smytje

Hi all,

I am new to the forum and have done my best, unsuccessfully, to find a relevant article that is up-to-date post Obamacare - although it strikes me that, even then, there are still known knowns, known unknowns and unknown unknowns

In July of last year I started the Spousal Visa process (I-130) with the London Embassy - my wife is a USC - Texan, which is where we are looking to settle. Unbeknownst to us, this was just a month before I was to be diagnosed with Hodgkins Lymphoma, a cancer of the immune system. On a cheery note, I successfully completed my treatment on Jan 21st and I am now waiting for the all clear (due, and highly anticipated, in early March).

My question is this: Assuming I get the all clear and I am given the spousal visa, what are the odds that I will be able to get a health care policy with a pre-condition? and what sort of rate can I expect to pay for the entire family given that I have a wife and child (2yrs old)?

Of note, I will be setting up a C corp, through which I gather I can offset my healthcare policy costs and some healthcare costs.

Of equal note, as a Green Card holder I have been informed that it would be illegal (attracting a hefty fine) for me to hold a policy with (for example) BUPA International that covered me for treatment everywhere bar the US - i.e. allowing me to return to the UK for private treatment if I fail to beat the 10% odds of me contracting the cancer for the second time. As an alternative, I could rely on the NHS for at least two and a half years with out losing US residency (more if I relinquish my US residency and become domiciled in the UK again..), but I'd rather have a private policy to ensure I get the best possible care.

I appreciate any advice - and apologies if someone has asked something sufficiently like this before. I found the Health Care blog very informative, but I am wondering if anyone has found themselves in a similar predicament.

I am hoping that our dream of moving to 'Bigger and Better' Texas is still attainable!

Noorah101

I would say many folks who move to the USA via a spouse immigrant visa get added to the USC spouse's existing health care plan.

You didn't mention that as an option for you, though. Is it?

Rene

smytje

Thanks for the prompt response.

The wife is planning to set up her own law practice rather than work for a company at this point. We are currently investigating the possibility of the Texas Bar offering a health plan that I can join, as a spouse; but in case that doesn't work I am looking at all avenues.

Bob

ACA would mean it's a moot point about pre-existing....so just go to the healthcare website and put in the details for quotes, which are meaningless unless you have an idea of what you can deal with for co-pay/deductible etc, etc.

Probably nudging more towards a grand a month as a ball park, but less if you go high deductible, more for none etc.

The BUPA thing is also moot, you won't be resident of the UK so the policy would be void, unless it was employer based.

Michael

You can use the healthcare.gov web site which handles the Texas ACA plans to get an estimate of the costs but some have had problems accessing that information from overseas (maybe only when they try to create an account). The plans can't discriminate on price for pre-existing conditions. Details of the plans (bronze, silver, gold, and platinum) are described for each plan.

https://www.healthcare.gov/

Michael

I don't think you want to setup a "C" corporation since that is for large companies and have to pay corporation income tax as well as individual income tax. You will probably want to setup a "S" corporation where can elect to be taxed as an individual. For a large company with expensive lawyers and accountants, there can be advantages of a "C" corporation but usually not for a small company.

smytje

Thank you both.

Bob - Good to know about ACA and a grand a month doesn't seem too bad (I had honestly expected 2 to 3 times that amount?!).

I was looking at BUPA International rather than BUPA - they cover medical care for all countries and those who have an existing UK BUPA policy can opt to continue coverage under BUPA International, but sadly not with a pre-condition.

Michael - that link has honestly made my day. I am going to take a good look at the website tonight.

smytje

Michael -Re the C Corp: I have taken advice and, given my circumstance, it does appear to be the path of greatest efficiency. I am getting a second opinion though.

Michael

If you are all currently overseas, you can get coverage starting the month following entry to the US (an immigration event) otherwise you have to wait until open enrolment which is at the end of the year. This year, open enrolment was from November 1 - March 31 but next year it will probably be from November 1 - December 31. During open enrolment, you can also select a different plan if you are unhappy with your current plan.

An HMO is a plan where you are assigned a primary care physician and normally have to get a referral for specialists.

A PPO is a plan with usually many doctors and hospitals and can possibly have doctors outside your local area that are in-network. You chose your own doctors and see a any specialist desired. If the doctor or specialist chosen is in-network, the co-pay is less but you can see any doctor or specialist but at a higher co-pay.

sir_eccles

There are only three things that can affect your ACA based premium: age, smoker, number of people to cover.

smytje

Michael - I will want to get coverage as soon as I land, so I will certainly be using the immigration event. PPO looks like the better option for me.

sir_eccles - 36, no and 3.. hopefully not too contentious for the actuaries..

Michael

If you want choice, PPO is the best. All the plans have an annual maximum out of pocket expense (excluding the premium) of $6,350 for an individual or $12,700 for a family (some have a lower maximum out of pocket expense). The primary difference between the plans are the deductible, co-pays, and number of the in-network doctors and hospitals.

sir_eccles

Look carefully at what is being offered in Texas, while HMO and PPO are the most common but there are occasionally others such as open-HMO which is a sort of hybrid. Bottom line you really have to look very carefully at the fine print of each policy offered not just pick based on the numbers.

Example we saw two almost identical policies with virtually the same name differing by $4. Took some digging but eventually discovered the difference was pediatric dental cover.

civilservant

You cannot 'rely on the NHS for at least two and a half years with out losing US residency' since the second you become a resident of the US you lose your entitlement to free NHS care.

It's not based on contributions, it's based on residence.

If you 'move' back to the UK for purposes of residence than your GC is at risk anyway, since you will no longer actually be resident in the US.

Michael

For health insurance, ACA defines what has to be covered so all plans should cover the same procedures with differing deductibles and co-pays depending on whether it is a bronze, silver, gold, or platinum plan. For dental, that can vary more since ACA is not that concerned about dental coverage.