Perry_1990

Hi All,

I have seen a few posts regarding HealthCare in the US, Through my work they offer 2 kinds a "Traditional Pro Plan" and a "High Deductible Plan".

I have seen that the High Deductible plan is the one to go for. It says that for a Family it is $4,000 (combined Med/ RX) - What does this mean?

For Out of pocket Maximum it says $9000 for family. What does this mean?

it also says 10% after deductible certain treatments like X-ray, emergency room benefit, therapy services etc. What does this mean?

I am just trying to see how much it will roughly cost me a month before we decide on moving to Houston.

PetrifiedExPat

I would ask you prospective employer for the plans that they offer, go from there (plus the wife and kids!)

Pulaski

If that is the premium then you'll be paying $333/mth for health insurance, which sounds about right for a HD plan
If everything goes to he11 in a handbasket for you and your family, that is the maximum you would be required to pay "out of pocket" towards your health care costs in any one calendar year (this does not include the health insurance premiums). Look in the paperwork because there may also be personal MOoPs too - I think we have individual MOoPs of $3k, and a family MOoP of $8k - this would be more significant if we had more than one child, as if only one member of a family gets sick them it is the personal MOoP that is relevant. Bear in mind that "out of pocket" expenses will becoming out of your Health Savings Account, which is my contributing to it, to build up a balance is important, especially in the early years.
.... I think what this is saying, (trying to match what you said to what I know about US heath insurance) You are required to pay 10% towards major costs. I had a short stay in hospital some years ago - mostly so they could keep me hooked up to a drip, and I had to pay $2k towards a $20k bill. Hospitals/ medical providers will offer you a payment plan, so you don't necessarily have to pay that in one lump sum - I paid $2k interest-free over 24 months.

You will also need to (you'd have to be a foool not to) factor in contributions to a Health Savings Account to fund any out-of-pocket expenses. This is pre-tax, but the annual maximum for a couple/ family is currently, for 2022, $7,300 pa. You don't have to contribute the maximum, but I would strongly recommend aiming for at least 50% of that amount.

Pulaski

Er, that's what he did - he said "Through my work they offer ..."

PetrifiedExPat

Admittedly my statement was brief and clear as mud. I wondered how much the monthly premium were..

PetrifiedExPat

Also maybe pertinent to OP, and I have always wondered... For instance, if you contribute 5k per annum, and do not utilize any of the pre-tax contribution, how much can be rolled over? If not all the amount can be rolled over, what happens to the rest?

Pulaski

With an HSA the entire balance is yours, for ever. That's the whole point of an HSA.

In fact, once you retire you can do whatever you like with it, you don't even have to use the funds for health care. If you want to draw it all after you retire and use it to buy a Ferrari you are free to do that!

Olly_

To try and keep things simple, insurance usually has a deductible (an excess in UK speak) which is the amount you have to pay out of pocket before the plan will pay for anything at all.

The 10% after deductible you mention refers to co-insurance - after you've hit the deductible for the year the plan will pay 90% of your medical expenses and you will have to pay 10% until you hit the maximum out of pocket. At that point insurance will cover 100% for the rest of the year.

It gets way more complicated by in and out of network providers (my insurance has a higher deductible and max out of pocket for out of network vs in network for example) but hopefully that helps you understand the basics.

Owen778

HSAs you get to keep, and can use like a retirement account. Other account types you lose the remaining money at the end of the year.

ddsrph

I think the $4000 is the family deductible with $9000 max annual out of pocket.

Pulaski

$4k would be extremely low for a family deductible for an HD plan, our individual deductibles are $3k each, though I agree that quoting the premium as an annual figure is a little strange.

Jerseygirl

Apart from the deductibles/premiums etc etc etc…you really need to keep your wits about you when needing treatment. For instance…hubby went to the ER with chest pains. Every test known to man was done and he was given the all clear. The doctor asked if we could wait a few minutes so he could introduce his attending. We said hello and left. A week or so later we got a 3 figure bill…the attending doctor wasn’t in network. On another occasion hubby had an appointment with his doctor to go over some results. The doctor had been called away for an emergency, hubby was asked if the practice nurse could give him the results. Yup you’ve guessed it…she wasn’t in network!!! 😱

Even if you are at death’s door, you need to check that every single person you come into contact with is in network. If not you will be billed. Before you ask, we had first class insurance through hubby’s company.

Rete

Also bear in mind that ambulance service is not included with most healthcare plans. You pay for this out of pocket but can gt reimbursed with your HSA.

Pulaski

I hate to say it, this late in the day, as I know you have posted this annecdote several times, but I had a similar experience at an "in network clinic" getting billed for an "out of network" doctor. On pushing back on the bill I discovered, or to be more precise, our insurer discovered, that the doctor's paperwork/ registration had been started but had expired/ not been completed/ not been processed, so basically an adminstrative SNAFU. After several weeks of the doctor/ clinic/ insurer completing and filing the paper work, I got a revised bill for the correct, in-network amount. I strongly suspect that it isn't possible to have an out-of-network doctor working in an in-network medical facility other than due to an administrative SNAFU, which can be fixed after the fact.

Jerseygirl

Each time, I challenged the bill and had it removed…but it took quite a while. Can you imagine something like that when you have a serious illness, with goodness knows how many bills thrown at you? Another time I received a bill from the company that provided a service…it was 20 years ago and can’t remember the details. Turned out they billed me for the difference between their fee and the arranged fee with the insurance company. I called the insurance company and they informed me that they could not do that. The guy asked me to stay on the line while he called the company. I heard the conversation and it was sorted out. This was yet another of several occasions where we had been wrongly billed by a third party.