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Curious on US health insurance

Curious on US health insurance

Old Oct 1st 2021, 5:48 pm
  #31  
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Default Re: Curious on US health insurance

Originally Posted by SanDiegogirl
As I stated above there are supplementary plans to 'top up' original Medicare. Some are Advantage plans, others are true supplementary plans. Even if you don't go for any type of 'top up' plan I think Medicare is still better in terms of costs and complexity than individual plans.
Medicare Advantage is utterly different from a supplementary plan. It does NOT “top up” original Medicare. As I stated above, the first choice Medicare recipients have to make is whether to go with original Medicare or to go with Medicare Advantage.
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Old Oct 1st 2021, 5:54 pm
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Default Re: Curious on US health insurance

Originally Posted by robin1234
Last year, I counted how many pieces of mail I got during Medicare season, advertising Medicare plans (Sept - Nov, mostly.) It was over fifty. A lot of it was borderline dishonest, especially since a high proportion of Medicare recipients may have issues with memory, judgment etc. Some of the envelopes are disguised so they look like they come from the government, and other such ploys. The sales and advertising budgets must be significant.
I especially dislike those celebrity endorsements selling advantage plans implying it’s just Medicare. Some advantage plans can work to people’s benefit but like you said many are not in a good position to evaluate them.
Advantage plans were designed by Republican legislators namely Bill Frist to save Medicare due to cost savings. In reality they cost the government 15 to 20
% more. As lot of doctors don’t accept them so you have to be very careful with your provider selections. A lot of seniors sign up for them with no clue what they are getting.
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Old Oct 1st 2021, 6:12 pm
  #33  
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Default Re: Curious on US health insurance

Originally Posted by Shard
As the title says, I have a some curiosity about how US health insurance works. I'm not moving the the US so don't need full links nor really detailed explanations.

What I'm wondering is whether people can get health insurance if they were previously healthy but then develop a chronic condition. For example a healthy 30 yo with no insurance becomes epileptic (or something requiring long term treatment) can they obtain a healthcare plan or does having the condition mean they are uninsurable?
As far as I know employer supplied plans dont take any account of previous conditions so its an non issue, if you can find a job with benefits.

The short answer to your question how do they work is "Really Badly"
The bureaucracy required is absolutely mind blowing, and the frustration levels navigating it often off the scale. Then there is the issue of finding service providers that know what they are doing, but maybe thats more of a southern issue. And I am lucky enough to have "good" benefits from one of the largest providers....
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Old Oct 1st 2021, 6:32 pm
  #34  
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Default Re: Curious on US health insurance

Originally Posted by ddsrph
I especially dislike those celebrity endorsements selling advantage plans implying it’s just Medicare. Some advantage plans can work to people’s benefit but like you said many are not in a good position to evaluate them.
Advantage plans were designed by Republican legislators namely Bill Frist to save Medicare due to cost savings. In reality they cost the government 15 to 20
% more. As lot of doctors don’t accept them so you have to be very careful with your provider selections. A lot of seniors sign up for them with no clue what they are getting.
And, although people are free to switch from Medicare Advantage back to Original Medicare, I believe they may be subject at that point to higher premiums on the Medicare Supplement plans that they may then need.
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Old Oct 1st 2021, 7:18 pm
  #35  
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Default Re: Curious on US health insurance

Originally Posted by Rete
Don't you always go with what you know and what is consider status quo?

Why would they want healthcare sponsored by a government that few trust or voted for? Medicare is okay for the most part but requires a supplemental policy if you don't want medical bills sent you for uncovered services. Medicare does have a Part "D or E" that covers prescriptions, I believe. But it doesn't cover eye wear or hearing aids.
Satus quo is exactly why Canada wont change it's system, at this point I think I would prefer Medicare or Medicaid if I were eligible as even with their flaws they cover things that Canada refuses to cover, Canada may have the most unequal universal healthcare system around, need money to access vision, dental, mental health and a slew of other healthcare needs not deemed worthy of coverage by the universal system, I am literally considering just pulling a tooth out myself to solve the pain....crazy thought to think that if I could manage to relocate to California that Medi-Cal for low income is better than the universal system in Canada, who would have thought that.....
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Old Oct 1st 2021, 7:24 pm
  #36  
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Default Re: Curious on US health insurance

Originally Posted by Shard
I can understand the status quo argument, and distrust of a particular government or even government in general. My point was more that Europeans and Canadians see universal healthcare as a right, whereas there are some in American that not only turn a blind eye to those who are denied healthcare, but believe such a (unsympathetic) system fosters productivity and striving for success. And that's probably true. But it is a trade off that society must undertake.
*certain healtcare as a right in Canada, Canada certainly doesn't see prescription access, dental, vision, mental healthcare as a right as much of these are not covered at all, covered for certain ages, or only covered sometimes.

