Health system in USA
 

Hi
My husband, three kids and I are moving to California this summer and don’t plan to come back.
I’m completely unsure of how health insurance works there.
I’m setting up a business so I’m thinking I could insure all of us through the company expenses.
What happens if you just need to see a GP? Does insurance pay for this or do you pay when she see the GP? Do you register with a local GP like in the UK?
Do you have to pay for children’s vaccinations like polio etc?
Do you have to pay for maternity care or is this covered by insurance?
Thanks

Re: Health system in USA
 

Welcome to BE. In your other post, you state that you are applying for an E2 visa -- that means that if you fail at renewal, you will have no option but to return to the UK, plus your children will age out at 21. It also seems a little late to be starting to think about health insurance. There are many threads on the topic on this forum if you do a search. And yes, you will pay premiums and you will pay co-pays and you will pay deductibles, depending on your policy.

Re: Health system in USA
 

Two things:
1. If you're on an E2 visa, your children will most likely be required to return to the UK once they age out of eligibility. I hope you already realise this.

2. You pay for everything. Either through paying the insurance premiums or by paying directly. You will be able to get health insurance through your business, but it will cost you a lot, especially with three children. I think the number I remember from looking into insuring our family of five earlier this year is about $11,000 per year.

The answer to many of your other questions depends on the details of your insurance. Generally, you have a primary care provider (PCP), which is kind of equivalent to your local GP. For some types of insurance, you must use a single PCP and go through them for referrals for any specialty medicine, for others, you can go straight to the specialist.

Look into definitions of co-pay, deductible and (maximum) out of pocket, to better understand how the finances of US health insurance work. The out-of-pocket maximum is commonly somewhere from $8000 to $12000 per year, but it varies by policy.

The cost of seeing your PCP depends on your policy. HDHP policies cost less, you cover the whole cost (and all other medical costs), until you've reached your deductible. Other types, you might pay a co-pay amount (maybe $25) and the insurance pays the rest.

Vaccinations and other preventative medicine is often fully covered by the insurance. You're paying for that through the premiums, of course.

Maternity care is a major event, and you will pay a large proportion of it yourself, up to your out of pocket maximum.

Re: Health system in USA
 

Hi we are applying for E2 for quickness but as we are investing $1m and creating over 10 jobs we can apply for a green card later once we have settled down there.
I wondered how it works to see a GP?

Re: Health system in USA
 

Thanks very useful
We are eligible for an investor green card due to the amount we are investing but this takes time so applied for an E2 for now.
Also my children are babies at the moment so plenty of time!

Re: Health system in USA
 

How it works to see a GP (or "family doctor") depends on your insurance.

Some insurances have a list of doctors you have to choose from ("in network"). Others don't. You call the doctor's office directly to make an appointment. They usually deal with the insurance.

For some you have to pay part of the visit (the "co pay"). For some you don't.

It really all depends on your plan.

Re: Health system in USA
 

Health Insurance : British Expat Wiki

That will answer some basics.

Re: Health system in USA
 

carcajou is right, it all depends on the insurer. But once you're established, it won't be much different to the UK, except you may have to pay something for your trip at the Dr's office.

Re: Health system in USA
 

I would not call it a system as such.

Anyway with 10 plus employees you have HR/Office Manage whatever who will be sorting this out for Employees and their family's?

Re: Health system in USA
 

There are many healthcare plans out there. Obviously, you are well situated financially and will have a good pick of what is offered.

To my way of thinking, perhaps because I have always had it, is the PPO healthcare policy as opposed to the PCP policy. There is no in network requirement for me to chose a doctor or a hospital. I do not require a referral from my primary doctor to see a specialist.

There are also policies that allow you to contribute before tax funds to an account to be used for reimbursement of medical expenditures that you have to pay out of pocket, i.e. co-pay at a doctor for a visit, co-pay on medicines, co-pay for hospitals. The Flex Spending can only be used for medical expenditure reimbursement.

There is another Healthcare Saving Account and is great for those earning a high income and have a policy with a high deductible. For example, if you have a deductible of $50,000 to be reached before your healthcare starts paying the bills, you must put so much into the HSA each pay period. For example, my daughter's family policy is a deductible of $20,000. $600 per bi weekly pay period is taken from her husband's paycheck to go into this account. She pays the doctor for the visit and then files a claim for a refund of the monies from the HSA. This is perfect for a family that doesn't have medical issues, at least in my opinion, as the amount put into the HSA adds up quickly. For her family, there is never enough in the account as a cushion due to their Asperger child's behavioral modification treatment which is $12,000 a year. And that is through a income adjusted payment schedule with the organization they are using.

There is much to learn about healthcare and one of the mods gave you a link to look at on BE's wiki and there are many threads about just this subject you can research.

Re: Health system in USA
 

Put simply, healthcare in the US is a privatized mess - that's coming from someone that works in finance for a large hospital/skilled nursing facility. You pay far more, and get less, than you do somewhere like the UK.

Re: Health system in USA
 

If you can get a PPO, get a PPO. It makes things much easier.

Re: Health system in USA
 

Definitely, but most PPOs also have preferred networks and you need to be careful when visiting a doctor or facility. I was burned twice in recent years with my PPO.

In 2015 I went for a routine colonoscopy to a doctor and facility that was in network. Unfortunately they found a polyp, and the lab that it was sent to for histology was not in network and I was charged $750 for that. It took over a year of appeals before they finally reduced the cost to $50.

In 2016 I went to a 24 hour emergency clinic just after midnight on a Sunday night with my first ever heart problem. I was there less than 3 hours, but it was a necessary visit and the treatment was good. The insurance paid most of the cost but it still cost me ~$5k out of pocket and I was told that if I had gone to the in-network big hospital ER unit it would have cost a lot less as the insurance company contract pricing was much better.

Re: Health system in USA
 

In what way do you get less? I had an emergency visit (on a Sunday) last month and had my Cat scan and results within a hour. Script given by the really kind doctor and everything taken care of within 4 hours.

Re: Health system in USA
 

We may have personal stories about good or bad health experiences but overall the USA spends far more on health care and has the worst outcomes.

Spending, Use of Services, Prices, and Health in 13 Countries - The Commonwealth Fund