John123456

Hello Folks

I have just joined this forum as I am looking for some very important info , about , I suspect , everybody's favourite subject, and that is american health care, health insurance.

I have spent many hours over the last few weeks, and months trying to read some of these posts, threads, trying to educate myself about the subject, as it's a completely diffrent story to what , we in the UK/Europe are used to.
Me, my wife, both in our early 40's, and our two kids, early teenage, are thinking of moving to the US to live there.
There isn't going to be a problem with getting our Green Cards, the only issue we are having problems figuring out, researching, is the american healthcare system

I am most likely going to be the only one working (worst case scenario), earning around $100 000/year on self employed basis. I could be able to earn more, if I wanted to work more, but we also want to take some time off for ourselves and spend time exploring the new country, so I assumed $100K as a safe number to expect.
We are planning to be living either around Indianapolis, IN, or around Charlotte, NC.

Because we are going to be having to buy our own health insurance by ourselves, on the open market, there are a few questions I would have to those of you that know the subject well:

1. Am I right to think, that the cost of a good health insurance for self employed and his family is going to be around $25K, per year?
We would like to buy a good or preferably very good health insurance, as if there is one thing we would not want to try to save on, would be our health care. I know it is very expensive, but what can we do, no other choice but to pay.
2. I've watched some horror stories about people having good health insurance and still having to pay out of network expenses.
One man had a heart attack, was taken to the nearest hospital by his neighbour, aparently the hopsital wasn't in network and he received a bill for over $100K, which his insurance didn't want to cover, because the hospital wasn't in network, and despite it being an emergency, which aparently was covered by his health insurance, even if he was treated in an out of network facility.
3. I've read some stories about people being taken to a hospital in network, but then somehow they got treated by some specialist who was out of network, and their insurance again didn't want to cover the bill, tens of thousands of dollars.
4. As part of my job I am going to be travelling a lot , around the US, if I get sick in some other state, and end up at the nearest hospital, which obviously isn't going to be in network, what would my options be, other than having to pay the bill in full, despite having a very good health insurance?
5. How do you manage these out of network surprise bills, which won't be covered by your health insurance, no matter how good your health insurance is?
6. There was an article recently in the local UK paper, everyone's favourite Daily Mail, where someone showed a bill of $2.8 milion for a 4 month hospital stay due to being infected with Covid. Lets assume the person had , lets say Gold health insurance where, if I am not mistaken, the patient covers 20% of the bill, and the insurance covers 80%, would that mean you, the patient get $560K to pay and the rest is being paid by the health insurance?
How can people even with best health insurance pay such bills?

Here's the link:
https://www.dailymail.co.uk/femail/a...-COVID-19.html

7. Lets say you have a very good health insurance, do you still have to pay a full price for these expensive medicines, that cost multiple what they cost in Europe?
8. Is there any website where I could get some health insurance quotes, entering some details and then also see how they would change if I was 50, 55, 60, 64 years old?

9. If you have high deductible health insurance, your visits to se a GP or a specialist, are they very expensive, or because you have a health insurance these fees are reduced, and not as expensive as you were not having any health insurance at all?

10. If I am not mistaken, when you reach 65 yo, and you paid your taxes for at least 10 years, you can expect to be getting some SS pension.

Do you know what is the lowest amount of SS pension that is being paid in such a case?

11. Is there such thing as best state for lowest health insurance costs?

The health insurance is the one thing that is stopping us from making the move, otherwise we would have already started the process.



Many questions, I know, answer those that you know answers to, and maybe if you could direct me to the place where I could get myself properly educated about the subject a bit more.

I prefer to ask questions before I make the move, rather than sell the house, move my belongings and then find it wasn't as easy to manage as I had hoped.

Thank you all in advance for your help with this very confusing subject

civilservant

1. That's probably a touch on the high side, but not unreasonably so. It's a good budgeting figure.

2. This isn't really a question. Does it happen? Absolutely. Not much you can do to prevent it, you end up fighting it out with the insurance company on the back end.

