Sheilauk

I was wondering if you live in Vermont and you are around 60 miles away from a a good Hospital in NY state can you use the NY Hospital instead of travelling much further to a Hospital with Nephrology in Vermont? Thank you.

Michael

It is going to depend on your policy. If it is a PPO (preferred provider organization) and that hospital is one of the preferred providers, you can use it with the same co-pay and deductions as any hospital that is a preferred provider. If it is not a preferred provider, usually there is a higher co-pay and deductible for using that hospital.

If your policy is a HMO (health maintenance organization), generally they are more restrictive. Except in an emergency, many HMO policies require you to only use doctors and hospitals that are in the plan.

Some of the PPO plans are regional and you must stay in the region to get the best deductible and co-pay but others have a national base of providers that you can choose from such as most ATENA plans.

Sheilauk

Thank you Michael for your helpful reply. We haven't got health insurance yet as we are still in UK going through the visa process. However upon being on the phone for many hours to various Health Insurance Companies in NY State and getting nowhere I was very surprised when I called Vermont Heath Insurance Companies to find how helpful they are. Hence the question. Apparantly in Jan 2014 it will be law in Vermont to have health insurance and they are bringing out a bronze, silver and platinum package but as yet price and benefits are unknown. Problem is they only seem to have one hospital that has a nephrology dept unless I'm missing something,

Michael

That is the new Obamacare program. Vermont will be setting up health care exchanges (basically a web site) instead of using the federal run exchanges where private health insurers will be able to sell health insurance. All families that don't have employer provided health insurance will be required to purchase health care insurance through the exchanges or will be accessed a tax penalty with a few exceptions. All states will have to setup their own exchange or use the federal exchange.

The cost is based on the families age and income. Insurance companies will be subsidized by the government for people with pre-existing conditions as well as a subsidy for families that have incomes below 400% of the poverty level. Insurance companies will be able to offer only bronze, silver, or platinum plans where the coverage, co-pays, deductibles, and maximum annual out of pocket costs are defined by the federal government. Therefore insurance companies will all offer the same coverage but some could be PPO's and others could be HMO's. All three plans are low deductible/low co-pay plans with the platinum plan having the best coverage. The government doesn't control the price that the companies can charge but they must accept any family at the same price they charge other families of the same age no matter how many pre-existing conditions the family has. Since all plans are basically the same, it is assumed that insurance companies will try to keep the price low to get the business. No longer will someone have to provide health insurance companies with the health records to determine if the health insurance company will insure that person and what coverage will be provided at what cost. In your case, you would likely check the plans offered by different insurance companies to determine if the hospitals that you want are on the preferred provider list.

The program is similar to the program that Switzerland uses.

The following is a calculator that estimates how much insurance will costs when Obamacare kicks in on January 1, 2014. It also indicates the approximate income based subsidy from the federal government. The link only produces estimates for single people or a family of 4 but if there are two of you, use the family of 4 calculation and your costs will likely be less than that.


http://healthreform.kff.org/SubsidyC...spx#calcParams

Sheilauk

That is incredibly helpful. Thank you