Anthony.DeSouza

I will be moving to Upstate NY on November 12, 2015 on my K1 Fiance Visa.

As I will be unemployed while waiting for my AOS/work permit I am wondering can/should I apply for ACA cover when enrolment begins on November 1st for 2016? Am I right thinking that path will be closed to me until after my AOS is completed?

I intend to get a full-time job with medical insurance ASAP, which I hope will happen by March/April 2016 at the latest. (I have a bachelors degree and 20+ years work experience in software development so I am optimistic on my prospects.)

I am pondering a few options:

- I am 45 and in good health so I might risk going without insurance, until I get full time employment. Snow mobiling will have to wait

- get added to my fiancée's plan - although the added insurance premium is 4 times what she is currently paying ($650+ a month). I am loathed to do this whilst unemployed.

- find a medical insurance/(ACA?) with a high deductible and low as possible monthly payments for a short term

Any advice would be appreciated.

kins

You don't have to wait for open enrollment. A permanent move from one insurance area to another is a qualifying life event. Take a look on ehealthinsurance.com to see how much an ACA policy might cost you in your area at your age.

One of my local friends was your age and in good health just a couple of years ago. Since then his insurance company has funded hundreds of thousands of dollars worth of cancer treatment for him. The first sign he had of the cancer was when he had a heart attack in his front garden.

When you say $650+ a month, is that for you AND your fiance? If so it's probably better than most other deals you'll find, especially as you'll get a family deductible. But without more info about the insurance it's hard to say.

Anthony.DeSouza

Thank you! I haven't grasped all the terminology with US health insurance. A family deductible would make sense. I will definitely look into ACA too. Thanks about telling me about your friend. The unknown always concerns me and to finally make it into the US then mess up over health would be lousy.

I'm fairly sure it was 4x hers plus her premium. I'll have to do the math again and find out what the deductions will be. That would be preferred, I'm just trying to be frugal before I get my work permit and employment.

Pulaski

If you have generally good health, and it sounds like you do, then I believe a high deductible (Brit-speak "excess") plan would be a good fit for you, even after you get a job. The fact that even "normal" insurance has a substantial deductible, which you are unlikely to meet even if you go to the doctor a couple of times a year, means that taking a much lower cost (premium) plan can make good financial sense - you get coverage in case of a medical catastrophe but pay for most small on-going expenses out of your pocket. That said, once you have a job you can fund a Health Savings Account, which is tax deductible and can be used to pay for your "out of pocket" expenses.

Anthony.DeSouza

Interesting. Thanks Pulaski - I am in good health and paying for small on-going expenses suits my typically very rare doctor visits. I will definitely read more about the Health Savings Account. Between figuring out how to do a tax return for the first time and how health insurance works I should be busy for a while!

kins

I'm in good health and have a high deductible silver plan plus an HSA. I've spent almost all the deductible this year on physio but most years I only spend about $500 or less out of pocket. My premium is $333 a month, my deductible is $2500 and my out of pocket cap is $4000. However that's in Maine. You'll be looking in NY so the range of plans will be different.

Anthony.DeSouza

Thanks Kins.

Sorry if I sound clueless - just trying to understand how what you described works

What does $2500 deductible mean? I was imagining that was what you had to pay upfront each year if you needed to receive any healthcare at all ? Now I am thinking it is the max you are allowed to claim in a year?

I don't I understand how "Out of Pocket" works. Are these for subsidised charges not covered in your plan? What happens when you reach your $4000 Out of Pocket cap? Do you then pay full price for anything extra?

Is a HSA something you can put money into and take out flexibly or is it protected?


Thanks for your continued help :-)

nun

In the US since Obama brought in the ACA law you have to be covered by health insurance or you get fined. You pay a monthly premium to the insurance company, but the insurance company won't pay for anything until you've paid a certain amount....that's the deductible......generally the higher the premium you pay the lower the deductible. Also after you've paid that initial deductible the insurer often won't pay all of the bill; they might pay 80% leaving you to pay 20% out of your own pocket (out of pocket). This is called co-insurance. Luckily, the plan will have a maximum annual amount that you have to pay and once that is reached the insurer starts paying 100% of the bills. That amount is the annual out of pocket maximum. For example

In NY and individual might pay $350/month in premiums for a Silver plan that will have a $2k annual deductible and a $5.5k annual out of pocket max.

https://nystateofhealth.ny.gov/individual

On a K-1 visa you won't be able to apply for ACA coverage or get onto your spouses plan (probably the best and easiest thing to do) until you are married and have applied for AOS so to cover the gap you need a temporary plan from a commercial insurer.

Pulaski

The deductible is what you pay before the insurance pays anything. After that you still pay part of certain things, such as a copay (fixed fee) for a consultation (commonly $25 or $30), a copay percentage for using "out of network" (not approved by your insurer) doctors or hospitals (often 10%-20% of the cost), and part of the cost of prescriptions. You keep on paying those things even though the insurance kicked in after your eligible medical expenses exceed the annual deductible, until you reach your maximum out of pocket which is exactly what it says, the maximum amount that you have to pay for medical consultations, prescriptions, treatments, procedures, and services.

The HSA works very similar to a private pension plan. You are limited to how much money your can put in pre-tax (about $6,800pa IIRC), and you can only use the funds for eligible medical expenses. It is yours to keep from year to year (do not confuse this with a much less advantageous scheme called a "flexible spending account"), and if you stay healthy until you retire whatever money has accumulated is yours to spend on whatever you want, though you'd still probably be well advised to keep it for medical expenses in retirement.

Anthony.DeSouza

Excellent. Thank you all!

sir_eccles

A lot of the details vary from plan to plan. It isn't always nothing paid out until the deductible is met. Regular Dr visits are likely to be just a copay. Preventative care is free. Etc.

Pulaski

Good point, yes any preventative treatments, including an annual marketing meeting physical check-up, are usually free or very low cost.

kins

I'm on a silver plan and regular doctor visits are not a copay - I pay the full whack. I could have gone for the copay option but it would have added significantly to the premium.

I believe all policies have to include one free annual physical, and also free contraceptive coverage for women.

OP - the other thing to be aware of is that even though you're paying a fair bit out of pocket for things like doctor's visits and prescriptions, you are paying the lower rate that your insurance company has negotiated. Usually if you don't have insurance then those rates are much higher, at which point you start negotiating yourself with your doctor/hospital...

The other thing to be aware of is that you can't really be frugal with healthcare. That's really the fundamental problem with healthcare in the US.