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Balamban

America specific, Filipino wife (via K1) medical insurance question.

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It's been a long haul but my fiancee is now my wife (for 3 months +) and all looks good for a long, loving, lasting relationship.


Short question version:  Can a Filipina, now a wife in America avail herself of Philhealth?

 

Long version:

 

I looked into Obamacare right after marriage and was shocked.   Essentially $300-400+/month and other than an annual checkup and flu shot--nothing is covered.  (until you spend $2500-4000 out-of-pocket) What a load of ####### America's strange medical insurance system is!  (I'm on Medicaid Advantage which in contrast is delightful--reasonably priced (with some exceptions such as meds which I can buy from Canada/India for less than 1/4 the co-pay, but I digress)).  Obamacare for her is a joke.  Need anything for just about anything and thousands must be paid out-of-pocket before Obamacare pops in.  I'm not working (currently in college FT) so no chance of company sponsored insurance.  It's painfully clear to me that younger, healthy people (her) are being forced to pay ~$4800/year for the less than 1/10th of one % chance that they will actually ever surpass the insane deductible.  (Note: Obamacare seems very location dependent meaning even in the North of one state might have a "good" deal and if in the South of that state--a terribly high-priced, insane out-of-pocket before insurance really kicks in, so this may or may not be the same plight depending upon where you live).

 

Let me sum it up.  My wife now has zero insurance.  Yes, if she (in the extremely unlikely possibility) had to stay in hospital for a month--in a word, we're screwed.  Now having missed the deadline, we must wait till next year to hop on the evil insurance bandwagon.  

 

Options:  Thus my question:  Can she avail herself of Philhealth?  Anyone know?  I know OFW's can.  Then at least she'll be 50% covered for a hospital stay.  She's very healthy, but still Americas is a scary place without insurance.  

 

What do others here do?  Go naked w/o insurance and hope for the best?  (Which is what we are doing)  Pay for Obamacare (many will have family medical from employers, I realize that) but some of you may not, and I would like to hear what you guys are doing?

 

We've done all the AOS stuff and anticipate (using VJ's data) AOS and ability for her to work ~ February.  She's intending to take an LNA class in January (earlier is impractical as her English is not yet good enough (but getting better and better).  So ~next March or so even if I am not yet working again, she likely will be with at least basic (hi-deductible garbage) Obamacare insurance as mandated through her employer.  (Btw, in many states LNA/CNA class (usually ~$1700) is reimbursed to you a month or so after starting and there are lots of jobs--a great way for many Filipinas to obtain a good job.

 

America is still a great country--but America's medical system is absolutely, shockingly insane--it's something that would make plundering Vikings proud.

 

Givining something back: if you ever need a med check out goodrx.com and also check out pharmacychecker.com (I have no connection to either).  Many meds can be bought via a Canadian pharmacy and shipped to America.  I've used pharmacychecker's pharmacies (three of them) since 2007 and have never had an issue, often at 15-20% of what I'd pay locally.  Goodrx is a coupon site and sometimes are even cheaper than what I must pay as a co-pay on my Medicare.  

Edited by Balamban
My conscience is a grammarian

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First off let's get something clear here. If you keep badgering my Viking lineage I'm going to have to plundering your garden of all your vegetables. I hope you have good sweet corn, cause that's my favorite. :jest:

 

Ok, to your question that you asked. I'm still awe of those who thought Obama and his administration was giving the American public such a great health care program. I do better on a company policy for less money then OC and it bogles my mind that we have a 1,000 people to assure and OC had upwards of 38 million and couldn't get anyone to sign up for those ridicules pricing. I couldn't agree more with your personal assessment.  

 

I have a policy that I use from AFLAC. It pays you cash for your doctors/hospital visits. It's not designed to take of your major costs but to supplement the cost with the deductible for the office visit or surgery. So for your wife, this might be a cost effective alterative given your situation. I had cancer abt 7 years ago and under there cancer policy I was paid $13,000 plus I was able to, from another policy from Aflac, pay some of my out of pocket expenses.

 

I can't answer the Philhealth question and will leave that to others.

 

Your mileage may vary.

 

Good luck


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PhilHealth is only good in the Philippines.  


