How good is medical coverage in the USA
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Join Date: May 2022
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How good is medical coverage in the USA
Hello guys,
Canadian here strongly considering moving to the USA.
One of the considerations (and a huge one at that) is just how good is medical coverage in the States? Would you guys care to elaborate on what the plans are, how much they cost and what they cover?
A company I would like to work for is Atlas, so I would be interested to know what the medical coverage is for that company is, in particular.
Any info appreciated.
Canadian here strongly considering moving to the USA.
One of the considerations (and a huge one at that) is just how good is medical coverage in the States? Would you guys care to elaborate on what the plans are, how much they cost and what they cover?
A company I would like to work for is Atlas, so I would be interested to know what the medical coverage is for that company is, in particular.
Any info appreciated.
Join Date: May 2015
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I immigrated to the US from Canada. I have great coverage with my airline. I pay $450 USD per month for a family plan.
The healthcare is much better in the US if you have good insurance. Little to no wait times and the facilities I’ve been in are much nicer. Going to an urgent care clinic you’ll be seen almost immediately.
What you will find confusing is all the “network “, copay, deductibles etc.
I pay $20 per visit to a doctor. I have a $200 deductible. There’s strange things with each plan. If I book certain things through other companies I can avoid the deductible. It’s a mystery at times.
My plan offers an FSA which means I can have additional payroll deductions on pre-tax income which I can then use with a special debit card to pay the copays and deductibles. Most plans will offer an HSA or FSA.
Once you get past the initial confusion I think you’ll prefer the higher quality service.
I used to live in Quebec and it was awful for healthcare.
The healthcare is much better in the US if you have good insurance. Little to no wait times and the facilities I’ve been in are much nicer. Going to an urgent care clinic you’ll be seen almost immediately.
What you will find confusing is all the “network “, copay, deductibles etc.
I pay $20 per visit to a doctor. I have a $200 deductible. There’s strange things with each plan. If I book certain things through other companies I can avoid the deductible. It’s a mystery at times.
My plan offers an FSA which means I can have additional payroll deductions on pre-tax income which I can then use with a special debit card to pay the copays and deductibles. Most plans will offer an HSA or FSA.
Once you get past the initial confusion I think you’ll prefer the higher quality service.
I used to live in Quebec and it was awful for healthcare.
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I immigrated to the US from Canada. I have great coverage with my airline. I pay $450 USD per month for a family plan.
The healthcare is much better in the US if you have good insurance. Little to no wait times and the facilities I’ve been in are much nicer. Going to an urgent care clinic you’ll be seen almost immediately.
What you will find confusing is all the “network “, copay, deductibles etc.
I pay $20 per visit to a doctor. I have a $200 deductible. There’s strange things with each plan. If I book certain things through other companies I can avoid the deductible. It’s a mystery at times.
My plan offers an FSA which means I can have additional payroll deductions on pre-tax income which I can then use with a special debit card to pay the copays and deductibles. Most plans will offer an HSA or FSA.
Once you get past the initial confusion I think you’ll prefer the higher quality service.
I used to live in Quebec and it was awful for healthcare.
The healthcare is much better in the US if you have good insurance. Little to no wait times and the facilities I’ve been in are much nicer. Going to an urgent care clinic you’ll be seen almost immediately.
What you will find confusing is all the “network “, copay, deductibles etc.
I pay $20 per visit to a doctor. I have a $200 deductible. There’s strange things with each plan. If I book certain things through other companies I can avoid the deductible. It’s a mystery at times.
My plan offers an FSA which means I can have additional payroll deductions on pre-tax income which I can then use with a special debit card to pay the copays and deductibles. Most plans will offer an HSA or FSA.
Once you get past the initial confusion I think you’ll prefer the higher quality service.
I used to live in Quebec and it was awful for healthcare.
Thanks for the reply! I know you tried to pm me but I guess my inbox is full even though it’s totally empty (wtf pprune?), so I can’t see your message unfortunately.
If you want, you can sent it to me via email and I will reply.
best regards,
Alex
Join Date: Mar 2024
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Hello guys,
Canadian here strongly considering moving to the USA.
One of the considerations (and a huge one at that) is just how good is medical coverage in the States? Would you guys care to elaborate on what the plans are, how much they cost and what they cover?
A company I would like to work for is Atlas, so I would be interested to know what the medical coverage is for that company is, in particular.
Any info appreciated.
Canadian here strongly considering moving to the USA.
One of the considerations (and a huge one at that) is just how good is medical coverage in the States? Would you guys care to elaborate on what the plans are, how much they cost and what they cover?
A company I would like to work for is Atlas, so I would be interested to know what the medical coverage is for that company is, in particular.
Any info appreciated.