3. Again, not really a question. See above.

4. Your options in this case would be to a) not pay it, b) file bankruptcy or c) fight it out with your insurer to try and get it covered.

5. It's called a payment plan. So much each month, there's really no other way unless you are independently wealthy. If you can pay in full, there's usually a significant discount to be had.

6. Correct. The co-insurance and deductible are yours. In this case, bankruptcy would probably be the result.

7. Totally dependent on your insurance, but yes, name brand drugs typically have astronomical copays or may not be covered at all.

8. Try the Obamacare exchanges, depending on state, if will either be one run by that state or the federal one and healthcare.gov

9. Usually there is a contracted rate for something like a GP visit. I have never had a HD plan, but as an example the contracted rate for a typical GP outpatient visit with my insurance is $107. I have a $30 copay, and the plan pays the rest. The provider usually bills around $377 to the insurance company and it gets contractually reduced.

10. There are many calculations that go into that, including how much you earned during the 10 years. I do not know that you will be able to get a decent estimate in advance. Perhaps someone else can advise.

11. Healthcare is not cheap in the US, no matter where you go, choosing where to live based on healthcare costs is a bit of a fools errand.

scrubbedexpat099

We can talk about current costs and cover but sounds like you have not started the process of getting a Green Card. That could easily take a couple of years depending on the route you are taking.

What cover cost situation will be in the future is anybody's guess.

Nutmegger

Which could leave the teenagers at a difficult stage in their education to be uprooted to a new country and new educational system.

Dave2726

I wonder if this helps?

https://www.ajmc.com/view/congress-e...s-and-patients

Caveat, I am in the process of applying for a visa (IR1) to move to the US. I have not yet lived there or had personal experience of using US healthcare / insurance. While I have an expressed interest given my medical history, others on this forum will be much better informed and more experienced to answer. The link above is just something I dug up because I too had / have some of your concerns... Disclaimer over!

tht

On 1. $25k seems a little low, I pay around $22k premium for a HDHP. We pay 100% for everything except wellness visits until we meet the deductible, individual deductible is $6,350 and family is $12,700. The OPM is 13,800, so once we hit that the plan pays 100%. So worst case for a year we spend $36k, with usual kids being sick visits we spend about $25k a year between premium and deductible

On 6. you are probably mistaken, many plans have an out of pocket maximum, see my example above:
https://www.cigna.com/individuals-fa...pocket-maximum

The good news is if you are self employed (and don’t do ACA) you can deduct that premium from your taxable income, so you are paying for it pre tax, which gives you the same benefit as an employer paying for it pre tax as part of your compensation package.

civilservant

I stand corrected. Boy am I glad I a) don't work for myself and b) don't have kids.

Geez

tht

On 10, yes the 10 years / 40 credits is part of the calculation, it also depends of your earnings that are taxed for SS up to a maximum per year, around $145k in 2021, but if you have significant NI contributions from in the and n qualify for a state pension there you may be subject to WEP. You also need to look to make sure you have enough credits to qualify for Medicare when you retire. https://www.healthline.com/health/medicare/medicare-work-credits

You may need to factor in that the $100k you estimate as “earnings” may not be the amount you pay SS and Medicaid tax on, all your costs like health insurance and QBI as well as actual business relate costs like your liability insurance, vehicle, etc. These will reduce your tax bill, and also your FICA which will I turn lower your possible SS at retirement.