Hank

"Chance Favors The Prepared Mind"

 

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Obamacare did give some a break, like self employed people, people with preexisting conditions who couldn't get on a company plan, early retirees etc. But on the whole it's been a disaster for someone like myself, who works for a small company. Premiums have doubled in the last 5 years, and my deductible went from 1800 to 3600.

 

Not much she can do besides use the ACA. Of course she's going to "lose" money on average, but if she gets cancer, heart disease, needs a lengthy stay in the ICU, burn unit etc. You're looking at $250k-1mil out of pocket. That's when a $4800 deductible starts to look tolerable...  

 

I'd buy the cheapest catastrophic plan you can that has an HSA and get her a job with benefits immediately. My wife's friend is an admin assistant for the state govt. Low pay, but excellent benefits including great insurance. Even some retailers (Starbucks, walmart) offer some plan... I believe even low level healthcare positions do so as well.

Edited by FluffyBalls

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1 hour ago, Hank_ said:

PhilHealth is only good in the Philippines.  

Hank, I never, ever thought I'd refute what you say here, however, recently (2018) Philhealth has undergone some major changes summed up in  the words "no Filipino will be left behind."  So perhaps some months ago your statement was 100% correct but it appears that today it is no longer correct as OFW's  (whether offshore national Filipino's as spouse fit into this appears a bit cloudy but it covers both formal (work permit) and informal including self-employed) are clearly covered for hospitalization reimbursement for overseas treatment.)  Admittedly this appears to be a big change and admittedly I'm not sure just how much will actually be reimbursed.

 

The question is even more important since my wife's mother is over 60 and permanently disabled--and from what I've read, her mother can be a Philhealth dependent even if the policy holder is overseas.  

 

Check this out: 


https://www.philhealth.gov.ph/members/overseas/


Advantages of being a
PhilHealth member
Overseas Filipinos may avail themselves of PhilHealth benefits for hospital confinements and out-patient surgeries in the Philippines.
Confinements of Overseas Filipinos and their dependents in any accredited health care institution in the Philippines are being paid for by PhilHealth through the All Case Rate payment scheme.
Confinements of OFs overseas may be reimbursed
Overseas Filipinos confined abroad are entitled to PhilHealth benefits through claim reimbursements.Members are given 180 days upon discharge to submit their claim documents to any of the PhilHealth offices in the Philippines.

 

 

Edited by Balamban

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1 hour ago, Greenbaum said:

 

I have a policy that I use from AFLAC. It pays you cash for your doctors/hospital visits. It's not designed to take of your major costs but to supplement the cost with the deductible for the office visit or surgery. So for your wife, this might be a cost effective alterative given your situation. I had cancer abt 7 years ago and under there cancer policy I was paid $13,000 plus I was able to, from another policy from Aflac, pay some of my out of pocket expenses.

 

 

Aflac sounds like a good idea, thanks.

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2 hours ago, Balamban said:

Hank, I never, ever thought I'd refute what you say here, however, recently (2018) Philhealth has undergone some major changes summed up in  the words "no Filipino will be left behind."  So perhaps some months ago your statement was 100% correct but it appears that today it is no longer correct as OFW's  (whether offshore national Filipino's as spouse fit into this appears a bit cloudy but it covers both formal (work permit) and informal including self-employed) are clearly covered for hospitalization reimbursement for overseas treatment.)  Admittedly this appears to be a big change and admittedly I'm not sure just how much will actually be reimbursed.

 

The question is even more important since my wife's mother is over 60 and permanently disabled--and from what I've read, her mother can be a Philhealth dependent even if the policy holder is overseas.  

 

Check this out: 


https://www.philhealth.gov.ph/members/overseas/


Advantages of being a
PhilHealth member
Overseas Filipinos may avail themselves of PhilHealth benefits for hospital confinements and out-patient surgeries in the Philippines.
Confinements of Overseas Filipinos and their dependents in any accredited health care institution in the Philippines are being paid for by PhilHealth through the All Case Rate payment scheme.
Confinements of OFs overseas may be reimbursed
Overseas Filipinos confined abroad are entitled to PhilHealth benefits through claim reimbursements.Members are given 180 days upon discharge to submit their claim documents to any of the PhilHealth offices in the Philippines.

