried looking through them all but it's just overwhelming. Grateful for any information and advice!

 

Emily.

 

On ‎10‎/‎30‎/‎2017 at 11:45 AM, Sarah&Facundo said:

Following because my fiance is coming soon and I have NO idea what to do with him. Hopefully someone has more information!

Hi you two, hopefully this can be of some help. I answer a lot of the health insurance questions these days especially when it starts getting to this time of the year when open enrollment is upon us.

 

You have said your fiancé doesn't have health insurance. But then you say he has state funded healthcare... what do you mean by that exactly? Is he using Medicaid? Or did he purchase insurance via his state health exchange? Once you find out that info, can clarify options for you. But beyond that, there are plenty of things that you can do to make things easier for yourself. First some background info though to clarify how the system works.

 

---Everyone living in the US, whether they are immigrant or citizens are eligible for health insurance.

---However no one actually has to purchase health insurance if they a) don't want it for any reason, and b) cannot afford it

---When you don't have insurance however things can become very expensive for a person, especially if they have a serious accident or illness.

----For basic care there are plenty of minute-clinics that take patients with no insurance for basic simple injuries or illnesses (that is you pay out of pocket for everything). You can also go to the ER of course. You'll be unlikely to be turned away unless it is a private hospital or it is an elective procedure and you haven't paid a previous bill in full. I was once uninsured and required hospitalization. It was a big bill, but I slowly paid it off.

---When you don't have insurance the person is assessed a penalty in taxes, come tax time. It is by far cheaper to be assessed this penalty than it is to pay a years worth of monthly premiums.

 

Now let's look at the types of insurances available:

 

1) Insurances you buy privately: these can be purchased via any company that offers in the state you will reside. Think of typical big insurers like BCBS or Aetna. There are plenty of places online that run through price quotes or you can go to their sites directly.

 

2) Insurance via the exchanges: Every year there is a period of open enrollment. This period which lasts between November and December allows anyone that qualifies to sign up for health insurance on the Obamacare exchange. If you have a state exchange that is the first option. If the state does not offer an exchange (and some don't) you are eligible to use the federal exchange. I tend to think of the exchanges as a giant price-quote search engine. Most of the plans offers here will be nearly the same as you can buy privately and you'll have to compare both the exchange and private to see what actually saves money. You will be unlikely to qualify for the discounts that some Americans qualify for (via subsidies). If you do qualify you'll find prices will be more affordable. A footnote here would be that using insurance on the exchange is NOT the same thing as Medicaid or Medicare. You ARE NOT eligible for Medicaid or Medicare. If your husband is on Medicaid, you will NOT be eligible for the same, and you'll need to discuss with him whether you'll be doing option 1), 2) or 3) either together or just by yourself. Having joint health insurance together will be good in the long run as proof of a relationship, however you should work out what is best affordable to you as a couple.

 

Using the exchange: Remember I said if you qualify for the exchange. Since it is a government entity and not private it will require documents from a perspective immigrant. You will need to be married, have filed for AOS and at least have an NOA1 or EAD at the earliest. Of course this may take you out of open enrollment period. Luckily, if you act fast enough, you can qualify via 'special enrollment'. This is a clause in place for people who did not make open enrollment but still have qualifying factors such as new marriage or immigration. But this does have a limited timeframe to act. Many people find themselves uninformed and delayed, and by the time they realize they can sign up... it's too late.

 

3) Wait and obtain insurance via a new employer (or your fiancé/husband finds an employer that offers insurance). This will take a while of course until you get established, file for AOS with EAD and get working. My husband's first job did not offer insurance until he was promoted to a full time employee. Plans offered by employers are generally the best of the bunch. You pay a portion out of your check and the employer pays the rest. So what did we do for health insurance for us? When he arrived I made sure he got his SSN as soon as possible, we married, and filed for AOS. I then went to my private health insurer, and changed our policy to a joint plan. They asked very few questions and only wanted proof of marriage. My husband was covered just like me. Later on when he was promoted, we now are on a joint policy via his workplace. You will not be charged a penalty for small gaps in health insurance, but keep waiting too long, and you will be.

 

IF you choose to wait: there are temporary insurances out there, a lot are marketed to new immigrants. However these do not absolve you of the tax penalty. By federal law these are considered subpar insurance (not true insurance that offers everything an insurance must offer by law), and you'll find whatever coverage offered by them, dubious at best. For some people they like them, even if they should never use them. Travel insurances are also not for you, as you'll be moving here not visiting.