Have a tooth infection and can't afford a dentist, tough luck, live in BC and 19-64 well no vision for you, have a RX the government deems to expensive, too bad so sad, need mentalhealth services beyond medications, screw you mentality.

Canada is only marginally better than the US, and may just have the worlds most unequal universal system.

Don't let Canadian' fool you into think they beleive healthcare is a universal right because Canadians are more than willing to exclude healthcare they deem a luxury or not necessary even though they are very much necessary healthcare needs for a lot of people.

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Old Oct 1st 2021, 7:44 pm
  #37  
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Default Re: Curious on US health insurance

Originally Posted by robin1234
And, although people are free to switch from Medicare Advantage back to Original Medicare, I believe they may be subject at that point to higher premiums on the Medicare Supplement plans that they may then need.
That's if they're able to switch back to a Supplement Plan at all- if they develop certain medical conditions they may not be able to switch back to a Supplement Plan.
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Old Oct 1st 2021, 7:56 pm
  #38  
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Default Re: Curious on US health insurance

Originally Posted by Jsmth321
Satus quo is exactly why Canada wont change it's system, at this point I think I would prefer Medicare or Medicaid if I were eligible as even with their flaws they cover things that Canada refuses to cover, Canada may have the most unequal universal healthcare system around, need money to access vision, dental, mental health and a slew of other healthcare needs not deemed worthy of coverage by the universal system, I am literally considering just pulling a tooth out myself to solve the pain....crazy thought to think that if I could manage to relocate to California that Medi-Cal for low income is better than the universal system in Canada, who would have thought that.....
I agree it's not a good system if it doesn't include dental care.
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Old Oct 1st 2021, 7:58 pm
  #39  
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Default Re: Curious on US health insurance

Originally Posted by Jsmth321
*certain healtcare as a right in Canada, Canada certainly doesn't see prescription access, dental, vision, mental healthcare as a right as much of these are not covered at all, covered for certain ages, or only covered sometimes.

Have a tooth infection and can't afford a dentist, tough luck, live in BC and 19-64 well no vision for you, have a RX the government deems to expensive, too bad so sad, need mentalhealth services beyond medications, screw you mentality.

Canada is only marginally better than the US, and may just have the worlds most unequal universal system.

Don't let Canadian' fool you into think they beleive healthcare is a universal right because Canadians are more than willing to exclude healthcare they deem a luxury or not necessary even though they are very much necessary healthcare needs for a lot of people.
Have you contacted your local heath unit? Where we lived in Ontario they had dental officers who could get work done for low income individuals, one of my neighbors was the dentist in charge. It was minimal but better than nothing.
Honestly we are so frustrated with the situation we would swap my privately insured US healthcare for OHIP provision in a heartbeat. But thats not to say both couldn't be a lot more universal. Here in the US there is this weird thing that for health care you want as much expense early in the year as possible so you can in order to cover your deductible and max out your out of pocket limit (about 4k total annual liability for my family) and then everything after that is effectively free, or at least whatever portion of treatment the insurance company sees fit to cover, but for Dental you want to spread expense over multiple years because insurance maxes out at 3k a year payout and after that you pay everything. You do get ridiculous coverage exceptions such as if you are spending the money to get dental implants and they need to do a bone graft, thats covered (well, 50 or 80%) , but sedation while they cut through your gums to do it, is not. In our experience you cant even get a quote up front for most medical procedures so you dont even know what sort of financial hole you might be digging for yourself. So much for "informed consent".

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Old Oct 2nd 2021, 3:00 am
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Default Re: Curious on US health insurance

I am on a wait list for a charity dentist, so eventually I will get seen, just a pain that its not covered so people can see dentists on a more regular basis for routine care since healthy mouth leads to a healthier body and a sick mouth leads to a potentially sick body.

Dentists in BC are like that, how much will this cost, and you get some big range, ffs is it $500 or is is $2,000 because I kind of need to know as that is a huge flipping range in price....then dentists and their upselling, no I don't want insilign, no I do not want whitening, just fix the tooth.

I can get more accurate quotes from the dogs doctor than I can from a dentist.