For example: Technological advancements in the US healthcare system, and the Affordable Care Act (ACA), etc.
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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.
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.
The thing to watch out for is there is huge variability between insurance plans - even employer supplied insurance plans. Some employers will give you an option of several different plans (usually with significant differences in the employee contribution to the cost).
If you're young and relatively healthy, you may want to gamble on a lesser coverage plan with a significantly lower employee contribution, but as you get older (or if you have pre-existing conditions) you'd be well advised to get the best plan available.
Do research on the company health plan offering(s). Ask around - current employees are usually the best source of information on their experiences with a health plan.
There were a lot of things not to like about working for Boeing, but their health insurance options were first rate (with a very low employee contribution).
25 years ago -at the ripe old age of 42 (
) I had a heart attack while traveling on company business. I didn't even know it at the time (just felt lousy) - finally going to the doctor after I returned home. Long story short, doctor quickly diagnosed that I'd had a heart attack, had an ambulance take me the one block to the hospital (never mind the actually problem had occurred 3 days on 2,500 miles earlier), angiogram the next day confirmed complete blockage of one cardiac artery, another ambulance ride to a hospital capable of heart surgery, angioplasty and a stint the next day, released to go home the day after that, treadmill and pronounced completely healthy 10 days after that.
Total out of pocket? Just over $100
Oh yea, the type of blockage and resultant heart attack are known in the medical community as "The Widow Maker"
I was lucky in more ways than one...
If you're young and relatively healthy, you may want to gamble on a lesser coverage plan with a significantly lower employee contribution, but as you get older (or if you have pre-existing conditions) you'd be well advised to get the best plan available.
Do research on the company health plan offering(s). Ask around - current employees are usually the best source of information on their experiences with a health plan.
There were a lot of things not to like about working for Boeing, but their health insurance options were first rate (with a very low employee contribution).
25 years ago -at the ripe old age of 42 (
) I had a heart attack while traveling on company business. I didn't even know it at the time (just felt lousy) - finally going to the doctor after I returned home. Long story short, doctor quickly diagnosed that I'd had a heart attack, had an ambulance take me the one block to the hospital (never mind the actually problem had occurred 3 days on 2,500 miles earlier), angiogram the next day confirmed complete blockage of one cardiac artery, another ambulance ride to a hospital capable of heart surgery, angioplasty and a stint the next day, released to go home the day after that, treadmill and pronounced completely healthy 10 days after that.Total out of pocket? Just over $100
Oh yea, the type of blockage and resultant heart attack are known in the medical community as "The Widow Maker"
I was lucky in more ways than one...
If you are a well compensated professional health care in the US is great.
Except that coverage is essentially tied to the employer, and if there is a reason for being not employed the costs are breathtaking. The other factor is, under the present system, don't get used to a doctor. The insurance companies shuffle which practices and hospitals they work with and the practices seem mostly managed by health care management corporations who are leaning on doctors to bring in that sweet, sweet, insurance cash and any doctor not able to get through 25 patients a day (or so) just isn't cutting it and either the practice will be kicked out of the corp or the doctor will.
A side example: you go to get a blood test. Great - your doctor is part of your insurance network. They send that out to a lab. Bad news - the lab is not part of your insurance network. Your $50 co-pay visit now has a $3000 lab test cost. Make enough noise and the doctor may eat that difference or work out some other deal, but for the time being that $3000 is sitting in your lap as medical debt.
And even if your doctor concludes that only one, specific medication will be the correct one, your insurance company can deny the claim for it. They may recommend some other similar drug, perhaps one that you were already on and did not work, but they will pay for that. It's easy for a drug price to be $10 with insurance and $5000 without.
Except that coverage is essentially tied to the employer, and if there is a reason for being not employed the costs are breathtaking. The other factor is, under the present system, don't get used to a doctor. The insurance companies shuffle which practices and hospitals they work with and the practices seem mostly managed by health care management corporations who are leaning on doctors to bring in that sweet, sweet, insurance cash and any doctor not able to get through 25 patients a day (or so) just isn't cutting it and either the practice will be kicked out of the corp or the doctor will.
A side example: you go to get a blood test. Great - your doctor is part of your insurance network. They send that out to a lab. Bad news - the lab is not part of your insurance network. Your $50 co-pay visit now has a $3000 lab test cost. Make enough noise and the doctor may eat that difference or work out some other deal, but for the time being that $3000 is sitting in your lap as medical debt.
And even if your doctor concludes that only one, specific medication will be the correct one, your insurance company can deny the claim for it. They may recommend some other similar drug, perhaps one that you were already on and did not work, but they will pay for that. It's easy for a drug price to be $10 with insurance and $5000 without.