 

 

 

PhilHealth will offer reimbursement to those aboard, not coverage, and don't expect the reimbursement to cover U.S. medical costs .. ;)  


Hank

"Chance Favors The Prepared Mind"

 

      HandArrow.gif.adeb854ba620933849ae921ca0b44a0c.gif  Link to the Visa Process for Manila Embassy once you have your NOA2 : Click Here

 

Contact Hank: HERE

K-1 visa approved 21 March 2012

...Citizenship... complete!

 

 

 

 

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1 hour ago, FluffyBalls said:

Obamacare did give some a break, like self employed people, people with preexisting conditions who couldn't get on a company plan, early retirees etc. But on the whole it's been a disaster for someone like myself, who works for a small company. Premiums have doubled in the last 5 years, and my deductible went from 1800 to 3600.

 

Not much she can do besides use the ACA. Of course she's going to "lose" money on average, but if she gets cancer, heart disease, needs a lengthy stay in the ICU, burn unit etc. You're looking at $250k-1mil out of pocket. That's when a $4800 deductible starts to look tolerable...  

 

I'd buy the cheapest catastrophic plan you can that has an HSA and get her a job with benefits immediately. My wife's friend is an admin assistant for the state govt. Low pay, but excellent benefits including great insurance. Even some retailers (Starbucks, walmart) offer some plan... I believe even low level healthcare positions do so as well.

Oy vey, how far America has fallen..." That's when a $4800 deductible starts to look tolerable..."  (I'm not disagreeing, I'm just wondering of 1000 healthy non-smoking, non-drinking    of course you have to add in the $3600-$4800 annual insurance premiums.   From an actuarial point of view I wonder if, for a health 30 year old woman who will not get pregnant if putting aside the $4800 and "going naked," makes far more sense.  

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Philhealth as far as I am aware can only be used within the Philippines. Now an OFW can participate in it and register, know that they can only avail of it when they are in the Philippines. Any dependents that they add to their Philhealth account will of course be able to avail of the benefits as well, provided said dependents are also in the Philippines. However, can OFW cant be outside the country and expect PhilHealth to come to the rescue there (it won't). Now, perhaps (don't quote me on this part) an OFW, after getting their hospital bills abroad can perhaps submit a reimbursement claim to PhilHealth and their benefits can be paid in cash but seriously, PhilHealth benefits pays peanuts, it cannot even cover the full cost of hospitalization in the Philippines, how much more medical expenses incurred in the US / abroad?! My advise as a Filipino living overseas? Don't bother with PhilHealth. The only reason why one might get PhilHealth while living overseas is if they have family back home that they want covered. That's it.


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Here is a old thread here on VJ that we had talked about insurance. Maybe something there you glean from.

 

 


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Adjustment of Status

AOS March 5, 2014 Submitted AOS with EAD/AP package to Chicago USICS

Delivered March 8, 2014 AOS packaged delivered to USCIS drop box

Accepted March 19, 2014 Text message with receipt numbers

Biometrics April 16, 2014 Biometrics completed

EAD May 23, 2014 Employment Authorization Document approved and went to card production

TD May 23, 2014 Travel Document approved and went for card production

Receipt EAD/AP May 30, 2014 Received combo card EAD/AP

Green Card Approved July 11, 2014 Approved, no interview. Went to card production.

Green Card received July 17, 2014 GC received without interview

Removal of Conditions

Mailed I-751 Dec 16, 2015 Submitted ROC (removal of conditions)

Received Dec 18, 2015 USPS notification of successful delivery

Check Cashed Dec 21, 2015 Check was cashed

NOA-1 Issued Dec 21, 2015 NOA-1 for ROC issued

NOA-1 Issued Dec 26, 2015 NOA-1 Received

Biometrics Appt. Jan 29, 2016 Biometrics Appointment Scheduled [Completed]

 

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And the link posted earlier is dated  2014 (not 2018) ... so this is all old.    

  • © 2014 Philippine Health Insurance Corporation | Citystate Centre, 709 Shaw Boulevard 1603 Pasig City | Call Center (+632) 441-7442

 

As for PhilHealth providing coverage in the U.S.A ..... Rub A Lamp!