 

---

 

Copays and deductibles. Copays are a small fee that you pay for visiting a doctor or obtaining a prescription. They can range between $5-80+ depending on the insurance or circumstances. In general the highest copays are going to be stuff involving the ER. How much you will pay for a premium, how much you pay for a copay, what your deductible is etc will all depend on what sort of insurance you have. You'll generally notice it operates on tiers. The lowest tier of bronze offers the cheapest upfront cost to you in premiums, but will hit pretty heavy on everything else. Silver plans will offer a medium to high upfront price of premium. And gold will offer the highest upfront cost in premiums, however you'll find a very small deductible and very few copays. This is the best if it can be afforded, though the average person likely tries to stay with bronze or silver. A deductible can range from $1k-10k for example. In simple terms: for a person that regularly goes to the doctor every month and has a lot of medication or needs treatments, they will meet that smaller deductible easily and won't have to pay anything else for the rest of the year until it resets. But for a person that is fairly healthy and only needs to see a doctor once or twice a year, they will never meet that deductible and will continue to have to pay whatever copays or bills (whatever the insurance doesn't pay) come their way.

 

Plans offered are going to be HMOs, PPOs, and POS. I tend to like POS plans myself, that generally give the patient more freedom to choose doctors they want to see instead of being restricted a small particular pool the insurance 'approves' of. You'll need to look at each plan with your new spouse and weigh all options, pros and cons of cost, and the long term before deciding. Just don't wait too long. Your spouse, as the citizen should also be proactive in explaining all these new concepts to you and assisting you when you come to a term you don't understand. Its a big confusing world about insurance out there, especially when you're just used to the NHS.

 

--

Bottom line is having health insurance is a big decision that will help protect you in the long term and especially so if you are planning on starting a family or have health concerns. For many people though, they still cannot afford it and go without. My suggestion is to follow the instructions on VJ and obtain your SSN as soon as possible. You do not need it to obtain health insurance by law, however, you'll find it a lot less hassle when you do. And lastly, be prepared for sticker shock. It is rarely ever cheap.

 

 

Edited October 31, 2017 by yuna628

[TransplantUSA 167]

2 hours ago, yuna628 said:

 

Hi you two, hopefully this can be of some help. I answer a lot of the health insurance questions these days especially when it starts getting to this time of the year when open enrollment is upon us.

 

You have said your fiancé doesn't have health insurance. But then you say he has state funded healthcare... what do you mean by that exactly? Is he using Medicaid? Or did he purchase insurance via his state health exchange? Once you find out that info, can clarify options for you. But beyond that, there are plenty of things that you can do to make things easier for yourself. First some background info though to clarify how the system works.

 

---Everyone living in the US, whether they are immigrant or citizens are eligible for health insurance.

---However no one actually has to purchase health insurance if they a) don't want it for any reason, and b) cannot afford it

---When you don't have insurance however things can become very expensive for a person, especially if they have a serious accident or illness.

----For basic care there are plenty of minute-clinics that take patients with no insurance for basic simple injuries or illnesses (that is you pay out of pocket for everything). You can also go to the ER of course. You'll be unlikely to be turned away unless it is a private hospital or it is an elective procedure and you haven't paid a previous bill in full. I was once uninsured and required hospitalization. It was a big bill, but I slowly paid it off.

---When you don't have insurance the person is assessed a penalty in taxes, come tax time. It is by far cheaper to be assessed this penalty than it is to pay a years worth of monthly premiums.

 

Now let's look at the types of insurances available:

 

1) Insurances you buy privately: these can be purchased via any company that offers in the state you will reside. Think of typical big insurers like BCBS or Aetna. There are plenty of places online that run through price quotes or you can go to their sites directly.

 

2) Insurance via the exchanges: Every year there is a period of open enrollment. This period which lasts between November and December allows anyone that qualifies to sign up for health insurance on the Obamacare exchange. If you have a state exchange that is the first option. If the state does not offer an exchange (and some don't) you are eligible to use the federal exchange. I tend to think of the exchanges as a giant price-quote search engine. Most of the plans offers here will be nearly the same as you can buy privately and you'll have to compare both the exchange and private to see what actually saves money. You will be unlikely to qualify for the discounts that some Americans qualify for (via subsidies). If you do qualify you'll find prices will be more affordable. A footnote here would be that using insurance on the exchange is NOT the same thing as Medicaid or Medicare. You ARE NOT eligible for Medicaid or Medicare. If your husband is on Medicaid, you will NOT be eligible for the same, and you'll need to discuss with him whether you'll be doing option 1), 2) or 3) either together or just by yourself. Having joint health insurance together will be good in the long run as proof of a relationship, however you should work out what is best affordable to you as a couple.