Originally Posted by iaink
Have you contacted your local heath unit? Where we lived in Ontario they had dental officers who could get work done for low income individuals, one of my neighbors was the dentist in charge. It was minimal but better than nothing.
Honestly we are so frustrated with the situation we would swap my privately insured US healthcare for OHIP provision in a heartbeat. But thats not to say both couldn't be a lot more universal. Here in the US there is this weird thing that for health care you want as much expense early in the year as possible so you can in order to cover your deductible and max out your out of pocket limit (about 4k total annual liability for my family) and then everything after that is effectively free, or at least whatever portion of treatment the insurance company sees fit to cover, but for Dental you want to spread expense over multiple years because insurance maxes out at 3k a year payout and after that you pay everything. You do get ridiculous coverage exceptions such as if you are spending the money to get dental implants and they need to do a bone graft, thats covered (well, 50 or 80%) , but sedation while they cut through your gums to do it, is not. In our experience you cant even get a quote up front for most medical procedures so you dont even know what sort of financial hole you might be digging for yourself. So much for "informed consent".
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Old Oct 2nd 2021, 1:36 pm
  #41  
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Default Re: Curious on US health insurance

Originally Posted by Jsmth321
I am on a wait list for a charity dentist, so eventually I will get seen, just a pain that its not covered so people can see dentists on a more regular basis for routine care since healthy mouth leads to a healthier body and a sick mouth leads to a potentially sick body.

Dentists in BC are like that, how much will this cost, and you get some big range, ffs is it $500 or is is $2,000 because I kind of need to know as that is a huge flipping range in price....then dentists and their upselling, no I don't want insilign, no I do not want whitening, just fix the tooth.

I can get more accurate quotes from the dogs doctor than I can from a dentist.
History of spontaneous pain especially if severe usually means you will need a root canal or extraction of tooth.
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Old Oct 2nd 2021, 8:08 pm
  #42  
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Default Re: Curious on US health insurance

Originally Posted by ddsrph
History of spontaneous pain especially if severe usually means you will need a root canal or extraction of tooth.

I would bet money it will be an extraction, root canals are pretty luxury item, there is a reason low income people often have missing teeth, they get basic access to charity detntists but resources are thin, so extraction is usually done rather than spenting time and limited resources on root canals and such, pretty much why US prisons do extractions over root canals on inmates.

Also why I have 2 molars missing, I couldn't afford the thousands for a root canal, so the $300 solution to eliminate the pain it was.

It's amazing how expensive root canals are and dental in general in BC.
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Old Oct 2nd 2021, 9:05 pm
  #43  
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Default Re: Curious on US health insurance

Originally Posted by SanDiegogirl
As I stated above there are supplementary plans to 'top up' original Medicare. Some are Advantage plans, others are true supplementary plans. Even if you don't go for any type of 'top up' plan I think Medicare is still better in terms of costs and complexity than individual plans.
There is also what is colloquially called “Part C” coverage which enrollment in an HMO. You assign your Part B premium to the HMO. We’re with Kaiser and that includes Part D prescription coverage with no extra premium.
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Old Oct 2nd 2021, 9:19 pm
  #44  
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Default Re: Curious on US health insurance

Originally Posted by S Folinsky
There is also what is colloquially called “Part C” coverage which enrollment in an HMO. You assign your Part B premium to the HMO. We’re with Kaiser and that includes Part D prescription coverage with no extra premium.
I had forgotten about that part. How does it work when you are driving cross country and hundreds of miles outside their normal coverage area?
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Old Oct 2nd 2021, 9:32 pm
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Default Re: Curious on US health insurance

[QUOTE=Jsmth321;13057979]I would bet money it will be an extraction, root canals are pretty luxury item, there is a reason low income people often have missing teeth, they get basic access to charity detntists but resources are thin, so extraction is usually done rather than spenting time and limited resources on root canals and such, pretty much why US prisons do extractions over root canals on inmates.

Also why I have 2 molars missing, I couldn't afford the thousands for a root canal, so the $300 solution to eliminate the pain it was.

It's amazing how expensive root canals are and dental in
general in BC.[/QUOTE
There is a good reason more dentist don’t treat welfare/Medicaid patients. The state reimbursement is usually very very low. Frequently below the dentists cost to provide. A dental practice strives to have a 50% over head but many times it’s close to 70%. Another major factor is patient reliability ie failing to show up for scheduled appointments. If their tooth stops hurting why bother to show up. Many have no concept of the impact this has on some dental practice. I worked a little for hourly pay at a free public health medical/dental clinic. It would not be unusual to have only 20% of a days scheduled patients show up and we only treated children.


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