Health Insurance In America

How much does health insurance cost in the US?

This comes as no surprise to me. I think universal health care would be a wonderful thing for the American people. I used to work in health care in the United States and the misconceptions I encountered over Canada's universal heatlh care were rather disturbing. However, I must concede that Canada's health care needs some major revisions. The care itself is excellent. It's the cost, the waiting times and the increasing work load on health care workers, especially physicians that has degenerated. Before I left to work in the USA, I would have said all of this was not a huge factor. But today it is a key concern. I blame much of it on the government and how they handle budgets and taxes. The current provincial government is more concerned with big business and the wealthy than it is with its citizens. Future generations will pay for this and the repercussions are already being felt. But I'm getting off topic here. I would fully endorse universal health care in the USA for a number of reasons. I think HMO's - Health Maintenance Organizations - spend far too much money on administrative costs. Having everything under one umbrella would help reduce the paper waste. As it is right now, there are an estimated 15% of Americans without health care insurance. Can you believe that???? I have encountered individuals like this. They make enough to live off of but not enough to afford insurance. (i.e. the working poor) And what happens when they are sick? They will not go to see a physician unless their situation makes it unavoidable. And anyone in health care can tell you that it costs less to treat an individual at the beginning of the disease process than when they have gotten to the point of no return. Prophylactic health care is the most cost effective means. But this will never happen under the current health care system in the United States.


To Wilso, I can't answer the question of what the cost of medicare and medicaid are per year (these are both American government funded health care insurance programs for the elderly, the disabled and those with low income) but I do know the fee my American employer paid for me was $158.55 per month for an HMO. But keep in mind that was in the year 2000, and the cost for a single individual. I know family plans are more and I know the fees have gone up since 2000.

There are so many variables, Wilso, that it is very difficult to answer your question.

It depends on your age, the amount of deductible you're willing to pay, whether your employer offers a HMO or PPO plan or you have to get an individual policy (VERY pricey), how many people in your family are covered, etc. etc.

I can give you my family's costs, if it will help you get a handle on this. (I had to pull the file for this. It is very involved.) My husband and I are 50 & 49 respectively, and we have a 9-yr-old son who is also covered under my husband's employer's plan. The company he works for is part of a multi-national corporation, so it has a "good" corporate plan. I am self-employed, so my insurance is far cheaper if I am listed as a "dependent" on his plan.

We pay a $167/month payroll deduction PLUS:
--a $300/person calendar year deductible
--a $25 co-pay for each doctor visit
--a $30 co-pay for each prescription (more if drug is not on "preferred" list)
--10% of all charges related to inpatient hospital services, outpatient surgical services, family planning services, bone scans, MRIs, CT scans, cardiac stress tests, PET scans, ultrasounds, physical therapy, speech & hearing therapy, ambulance charges, emergency room charges, and durable medical equipment
(There is more fine print, but it gets even more tedious!)

We have a $6,000/family maximum annual out-of-pocket total, after which the insurance is supposed to automatically pick up all costs. (This is frequently disputed, however.)

In addition, the PPO (Preferred Provider Organization...similar but not quite as restrictive as HMO, "Health Maintenance Organization") has a list of participating doctors and hospitals/clinics from which you must choose, or face higher co-pays and percentages. The PPO also has a list of "preferred" drugs, and we pay higher prescription costs for medications not on their list.

Like I said, it is very complicated. Does this give you any idea, Wilso? How does it compare with medical expenses in Australia?

I pay 369 per month. I have no deductable and pay 15 per office visit, and a lowered rate for prescriptions. It astounds me that I have to pay for anything beyond the 369/month.

The lack of some sort of national health insurance is a scandal. I'm glad there is now evidence that it's in our financial best interest to have it.

If Bush really wanted to make an impact, he'd come up with such a plan. Instead he advocates for marriage as the solution for all social ills, and a flight to Mars. It's pathetic...

