Author Topic: Health Care Insurance in the United States  (Read 2624 times)

guelphinvestor

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Health Care Insurance in the United States
« on: December 27, 2016, 02:10:59 PM »
Hi

I am a Canadian citizen, and I am considering working in the United States.

Part of my motivation is the higher American dollar, which I believe will help me save more money.

I am wondering how to take into account health care costs.  The company says the deductible is $500 and the co payment is %10.

I have had some heart procedures in Canada, which did not cost me anything. 

Would this pre existing heart condition make my premiums higher ?
Could I end up paying thousands of dollars in the event that I need a procedure done ?

I am just trying to figure out how much of a dollar value to put on having to handle my own health care insurance.

Thanks.

StarBright

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Re: Health Care Insurance in the United States
« Reply #1 on: December 27, 2016, 02:36:33 PM »
In addition to deductibles and co-pay you need to look at Maximum "Out-of-Pocket" amounts both in and out of network. You also need to be clear on what you are paying for the premiums monthly/per paycheck.

If you've had heart procedures and are likely to need more in the future than the Max Out-of-Pocket numbers could be important to you.

As an example of how this can work I offer the following:

A couple of years ago my DH had an emergency appendectomy with complications that required follow up surgery. We went through his deductible, hit the Max on his "out of pocket" in network, and then thanks to the emergency room not having ANY in-network anesthesiologists, we also were hit with a separate "out-of-networkm out-of-pocket" limit. It was ugly :/

So price-wise our coverage worked like this:
approx $550 a month towards premiums (this was for a family of three at the time)
$3,000 deductible
$7,500 out of pocket max
$an additional several thousand paid towards out-of-network, out-of-pocket max (can't remember the exact number because I spent several months negotiating it down because he was dying and we didn't have time to get an in-network person for his surgeries.)

If you are single, and have a low premium AND low deductible (which $500 is) and  have low MAX numbers it could work in your favor. But if you have a $500 deductible and 20k max and need heart surgery it could really hurt you.

Just run your numbers.

Also, if the insurance comes with your job then chances are your previous surgeries would not effect your premium, but if the employer self-insures then you might run into issues with premium pricing after you establish medical history with that insurer - but that would likely effect the rates for the whole company and not just you as an individual (though I'm not as clear on that- I only know enough to be dangerous.) If ACA gets repealed (likely) it will also depend on which state your job is located in - different states mandated different ways of organizing coverage pre-ACA.

Best of luck with your decision!

« Last Edit: December 27, 2016, 02:41:35 PM by StarBright »

wenchsenior

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Re: Health Care Insurance in the United States
« Reply #2 on: December 27, 2016, 02:39:25 PM »
Hi

I am a Canadian citizen, and I am considering working in the United States.

Part of my motivation is the higher American dollar, which I believe will help me save more money.

I am wondering how to take into account health care costs.  The company says the deductible is $500 and the co payment is %10.

I have had some heart procedures in Canada, which did not cost me anything. 

Would this pre existing heart condition make my premiums higher ?
Could I end up paying thousands of dollars in the event that I need a procedure done ?

I am just trying to figure out how much of a dollar value to put on having to handle my own health care insurance.

Thanks.

It's extremely variable depending on your employer's plan, but a 10% copayment on a surgical procedure could hypothetically run you several thousand dollars easily. 

Altons Bobs

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Re: Health Care Insurance in the United States
« Reply #3 on: December 27, 2016, 03:01:19 PM »
$20k out of pocket max is unlikely because the law says in 2017, the OOP max can be $7,150 max per person. But your potential employer's plan probably is a plan that was established before 2017, so the OOP max is going to be lower. Unless it's a pre-ACA grandfathered plan that they kept, then the OOP max could be very high. You need to get specifics on the plan, out of network coverages like the unexpected anesthesiologist charges that StarBright mentioned.

I'm a red panda

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Re: Health Care Insurance in the United States
« Reply #4 on: December 27, 2016, 03:13:17 PM »
Are you single or needing family coverage; it changes the equation a bit if it is family because you need to consider a family level deductible and out of pocket max.


However, insurance through an employer is your premiums are going to be what the company establishes; your previous condition won't matter (at least how it works now and used to work; who knows what Trump will do...)

I've also been screwed by the out of network thing when NO ONE in network could do the procedure; and it turns out that even though I had a $6k out of network maximum (my in-network out of pocket max is a separately measured $3k), that is subject to "allowable charges" so I was still out a few thousand more than that....

StarBright

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Re: Health Care Insurance in the United States
« Reply #5 on: December 27, 2016, 03:15:34 PM »
$20k out of pocket max is unlikely because the law says in 2017, the OOP max can be $7,150 max per person. But your potential employer's plan probably is a plan that was established before 2017, so the OOP max is going to be lower. Unless it's a pre-ACA grandfathered plan that they kept, then the OOP max could be very high. You need to get specifics on the plan, out of network coverages like the unexpected anesthesiologist charges that StarBright mentioned.

I didn't realize the number was "per person" on OOP- thanks Altons Bobs! in my research I'd always seen it listed as something like 6k for individual or 12k for family but it makes sense that there would have to be some sort of limit.

So hurray OP- it likely won't be 20k!

I'm a red panda

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Re: Health Care Insurance in the United States
« Reply #6 on: December 27, 2016, 03:39:33 PM »

I didn't realize the number was "per person" on OOP- thanks Altons Bobs! in my research I'd always seen it listed as something like 6k for individual or 12k for family but it makes sense that there would have to be some sort of limit.

So hurray OP- it likely won't be 20k!

Well, isn't the limit "per person"; but if you are on a family plan, the expenses aren't seperated out per person- so one person can still be responsible for it all, if that's how the care works out.

StarBright

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Re: Health Care Insurance in the United States
« Reply #7 on: December 27, 2016, 03:55:51 PM »

I didn't realize the number was "per person" on OOP- thanks Altons Bobs! in my research I'd always seen it listed as something like 6k for individual or 12k for family but it makes sense that there would have to be some sort of limit.

So hurray OP- it likely won't be 20k!

Well, isn't the limit "per person"; but if you are on a family plan, the expenses aren't separated out per person- so one person can still be responsible for it all, if that's how the care works out.

ahh- you're right, I think. At least that is how it seemed to work with us, but maybe OP is single :)

guelphinvestor

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Re: Health Care Insurance in the United States
« Reply #8 on: December 27, 2016, 08:14:41 PM »
Thanks for all of your detailed responses.

What dollar value would you assign to having to get health insurance ?
The numbers I was quoted was around $1600 a year, plus $500 deductible plus 10% co pay.

In Canada this would all be covered, so should I add $4000 to my expected salary ?

Paul der Krake

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Re: Health Care Insurance in the United States
« Reply #9 on: December 27, 2016, 08:22:10 PM »
That sounds about right. Maybe pad it by a couple thousands given your condition.

 

Wow, a phone plan for fifteen bucks!