Health care in the US is outstanding unless you go for a bargain basement health care plan. Some employers offer just one plan others offer multiple plans. It is incumbent on you as "the consumer" to be familiar with the terms.
There are several general types of plans, and terms to know:
"Deductible" : This is the amount you need to get to before the plan pays anything. If you have a $500 deductible, that means you need to spend $500 out of pocket before the plan picks up anything.
"Out of Pocket Maximum" : This is the amount that once you meet, you pay nothing. If you have a $4000 max OOP, once you get to $4000, you pay nothing after that.
"In Network" : A health care provider that has "preferred standing" with the insurance company, and thus your coverage pays more.
"Out of Network" : One that doesn't. You wind up paying more.
"Co-pay". The cost split you owe out of pocket. Some times its a percentage split, like 80/20 (or some other combination), your insurance pays 80% of the "reasonable and customary" cost, you pay 20%. Sometimes it's a minimum like $15 per visit.
Common plan types:
PPO - Preferred provider. These are generally "traditional" insurance plans. Low deductibles & OOP, broad list of "in network" providers, good coverage overall. Generally don't need referrals to see a specialist, just pick one out of the phonebook and go. Relatively high premiums.
HSA - "Health Savings Accounts" plans. Roll the dice. These plans would be better characterized as "catastrophic care" plans. Very high deductibles, high OOP, and they may have narrower provider lists. They do let you place money (and your employer may actually contribute to) in a health savings account, which are very tax advantaged, that you can use for health care needs. You need to race to fill the HSA account before you need to use it or prepare to pay out of pocket. The money carries over, so if you think you can eat high costs the first year, you might be able to make it work. Lower premiums, so obviously employers like favor these plans. Young healthy people love these plans because they're cheap, and the money in the HSA goes in tax free, grows tax free and can be withdrawn tax free. If you can make it a couple years without using it, you can get a large balance going that will grow forever.
HMO - "Health maintenance organization" plan. Low deductibles and low OOP, but very restrictive on their network, and often times you are restricted to using ONLY locations in their network otherwise it can be all out of pocket. Super low premiums, but can get expensive quickly.
There are other variations.
Overall, availability is really good, but it's subject to your location and the type of plan you have. In a PPO plan, with a good network can get an appointment with a primary doc in a day or so, and some specialists within a week or two. I say some because some are in demand out of proportion to their utility. Dermotologists are notorious for having silly wait times for appointments (6 months for the "good" ones). Cardiologists, urologists and other "ordinary" specialists, wait times are just a few weeks if that. These are times for an "average" suburban area, and will go up or down depending on population density.
Imaging and tests are zero problems as there's practically an imaging place on every street corner. X-ray, CTs, ultrasounds all the way to high resolution MRIs are booked just a few days out, if not next day. More complicated stuff will take longer. Routine prescriptions are zero problems, and there is a pharmacy practically in every grocery store, and insurance covers the vast amount of it. Sure, they charge co-pays, but it's often a token amount, like $10 or something. More complex stuff is going to depend strongly on your plan.
Some people who can afford it get a "concierge" plan. The doctor only has maybe a hundred patients and the clients pay $2-3k a year. But you get same day appointments and the Dr's cellphone number. Plus they know how to grease the appointments with the specialists and are dialed into the good ones.
Overall, the big takeaway is the quality of your plan. The good ones pay more and are less hassle to deal with. The cheap ones are exactly the opposite. You need to be more responsible, motivated & proactive for your own health needs, but the flip side is the wait times are not what they are in other places.
Last edited by NuGuy; 27th Mar 2024 at 19:30.