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US health insurance

Old Aug 6th 2021, 2:04 pm
  #61  
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Default Re: US health insurance

Originally Posted by John123456
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So I will pose a question for you: why would anyone in their right mind leave the NHS to come to the US knowing they were ill?
Because contrary to the propaganda that Brits routinely buy into, the NHS is not in fact the "envy of the world" and literally no country in the world is looking to adopt the NHS as their healthcare system of choice.

The primary benefit of the NHS is that it's free at the point of use for anyone who is covered, which is hardly something that the NHS has been able to uniquely achieve - there are many countries in the world that are able to offer the same to their residents.

Probably the biggest drawback of the NHS, at least in my personal experience, is that it doesn't really matter if it's "free" if you have to wait for months and months before you can be referred to a consultant, or if a drug or therapy that might benefit you is licensed in the UK yet not funded by the NHS. It's a very good system if you need critical or emergency care and the treatment that the NHS will provide you in the event of a heart attack or a road traffic accident will not be markedly different to what you would receive in the US or in any other advanced economy, but you start to see the real problems with the NHS if you need secondary care, or if you have to be referred to any sort of specialty that isn't politically sensitive enough to benefit from adverse media attention and high levels of funding; dermatology and mental health are the two specialisms that spring to mind as being especially problematic.

The US of course is the very antithesis of the NHS where you can get pretty much anything and everything your doctor wants so long as you have the ability to pay for it, and if you have good insurance in the US then the treatment that you'll be able to receive will be night and day compared to the NHS.

I would in fact flip your question around and ask why anyone in their right mind would want to go back to the NHS if (and I know that this is a massive if) they have access to the healthcare system here in the US and the insurance coverage necessary to utilize it without bankrupting themselves?

This is of course a problem when you retire and no longer have access to such things like employer-funded PPOs, but that doesn't really negate the main thrust of what I'm getting at here.
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Old Aug 6th 2021, 2:13 pm
  #62  
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Default Re: US health insurance

Originally Posted by John123456
To simplify it even further, lets just say I got a green card, valid for 10 years, with full work permit, and I am going to be landing in the US next week.
Hopefully, this thread will not only help me, but will help other people in the future too.

Thank you
Then your next big investigation should be into how work visas and green cards are obtained and how they interrelate, as it appears your understanding is somewhat sketchy.
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Old Aug 6th 2021, 2:21 pm
  #63  
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Default Re: US health insurance

Originally Posted by John123456
I would prefer not to be adding type of visa into the mix.
Before posting, I spent many hours over the last month or two, reading various threads on this forum, and I could see how quickly these threads turn into slamming matches, and go quickly off topic, especialy when it comes to healthcare topics, and I would want to avoid it here.
A lot of people have been asking some very reasonable questions, unfortunately they have very quickly been forced to abandon their therads as answers they were being given were not answering questions they were asking.
To simplify it even further, lets just say I got a green card, valid for 10 years, with full work permit, and I am going to be landing in the US next week.
Hopefully, this thread will not only help me, but will help other people in the future too.

Thank you
If as you say you already have the green card you either did AOS while living here (on another status) or came with an immigrant visa and became a PR when you landed.

So you are already a PR living here, so do you not have health insurance ?
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Old Aug 6th 2021, 2:22 pm
  #64  
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Default Re: US health insurance

Originally Posted by TexanScot
Because contrary to the propaganda that Brits routinely buy into, the NHS is not in fact the "envy of the world" and literally no country in the world is looking to adopt the NHS as their healthcare system of choice.

The primary benefit of the NHS is that it's free at the point of use for anyone who is covered, which is hardly something that the NHS has been able to uniquely achieve - there are many countries in the world that are able to offer the same to their residents.