John123456

Thank you everybody for taking your time and replying to my questions.

civilservant
2. Aren't these insurance companies honouring what's in their own contracts? How long does it take to have it resolved? Surely, after surviving a heart attack, the last thing you want to do is to argues with your insurance company over a massive bill, that you can't afford to pay?
That's the video:
So, only because the case has attracted media attention, the hospital decided to drop the bill.
In the second case, the woman pay over $500 a month for her private health insurance premium, she has it on 20/80 basis, she now needs a kidney transplant, which would amount to $400K, but she needs to come up with her 20% share of the bill, which is $80K.
How do people get around these very serious problems?
3. If the only solution to these high medical bills is to become bankrupt, what's next? I suspect your house is reposessed, you are being stripped of all your assets, savings, car is gone, your credit score goes to zero, and then you start from beginning?
How do you then manage to rent a place to live without a credit score and any money?
How long it takes you to build enough credit score to be able to rent again?
Will you be ever able to build good enough credit score to get a mortgage and be able to buy your own place again?
If another illness in the family happens, it's ll over again, bakrupcy and so on....?

There is another good video on YT:

7. I had tried healthcare.gov, but I tried providing some deatils taken from the net , such as some random house address and random phone number, but it wasn't being accepted. Do you know what else i could do to get some quotes?

@Boliler

yes, I understand it, but just not to try to complicate things, I wanted to discuss the current situation and what it would ll look like , if I was to move there tomorrow.

@Dave 2726

Thank you for that link , I will check it out.

tht
Yes, it could be, especially that these monthly premiums go up by 5% every year, so what was average over $25K in 2020, this year it might be $27K. Aparently there were years these premiums were going up by 8 and 9 %, year on year.

What's HDHP and OPM?

So, lets say, if we take that $2.8 million bill for staying 4 months in hospital and being treated, in your case you would only pay $6350 or $12700?
Wouldn't you have to pay your share, say 20%, 30%, 40%, 50%, of that $2.8 million bill, and the rest your health insurance?

on 6. Yes, I took a look at those plans, but all silver, and even gold, say that for all procedures, your share of medical bill that you have to pay is 30%, so despite paying all these high monthly premiums, I would still have to pay my share, 30% , of that 2.8 million bill? Or am I getting it wrong?

The black young lady in a video I posted earlier, said she have to come up with 20% of that $400K bill for kidney transplant.

civilservant

You're getting confused here. If you end up using an out of network provider, then that means the insurance company does not have a contract with the provider. They cannot honor what doesn't exist. The hospital sends them the bill, they pay what they want to pay, and then you deal with the rest or fight it out with your insurer. Wanting too or not is irrelevant, it is what it is.

The only answer I can give you here is.... yes.

That's why many people in the US do not go to a MD even when they clearly need medical care, and why people die rather than seek treatment. The spectre of being wiped out my a major medical issue is ALWAYS there in the US. These companies exist to deliver profit to their shareholders, NOT for you and your healthcare.

Honestly, it seems like life in the US is not for you if you are irrationally worried about health insurance. It's something we all live with, and all deal with. I work in the medical field, and am CFO of a medical facility. I can tell you that I see, on a daily basis, people who cannot afford care and have been taken to court and had their wages garnished because of it. I also see people that negotiate down and pay their balances. If all comes down to having the means to do so, which is pretty much like everything else in this country. The almighty $ is king.

High Deductible Health Plan and Out Of Pocket Maximum

Olly_

Yes you are getting it wrong because plans have an out of pocket maximum, as soon as you hit that the insurance company will pay 100%.

Some stories you read online could well be pre-ACA when many things changed. There are also new rules about balance billing coming in at a Federal level at the beginning of next year.

civilservant

Often times that does not apply to out of network, which is what most of these stories seem to be talking about.

scrubbedexpat099

People who live here have to make do with what is available and the vast majority do not have the option of moving elsewhere.

I always think the worst position to be in is you have money and do not qualify for the subsidised option but not enough to not care and no Employer backed plan.

Best bet of course it to not need much medical care.

I have always assumed that it will take some sort big bang before anything significant changes.

tht

Yes some plans are very restrictive on providers, mine had out of network, but with a much higher deductible and out of pocket maximum.
so individual / family deductible goes to $10k/$20k
and the out of pocket maximum go to $15k/$30k.