 

 

 


Hank

"Chance Favors The Prepared Mind"

 

      HandArrow.gif.adeb854ba620933849ae921ca0b44a0c.gif  Link to the Visa Process for Manila Embassy once you have your NOA2 : Click Here

 

Contact Hank: HERE

K-1 visa approved 21 March 2012

...Citizenship... complete!

 

 

 

 

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4 hours ago, Balamban said:

Oy vey, how far America has fallen..." That's when a $4800 deductible starts to look tolerable..."  (I'm not disagreeing, I'm just wondering of 1000 healthy non-smoking, non-drinking    of course you have to add in the $3600-$4800 annual insurance premiums.   From an actuarial point of view I wonder if, for a health 30 year old woman who will not get pregnant if putting aside the $4800 and "going naked," makes far more sense.  

 

I would not recommend going without some form of health insurance. At the very least a catastrophic plan that caps the amount you're liable for in a given year. Even if your wife is healthy, doesn't smoke, won't get pregnant etc. , things like a perfectly executed slip and fall in a ceramic bathtub could turn into an $90k hospital bill. This happened to my neighbor a few years back, and he needed 2 surgeries on his neck, a 4 day hospital stay, physical therapy, a $$$ neck brace, and so on.  The insurance company will win, on average, but there are lots of individuals that the insurance company will lose money on.

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Thank you all for your input.  That fellow who fell in the tub was very lucky he didn't become a paraplegic.  It's a strange world when I consider health insurance before I consider the wages that will be paid--such is life in America today.  

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Hi!

 

I have no answer for your regarding PhilHealth but let me share something.

 

My Husband is self-employed all his life and it was to expensive for him to get insurance through O###care.

Anyway his accountant suggested to check CHM "Christian Healthcare Ministries" https://www.chministries.org/ he did thorough research and it's seems legit.

Quote from the website "Christian Healthcare Ministries is not a health insurance company. Rather, we are a group of thousands of Christians across the United States and around the world who share each other’s burdens in the area of health care costs. We also pray for and encourage one another. "

 

I came here from Philippines last 2013, it took a while before we found CHM. So we became a member last 2014. We only pay $150 each per month. the deductable is only $500. 

October 2016 I was diagnosed of Stage 3 Endometrial/Uterine Cancer, as a member of CHM,  we were able to find a doctor ASAP without waiting for an approval from a health insurance.  We chose our own doctor, we connected to Seattle Cancer Care Alliance, and refererred us to University of Washington immediately, as I need an URGENT attention because I had High Grade Cancer.  Having that said they interview my husband regarding his financial situation.  We only paid $500 for initial deposit through credit card when I had my surgery.

 

Overall from the surgery (October 2016), Chemotherapy December-April 2017 and Radiation Treatment (June 2017) my total bill was estimated $150,000++.  It was overwhelming because the medical bills were huge. I started submitting all the bills to CHM, according to them the reimbursement will start in 3 months.  While the medical bills were accumulating from 4 different hospitals.  They Hospitals gave us an option to pay our bills by monthly payments without interest, and paid them through Credit Card. (advantage of paying credit card - we got a lot of points hahaha).  Anyway after 6 months of submitting our bills, we started receiving "Reimbursement Cheques/Checks".  As of this month of October 2018, we received 99% of all the reimbursement.  99% because, 1% is the percentage that I apply for existing bills, like I have 3 months & 6 months follow up.

 

Now, I don't know if it makes sense to you why I share this.  But if it is safe and cheaper option while waiting for her to find a work in the future.

 

We actually shared this to our friends and they were so convinced and became a CHM too. (Of course they were only convinced after I started receiving $$$ reimbursements :) )

 

Cheers,

 

 

 


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We have a 6k individual deductible,  13k for family. 

Most cases we would never meet our individual deductible. This year alone though I met mine back in Feb, plus another 80k worth of bills. That thankfully we will not have to pay. Which we would have had more then my deductible if I was on the Premium insurance. 

 

We actually chose the high deductible because it was cheaper than the premium in the long run. Sure you pay for DR's out of pocket, but the insurance still keeps them under check so they can't bill you their make believe prices. If anything serious happens the deductible is all you ever pay. 


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