Probably the biggest drawback of the NHS, at least in my personal experience, is that it doesn't really matter if it's "free" if you have to wait for months and months before you can be referred to a consultant, or if a drug or therapy that might benefit you is licensed in the UK yet not funded by the NHS. It's a very good system if you need critical or emergency care and the treatment that the NHS will provide you in the event of a heart attack or a road traffic accident will not be markedly different to what you would receive in the US or in any other advanced economy, but you start to see the real problems with the NHS if you need secondary care, or if you have to be referred to any sort of specialty that isn't politically sensitive enough to benefit from adverse media attention and high levels of funding; dermatology and mental health are the two specialisms that spring to mind as being especially problematic.

The US of course is the very antithesis of the NHS where you can get pretty much anything and everything your doctor wants so long as you have the ability to pay for it, and if you have good insurance in the US then the treatment that you'll be able to receive will be night and day compared to the NHS.

I would in fact flip your question around and ask why anyone in their right mind would want to go back to the NHS if (and I know that this is a massive if) they have access to the healthcare system here in the US and the insurance coverage necessary to utilize it without bankrupting themselves?

This is of course a problem when you retire and no longer have access to such things like employer-funded PPOs, but that doesn't really negate the main thrust of what I'm getting at here.
I don't dispute any of this, the care can indeed be excellent here -- but to return to my original question in response to the OP's hypothetical, would you really up sticks to the US if you knew you were ill, and had to start navigating an unfamiliar system when feeling vulnerable in the first place? You know how tenuous employment can be here, and for someone to show up and then want a leave of absence -- while remaining on the company insurance no less -- sounds like a stretch. In addition, many, many people do not have access to the US healthcare system through their employment. I've been self-employed for the last thirty years and have always funded my own coverage. But I'm lucky, in that I could afford to do so.
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Old Aug 6th 2021, 2:43 pm
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Default Re: US health insurance

I understand the OP wanting to understand as much as possible about the health system. It is ridiculously complex. Unfortunately you will only gain an overall grasp and never be able to anticipate all the problems. Comparison of policies is impossible because there are just too many options. You ask for real life examples. Here's mine.

I was diagnosed with prostate cancer and had daily radiation treatment for 190 days. The cost every day was over $1,000.
On my insurance I am responsible for the first $2,500. I then pay 25% co-pay from $2,501 to $6,000 i.e $875. So the total I paid that year, and the maximum any year, is $3,375. Everything else was paid by my insurance and was well over $200,000 that year.
That is just one example on my employer's policy. Other policies will be different.

I also know someone who had sudden heart issues and the medical costs in that year were over $1m. She paid around $6,000 and everything else was covered by her insurance.


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Old Aug 6th 2021, 3:22 pm
  #66  
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Default Re: US health insurance

"All these what-ifs sound as if the person coming to the US was already aware of their medical situation. So I will pose a question for you: why would anyone in their right mind leave the NHS to come to the US knowing they were ill?"

I moved here with a chronic and expensive illness, moving away from the 'safety net' of the NHS. With a decent job and good employer insurance, managing my illness is affordable and the level of care I get is far superior to the NHS. Even with deductibles and Max OOP being met, I still pay less in tax (including the max OOP as a 'tax'), than I did in the UK.
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Old Aug 6th 2021, 3:31 pm
  #67  
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Default Re: US health insurance

Originally Posted by Winston_the_Great_Dane
"All these what-ifs sound as if the person coming to the US was already aware of their medical situation. So I will pose a question for you: why would anyone in their right mind leave the NHS to come to the US knowing they were ill?"

I moved here with a chronic and expensive illness, moving away from the 'safety net' of the NHS. With a decent job and good employer insurance, managing my illness is affordable and the level of care I get is far superior to the NHS. Even with deductibles and Max OOP being met, I still pay less in tax (including the max OOP as a 'tax'), than I did in the UK.
My daughter’s school friend was diagnosed with a rare, aggressive type of cancer when she was 16. When she died 3 years later her parents were $250,000 in debt. Both parents worked with good healthcare insurance. Debt over healthcare costs is the #1 cause of bankruptcies in the US.

