wikigardening

My husband and I and 2 children (11 & 6) are moving to Los Angeles in July on 01/03 visa. I was wondering if anyone had any recommendations about health care. - we are 45-50 and quite fit not over weight. Is it best to go bronze and hope all will stay ok? Also, my husband gets a massive high blood pressure reading when he has it taken - extreme white coat hyper tension that has had him in hospital because of it! He doesn't actually have high blood pressure, just the taking of it freaks him out. Will he have to have a medical to get insurance?

Thank you for any help. Lucy

scrubbedexpat099

So you are buying through the Exchange?

Personally I do not believe in dollar swapping with Insurance, however when the Government get involved and it moves away from Insurance then there can be opportunities.

Medical is not involved for OCare.

ian-mstm

With respect, this isn't actually an immigration-related question... it's about health care insurance. You'll get better help by posting in the general USA forum.

Ian

sir_eccles

No medicals.

By all means start on the bronze plans but I would caution against just picking the cheapest. Check the network as many are very narrow to save costs. Check prescription costs. Check to see what general visit copays are.

Pulaski

For most people in good or reasonably good health you are financially better off taking the lowest insurance premium and accepting the risk of paying more out of pocket for routine doctor's appointments. We (family of three) pay about $160/mth on an employer-provided scheme, and pay for the occasional doctor's appointments, and treatment for Little Miss P's allergies, "out of pocket" from our before-tax Health Savings Account (not to be confused with a Health Spending/ Health Reimbursement Account), which works like a British private pension, funded by before-tax payroll deductions, and subject to an IRS cap (just under $7k/yr).

Two colleagues who have three and four children, so much greater health costs than us, independently reached the same decision - "high deductible" (low premium) insurance + an HSA is the optimum choice. BOTH my colleagues have had one of their children break a bone and STILL concluded that the HD policy was the better choice. .... Remember your "exposure" is mostly the annual deductible, so it makes virtually no difference whether an injury costs $5,000 or $10,000. And for the rest of the year healthcare for that child is effectively almost free (the deductible has been fully used up, so only copays might be due.

It took us several years to realise that the worst case outcome (several claims or a large claim) was about the same (high deductible v "regular insurance") in terms of the cash out of pocket paid in insurance premiums plus direct costs, but that most years we benefit from the low premiums and can just accumulate the HSA money, which we have done ever since. The alternative (high premiums) was effectively flushing about $1,000/mth down the toilet.

Also bear in mind that even a high-premium policy may have a deductible, so that you could likely pay for at least a couple of visits to the GP before the insurance kicks in.

sir_eccles

This last bit is quite frankly rubbish!

Very very few policies put general visits to your in network GP against your deductible. Even the cheapest bronze plans often have a set number of "free" visits and most plans have a set copay for visits.

Note also preventative care is free under the ACA, annual checkups are free for kids in particular, vaccines etc. Some mammograms and plenty of other services.

Pulaski

That might not be your experience, but that doesn't make it "rubbish".

We used to pay out of pocket for GP visits, upto, I think $1,000. It was when we realised that in most years we were generating no reimbursable expenses that we resolved to switch to a HD policy.

sir_eccles

Which is why I advocate reading the fine print and not just picking the cheapest.

scrubbedexpat099

Locally, the big problem with an OCare policy is finding providers who will take it, reimbursement rate is lower than what they want.

Pulaski

Point taken, BUT the reverse is also true, read the fine print and don't just pick the most expensive either. ..... Because it might still leave you paying out of pocket for things you thought were covered, and if you aren't likely to generate enough expenses to use up the deductible on a expensive policy then argubly the additional premiums you paid (diff between cheap and expensive policies), were "wasted".

And BTW, to your point about GP visits being covered - you should check the small print there too, because while a chat with your GO might be covered, along with some prodding and poking, and use of the stethoscope, you might find that use of "additional technology", or a lab test of blood, fluids, or mucus, will be billed separately and might not be covered, or subject to an additional copay.

Bob

Just curious how long ago?

With the ACA, there's no co-pay for kids health check ups, or any cost to you, even for vaccines now.

Looking at the insurance statement, the health check up for one of the kids if we'd had to pay up for cash would have been $380 for the check up, $150 for what ever the blood test was, $100 for the eye/sound test and $100 for whatever the vaccine was.

We had looked at the high deductible plan v a regular plan a number of years ago and for us, it didn't make sense as the money didn't contribute plus the regular plan had much better coverage, especially regarding the extent of network coverage. We don't have the option now as they don't offer one any more but it would be interesting to see how things would have stacked up with the increasing cost of the premiums.

For what it's worth, the plans as far as network coverage went something like cheapest plan covered your local hospital and that was it, everything else was out of network, the next cheaper plan, covered the metrowest region excluding Boston, so again pretty rubbish, the next plan was the standard plan and in network was most of the state. The good plan, that we have, covers the whole country and at least Canada for in-work.

The difference being, us being on the hook for 10% in network and 20% out on the top plan going down to 40% in network and 60% out of network on the other end of the scale. We also have a much lower max spend, which then ranges up to quite high and for the cheapest plan, doesn't have a limit.

Should say, our plan is about $250 a month compared to $50 or there abouts for the cheapest option.

petitefrancaise

Interested to know how you know your husband only has high blood pressure when it is taken??

Like others have mentioned here - try to find out which insurance companies your local hospitals/doctors surgeries are in-network for. Having to hunt around for an in-network hospital can be a pain and a possible big financial hit if you get it wrong when there is an emergency.

If I were you, I'd also be looking at the local cardiologists to see which insurance they are in-network for too.

scrubbedexpat099

It is not just which Companies but which Plans.

kodokan

I bought a family plan on the ACA marketplace last year. Like you, we're healthy mid-40s with no medical conditions. It was a bronze one, with an overall deductible of $12.5k, and then a max out of pocket of... um, nearly $20k from memory.

So one question is do you have access to an emergency fund that could pay that deductible, if you had to?

The high blood pressure - is it the blood pressure taking that bothers him, or doctors generally? All the pharmacies here, including the ones in supermarkets, have a great open access public blood pressure machine. I quite often wander over in the middle of grocery shopping and stick my arm in it, to see what it is that day. If he did that enough times to make it mundane, you might get a more reliable reading.

petitefrancaise

so here's my question Kodokan..
if you are ill and end up paying out for healthcare up to the limit of $20k. That is just for one year? What happens the following year? If you were sick and needed on-going care how could that be managed financially? Could you go onto a plan with a lower out of pocket/deductible?

Also, if you were unlucky enough to become sick in say early December and not get out of hospital until end of January, then your liability could be $40k? for the same illness?