 

Using the exchange: Remember I said if you qualify for the exchange. Since it is a government entity and not private it will require documents from a perspective immigrant. You will need to be married, have filed for AOS and at least have an NOA1 or EAD at the earliest. Of course this may take you out of open enrollment period. Luckily, if you act fast enough, you can qualify via 'special enrollment'. This is a clause in place for people who did not make open enrollment but still have qualifying factors such as new marriage or immigration. But this does have a limited timeframe to act. Many people find themselves uninformed and delayed, and by the time they realize they can sign up... it's too late.

 

3) Wait and obtain insurance via a new employer (or your fiancé/husband finds an employer that offers insurance). This will take a while of course until you get established, file for AOS with EAD and get working. My husband's first job did not offer insurance until he was promoted to a full time employee. Plans offered by employers are generally the best of the bunch. You pay a portion out of your check and the employer pays the rest. So what did we do for health insurance for us? When he arrived I made sure he got his SSN as soon as possible, we married, and filed for AOS. I then went to my private health insurer, and changed our policy to a joint plan. They asked very few questions and only wanted proof of marriage. My husband was covered just like me. Later on when he was promoted, we now are on a joint policy via his workplace. You will not be charged a penalty for small gaps in health insurance, but keep waiting too long, and you will be.

 

IF you choose to wait: there are temporary insurances out there, a lot are marketed to new immigrants. However these do not absolve you of the tax penalty. By federal law these are considered subpar insurance (not true insurance that offers everything an insurance must offer by law), and you'll find whatever coverage offered by them, dubious at best. For some people they like them, even if they should never use them. Travel insurances are also not for you, as you'll be moving here not visiting.

 

---

 

Copays and deductibles. Copays are a small fee that you pay for visiting a doctor or obtaining a prescription. They can range between $5-80+ depending on the insurance or circumstances. In general the highest copays are going to be stuff involving the ER. How much you will pay for a premium, how much you pay for a copay, what your deductible is etc will all depend on what sort of insurance you have. You'll generally notice it operates on tiers. The lowest tier of bronze offers the cheapest upfront cost to you in premiums, but will hit pretty heavy on everything else. Silver plans will offer a medium to high upfront price of premium. And gold will offer the highest upfront cost in premiums, however you'll find a very small deductible and very few copays. This is the best if it can be afforded, though the average person likely tries to stay with bronze or silver. A deductible can range from $1k-10k for example. In simple terms: for a person that regularly goes to the doctor every month and has a lot of medication or needs treatments, they will meet that smaller deductible easily and won't have to pay anything else for the rest of the year until it resets. But for a person that is fairly healthy and only needs to see a doctor once or twice a year, they will never meet that deductible and will continue to have to pay whatever copays or bills (whatever the insurance doesn't pay) come their way.

 

Plans offered are going to be HMOs, PPOs, and POS. I tend to like POS plans myself, that generally give the patient more freedom to choose doctors they want to see instead of being restricted a small particular pool the insurance 'approves' of. You'll need to look at each plan with your new spouse and weigh all options, pros and cons of cost, and the long term before deciding. Just don't wait too long. Your spouse, as the citizen should also be proactive in explaining all these new concepts to you and assisting you when you come to a term you don't understand. Its a big confusing world about insurance out there, especially when you're just used to the NHS.

 

--

Bottom line is having health insurance is a big decision that will help protect you in the long term and especially so if you are planning on starting a family or have health concerns. For many people though, they still cannot afford it and go without. My suggestion is to follow the instructions on VJ and obtain your SSN as soon as possible. You do not need it to obtain health insurance by law, however, you'll find it a lot less hassle when you do. And lastly, be prepared for sticker shock. It is rarely ever cheap.

 

 

Wow. That is a lot to think about. I'm not entirely sure about his healthcare, all i know is that Oregon has health insurance for people? He rarely goes so I'm not sure.

 

I'll definitely have to do more research them. I went on a website calle ehealthinsurance and not knowing what to look for it was like $400 a month for both of us but with a $7150 deductible each. I just wanted to crawl into a corner haha! 

 

Thank you so much for your help, really appreciate it. I will have a conversation with my fiancé to see what he wants to do about it. I just want to be prepared as much as possible.

[yuna628 9,532]

18 hours ago, emylady said:

Wow. That is a lot to think about. I'm not entirely sure about his healthcare, all i know is that Oregon has health insurance for people? He rarely goes so I'm not sure.

 

I'll definitely have to do more research them. I went on a website calle ehealthinsurance and not knowing what to look for it was like $400 a month for both of us but with a $7150 deductible each. I just wanted to crawl into a corner haha! 

 

Thank you so much for your help, really appreciate it. I will have a conversation with my fiancé to see what he wants to do about it. I just want to be prepared as much as possible.

 

$400 per month is sadly an average price for a silver plan these days (on the east coast costs are pushing $800 for it), and that deductible is pretty standard unfortunately.