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Old Aug 6th 2021, 4:45 pm
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Default Re: US health insurance

Originally Posted by Winston_the_Great_Dane
"All these what-ifs sound as if the person coming to the US was already aware of their medical situation. So I will pose a question for you: why would anyone in their right mind leave the NHS to come to the US knowing they were ill?"

I moved here with a chronic and expensive illness, moving away from the 'safety net' of the NHS. With a decent job and good employer insurance, managing my illness is affordable and the level of care I get is far superior to the NHS. Even with deductibles and Max OOP being met, I still pay less in tax (including the max OOP as a 'tax'), than I did in the UK.
You moved to be with a USC spouse, I believe. Rightly or wrongly, I see that as a different circumstance from someone moving their family and positing that the breadwinner pretty much immediately take a leave of absence of indeterminate length. Glad it worked out for you, though!
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Old Aug 6th 2021, 6:49 pm
  #69  
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Default Re: US health insurance

Originally Posted by Jerseygirl
My daughter’s school friend was diagnosed with a rare, aggressive type of cancer when she was 16. When she died 3 years later her parents were $250,000 in debt. Both parents worked with good healthcare insurance. Debt over healthcare costs is the #1 cause of bankruptcies in the US.
That is just immoral. You couldn't even begin to imagine how broken those parents must have been. It would be enough to make most people stick two fingers up at the US and catch the next plane out.
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Old Aug 6th 2021, 7:56 pm
  #70  
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Default Re: US health insurance

In reading this thread, I think that there is a fair amount of fiction in Medical billing.

I found this article in today’s Los Angeles Times of interest.
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Old Aug 6th 2021, 8:14 pm
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Default Re: US health insurance

Originally Posted by Nutmegger
You moved to be with a USC spouse, I believe. Rightly or wrongly, I see that as a different circumstance from someone moving their family and positing that the breadwinner pretty much immediately take a leave of absence of indeterminate length. Glad it worked out for you, though!
I moved over with my USC spouse from the UK. Neither of us had jobs to go to and i'm the primary earner as my wife was looking after our two small children. It did work out well for us and i'm aware of others who have fallen into the very unfortunate scenario of burdensome medical costs. My point is that while the NHS provides a safety net, the quality of healthcare is streets apart. I would never advocate an NHS style system in the US, but I agree there needs to be fewer gaps in the US system.

When I first moved here i was working a consultancy job and self-financing the healthcare - that was expensive indeed. Had to find a proper job to cover the healthcare premiums (or at least 80% of them).
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Old Aug 7th 2021, 12:00 am
  #72  
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Default Re: US health insurance

Originally Posted by Jerseygirl
My daughter’s school friend was diagnosed with a rare, aggressive type of cancer when she was 16. When she died 3 years later her parents were $250,000 in debt. Both parents worked with good healthcare insurance. Debt over healthcare costs is the #1 cause of bankruptcies in the US.
Another bit of anecdotal information; my good friend's mother just had a heart-attack, and numerous visits / stays in hospital before dying soon after. Her mother was over-65 and therefore covered by medicare, but they saw bills nonetheless (bills they didn't have to pay). This series of incidents over the course of just a few weeks was billed at around $265,000. My g/f just had eye surgery (for retinal detachment). The whole process, start to finish, was less than 2 hours in the hospital (plus a few pre- and post-consultations). She's over 65 also, and covered by medicare, so doesn't have to pay, but the bills we've seen so far add up to $46,000 - and we don't think that's the end of it. I had a false-alarm heart-attack back in 2014; I had a bunch of tests, nothing conclusive, but it did include 2 nights in the hospital. The bill (paid for by my insurance) was over $50,000.

In all three cases, who knows what the actual payments were by the insurance companies; in the US, medical 'billing' seems to be a work of fiction, with little bearing on what is actually paid. It reminds me of the bartering you hear about in some countries in the markets ...
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Old Aug 7th 2021, 12:12 am
  #73  
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Default Re: US health insurance

Originally Posted by MidAtlantic
I understand the OP wanting to understand as much as possible about the health system. It is ridiculously complex. Unfortunately you will only gain an overall grasp and never be able to anticipate all the problems. Comparison of policies is impossible because there are just too many options. You ask for real life examples. Here's mine.