So I guess the worst case is really the $22k premium + $30k, so a total of about $52k gross if 2 of us we to need treatment outside the network in the same year. Of course when you get to that level you are in to itemized deduction territory, so it will reduce your tax bill and the actual net cost will be lower than, but you may still need the cash upfront.

hutchison

we had a $295k bill for my wife's back injury from one hospital alone, UVA Charlotesville, the neurosurgeon care was amazing, but they charge for it .
she just became paralyzed one morning from the waist down, a very rare occurrence. Her care / treatment was as follows; 1 week in ICU, 6hr spinal decompression surgery, and 1 month at a spinal rehab live in center (teach her IF/how to use a walking frame so she could be discharged, etc) which was part of the hospital (so under the one bill as separate line items).

apart from that single Bill for $295k from the hospital - direct - to the insurance company, we had to contract a separate ambulance journey to the hospital, and the out patient care after the hospital (physical therapies once she came home etc), those two other items were separate bills.

All 3 providers bills came to us at different times, while contracting these services they ask for your insurance details (card), the ambulance for example could have well been out of network but luckily it was in network, for the out patient care (home therapy) we of course made sure it was in network.

between IN and OUT of network providers, you run up two separate OOP max (according the terms of your particular insurance and they are all different) . so for example if you paid 4k OOP max IN network and you contracted an OUT of network provider, that OUT of network bill would be considered as separate to your IN network out of pocket max total , (two separate totals, which would build up independently.

our particular company policy is you pay 20% they pay 80% (20/80) with 4k OOP max for in network charges for a 'single person', or 7.5k for in network family.
family cover can be explained as, each individual member within the policy would pay up to a max of 4K before they were covered, up to a combined max 7.5K, so for example the 'other' person(s) may pay 3.5k on top of your 4k, before they also reached full coverage.

OUT of network, for us is 40/60 with 8k single person / 18k family. (after OUT of network OOP is maxed, its also 100% paid by insurance).

I have no experience with 'self-employed' policies, it seems from your research some are not covered 'out of network', but do any exist which cover out of network for self employed?.
and also you have preened that some insurance companies refuse to pay, i'm glad for that and thank you for alerting me!, I will continue to build another fund to cover at least some of this potential costs. (and medical costs in general).

Always a good idea, if at all possible if one of your family members could get a Job with healthcare provided , which can mean subsidized Insurance premium payments.

we have paid out premiums last yr about 4.5k , and paid the OOP max 4k = 8.5k last year on medical. This year we are paying more premium 5.8k and maxed our OOP both years , that's closer to 10k this year, i got have a tooth extracted soon, probably push us to 13k this year.

we were billed randomly this year from an out of network provider which was a neuro-monitoring service during the OP last year!, we contacted the hospital and said we had an agreement everything would be 'IN network' , and that, this Bill is a year late. it was approx $9000 bill, they said they had to contract the OUT of network provider as it was the only service provider that could provide this planned service during the OP and the surgeon deemed it necessary, I respect the surgeon for making that decision, and subsequently, the hospital dropped the majority of the bill but still charged us around $128 or so, we just paid it.

The in network out patient care my wife received after the discharge, which taught her how to walk again, was great!, and according to our policy we had some 60 therapy sessions covered (you need to read the small print in your policies over here, without question for example out patient therapy sessions), however, you still pay 20/80 IN network, and since another policy year for us has elapsed, this out patient care built up another years OOP max.

you need to keep fit over here and not frequent bad heath habits.

Another tip is opening up a HSA account, (health savings account) you can save money pre tax, but you can only use it for medical expenses, otherwise you will pay the tax on it.
I then invest my saved monies (my particular HSA allows me to choose investments within the saved money).

all the while I am paying 20/80 i'm using pre tax dollars, and whats even better is this year we had a 1.5K Bill paid through those investment gains, which are also non taxable

I hope a little helps your understanding.