Eva-great basics you laid out there...one thing you forgot---what percentage do you pay, and what % does the employer pay?
See Wilso--its all mad, really.
I deal with this from the employer end so, believe me....Id rather poke myself in the eye than broker out the new contract every year.
More in relation to Wilso so as to give him a look where he might be if he were here:
Im late 30's, single and pay 20% of my insurance which is 154/mo, I have one of the better plans (Blue Cross PPO) with only a $5.00 co-pay for doctor visits, $25.00 copay for Emergency Services, and a variable rate for prescriptions based on Generic and/or acceptable drugs on the plan.
My employer--pays 1800/mo for 4 employees (2-Single 2-Family) to have this plan available for us.

Medicare is a tangled web. There is part a & Part b, and your own insurance, if you still have that, plays a roll as well....I would only give basics and leave the actual details to someone who works with it everyday. Or wait.. bet theres a website! That could confuse you completely!

www.medicare.gov

good luck

Quinn...the employer pays 60%, we pay 40%. Ours is a Blue Cross Blue Shield PPO, too, but our terms are different so apparently each company cuts their own deal. OMG, you have to negotiate all this as part of your job?! I'd rather spend the afternoon in a dentist's chair!

Oh, and Wilso...every year companies have to negotiate a new health care plan, and it always means we get less benefits for more money. Always. Because health care costs keep going up.

And BC and BS bumps my health premium up by 15-20% each year.

littlek...are you not self-employed? Do you have an individual policy with BCBS, or do you get group rates through your bank, savings & loan, or other organization? I am always curious how people outside Corporate America manage to get coverage.

Dys and I are waiting for the bill for his emergency care when he had his stroke. I fear we will both have strokes when it arrives.

Forgot to mention that he has NO health care insurance.

I am not considered self-employed. I am considered in-home help. I have an individual policy from BCBS. Getting coverage is easy, paying for it is tough.

Diane, he's got medical insurance right? Please tell me he has coverage....

No, littlek. The hospital said that they cut the bill by 50% for those who have emergency treatment, but it has to be paid in full a month after the bill arrives.

If you don't hear anything from us for a long time, you'll know we're on the lam to Mexico.

holy guacamole! What about indigent status?

I pay $88 a month for family alberta government health care through work, this is covers most necessary health care, hospitals, tests, ect. Ambulances, prescriptions, eye care, dental, some medical procedures, some tests, phsycological, massage, physio, chiropractic and other procedures are covered by another health insurance company at about $125 a month.
I have to pay a small deductable on prescriptions and other service fees, ect, but I think most of that can be used against your taxes.
I don't pay a user fee to most general practitioners but I would with some specialists.

ooooohhh, my premiums don't cover dental, won't buy me a hearing aid, and only pay for one eye exam between the ages of 20 and 40.

So, what's the down side Ceili? Is there any?

Boy, oh boy. I wish I could get hamburger to come in and post right now.
Diane, he was so concerned when he read about dys leaving the hospital because of the cost involved (well, partly, but you know). He couldn't imagine having to base a decision on medical care on the cost. Well, maybe he could remember what it was like before we had OHIP (Ontario Hospital Insurance Plan) here, but that was a long, bad, time ago.

Even though things are clearly not perfect with Canada's medical system, you do know that you will get treatment when you need it, and not have to consider the cost very much. Often the only thing your private plan is looking at in terms of hospitalization is whether you're going to private or semi-private.

My work plan costs less than $40.00 Cdn per month. No cost to see a doctor, no deductible or co-pays for most meds, it's pretty much just upgrades from the public coverage available to all permanent residents, landed immigrants and citizens.

The big downside to our government plan is that if you have to be hospitalized somewhere else, OHIP will only cover what they would pay here. I often see hospital bills in excess of $6,000 U.S./day when people are in U.S. hospitals following accidents (room/meds/surgery/docs/x-rays etc.)- and OHIP reimburses about $200 of that. It's one of the reasons we'll often pay to air ambulance people back to Canada for treatment - the overall cost will be cheaper.

Is there any offer of travelers' insurance?

Ceili, I'd also like to know if there is a downside.

I've heard stories of Canadians coming to the States for medical care. Do you know why or if that really happens?