I was diagnosed with prostate cancer and had daily radiation treatment for 190 days. The cost every day was over $1,000.
On my insurance I am responsible for the first $2,500. I then pay 25% co-pay from $2,501 to $6,000 i.e $875. So the total I paid that year, and the maximum any year, is $3,375. Everything else was paid by my insurance and was well over $200,000 that year.
That is just one example on my employer's policy. Other policies will be different.

I also know someone who had sudden heart issues and the medical costs in that year were over $1m. She paid around $6,000 and everything else was covered by her insurance.
Those sounds like very representative numbers. My g/f had breast cancer around 20 years ago, and had surgery, radiation, etc. The bills we saw were mind-boggling (I can't recall the numbers now) but she had good insurance through her work and only paid a few thousand, like yourself.

The 'deductible' and 'maximum out of pocket' are the things to watch out for, as well as the rules relating to in- vs out-of-network. I'm now in early-retirement, not yet covered by medicare, and having to pay high premiums for my policy (not benefiting from a company-provided policy). My deductible is in the region of $8,000 and my max out-of-pocket is something like $15,000. And my premium is circa $800/mo (which I get a subsidy for, since I'm not earning). I'm counting the days till I reach 'medicare' age when things will get much cheaper. One good side-effect is - I pay great attention to my health!
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Old Aug 8th 2021, 7:48 pm
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Default Re: US health insurance

Originally Posted by MidAtlantic
I understand the OP wanting to understand as much as possible about the health system. It is ridiculously complex. Unfortunately you will only gain an overall grasp and never be able to anticipate all the problems. Comparison of policies is impossible because there are just too many options. You ask for real life examples. Here's mine.

I was diagnosed with prostate cancer and had daily radiation treatment for 190 days. The cost every day was over $1,000.
On my insurance I am responsible for the first $2,500. I then pay 25% co-pay from $2,501 to $6,000 i.e $875. So the total I paid that year, and the maximum any year, is $3,375. Everything else was paid by my insurance and was well over $200,000 that year.
That is just one example on my employer's policy. Other policies will be different.

I also know someone who had sudden heart issues and the medical costs in that year were over $1m. She paid around $6,000 and everything else was covered by her insurance.
When you were diagnosed with prostate cancer, were you still able to go to work, to be able to earn some money to meet your expences, and to keep your company health insurance paid?
If I understood it correctly the whole treatment lasted only 190 days ? after those 190 days of treatments, daily radiaitons, the prostate cancer was gone and never returned?

The person you knew who had these sudden heart issues, how did she deal with not being able to go to work and making sure her insurance premiums were being paid?
Was she able to work as normal, or had some time off work?
Did she have a short or long term disability insurance that paid her wages while she was not able to work?

If I am not mistaken short or long term disability insurance only covers 60% of your wages, and long term disability insurance only kicks in after 90 days of you being off work, am I right?

Thanks
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Old Aug 8th 2021, 7:55 pm
  #75  
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Default Re: US health insurance

Originally Posted by Jerseygirl
My daughter’s school friend was diagnosed with a rare, aggressive type of cancer when she was 16. When she died 3 years later her parents were $250,000 in debt. Both parents worked with good healthcare insurance. Debt over healthcare costs is the #1 cause of bankruptcies in the US.
I've read around half a million people , every year, go bankrupt because of unpaid medical expenses.

How was that possible, if her parents had good healthcare insurance? I thought you only needed to pay your yearly copays, deductibles, out of pockets, and the rest is being covered by your health insurance?
Her parents worked, so obviously she all the premiums , copays, deductibles, and out of pockets were being paid, and they still were left with $250K debt?
I'm confused now.
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