US healthcare/insurance question

[wathe]

American boardies, please help me make sense of this - it has left me scratching my head.  Reported in NYT today (excerpt),  "Crede Bailey, the director of the White House security office who was hospitalized for months with the coronavirus, had his foot and the lower part of one of his legs amputated as he battled the infection, a friend of his wrote on a GoFundMe page dedicated to his medical bills."

I know that health insurance is often linked to employment in the US.  But does this case make any sense?  Why would a director of the White House security office need a gofundme to pay for medical expenses?  Surely a White House security office director should have insurance through his employer?  Am I missing something here?

[wathe]

I'll add that I know that a lot of Americans are uninsured or under-insured.  But a White House director?  It feels like it doesn't add up and that I'm missing something.

My Canadian family members who work for government have kick-a$$ supplementary insurance plans through their employment (in addition to their publicly funded universal healthcare insurance).

[BusyMom5]

I have no idea what type of insurance he has, but anyone can have a GoFundMe.  There will be a deductible- maybe low, maybe high.  Possibly a co-pay until a maximum out of pocket amount.  It could also be for non-medical expenses, loss of work, a spouse's time off, ect.  I would assume that he has good insurance as a federal employee, and that its just a way to show support and for other non-medical expenses.  

[Tap]

Some insurances have a max out of pocket each year, and some do not. That number can be as high as 5,000-10,000. Since he was in the hospital so long, they could owe many, many thousands in bills for this year, and then next year, all those bills can start over. I assume he would be a  federal employee  and will have multiple insurance options. Lots of people chose lower level insurance plans, which have higher out of pocket costs per year. The fundraiser is also for renovation to his home, and therapies. Not all therapies are covered on insurance.  $50,000 can go very, very quick in that instance.

Just for a simple example....dd22 has both federal insurance (I pay $600/month for my family=not a cheap plan) and she has Tricare. I still pay $500-1000 each month for her treatments, supplements, and medications.  That doesn't include the flights to her specialists and expenses while there!.  

[wathe]

10 minutes ago, BusyMom5 said:

I have no idea what type of insurance he has, but anyone can have a GoFundMe.  There will be a deductible- maybe low, maybe high.  Possibly a co-pay until a maximum out of pocket amount.  It could also be for non-medical expenses, loss of work, a spouse's time off, ect.  I would assume that he has good insurance as a federal employee, and that its just a way to show support and for other non-medical expenses.  

Understood - but the gofundme specifically states  "staggering medical bills", and that's the bit that's left me wondering.

[Spryte]

Yes, even with insurance here, healthcare can be terribly expensive.  We have a high medical needs family, and even with our “platinum plan” it can mean tens of thousands OOP every year. Some years are brutal.  

[Tap]

1 minute ago, Spryte said:

Yes, even with insurance here, healthcare can be terribly expensive.  We have a high medical needs family, and even with our “platinum plan” it can mean tens of thousands OOP every year. Some years are brutal.  

Yep! We have a $5000 out of pocket max.....for my 2 girls that means we sometimes have $10,000 out of pocket for covered expenses.  DD22 was in the hospital for almost a month in 2019. Then she was on 2 months of in-home infusion treatments.  She has hit over $200,000 in billable yearly expenses multiple times in her life.  

Just having insurance doesn't mean the remaining portion isn't staggering!

[melmichigan]

He could have a very good plan and still have co-insurance.  He could have an HMO and have doctors and such that are out-of-network that they won't cover, or cover at a reduced percentage.  He may limitations to his physical therapy and out-patient services that mean those services won't be covered for anywhere the time in which he will require them.  There may be limitations on durable medical equipment for any type of prosthetic.  He also may have received treatment that is considered experimental, and not covered.  The list of possibilities is staggering.

 

Edited December 15, 2020 by melmichigan

[Jean in Newcastle]

Even with a good 80% coverage plan, 20% of a huge bills is still a big amount. 

[prairiewindmomma]

Even with hitting the out of pocket max he can still be responsible for copays for each therapy visit, co-insurances for meds, etc. Out of pocket max isn’t really that anymore.

[Spryte]

7 minutes ago, Tap said:

Yep! We have a $5000 out of pocket max.....for my 2 girls that means we sometimes have $10,000 out of pocket for covered expenses.  DD22 was in the hospital for almost a month in 2019. Then she was on 2 months of in-home infusion treatments.  She has hit over $200,000 in billable yearly expenses multiple times in her life.  

Just having insurance doesn't mean the remaining portion isn't staggering!

Ouch.  It so, so painful.  My copays on medicines for a five year period ran $1800 to $5000 a month.  We had to use our home equity.  And that was with insurance.  
 

I can’t even imagine the bills from Covid-necessitated ICU.  A two night stay, not ICU, relatively simple, last year cost us $4K, for our part, for reference, with the best plan we could get. What on earth would a longer, more intensive stay cost?  It’s staggering.

Edited December 15, 2020 by Spryte

[Tap]

Just now, Spryte said:

Ouch.  It so, so painful.  My copays on medicines for a five year period ran $1800 to $5000 a month.  We had to use our home equity.  And that was with insurance.  
 

I can’t even imagine the bills from Covid-necessitated ICU.  A two night stay, not ICU, relatively simple, last year cost us $4K, for our part, for reference, with the nest plan we could get. What on earth would a longer, more intensive stay cost?  It’s staggering.

Yep. Our healthcare system is phenomenally broke. 

Last year, dd22 had a heart infection. One of her hospital stays was for 7 days. Not ICU, just regular room. IV antibiotics, an echocardiogram, a minor surgical procedure and treatment. Her bill was $50,000 before insurance.  I can not even imagine, the bills for the patients who are in the ICU, and having multiple surgeries/procedures, ventilators, etc. They are probably hitting a million dollars for a few weeks of care.  Thankfully, he would have had insurance to help with the bulk of it, but having a good paying job, doesn't mean people have a big savings account to pay for thier portion of those costs.

[Katy]

His bills are probably in the millions, and depending on the plan selected he could owe anything between 10-50% of that.

[wathe]

I didn't realize that government employee health insurance would only pay for part of hospitalization expenses - I assumed it would pay for all.  Thanks for setting me straight.

Here, hospitalization is paid for 100% by the state for everyone*.  The only things I would pay for out-of-pocket would be "upgrades" - parking, in-room entertainment unit/TV, upgrade to private room etc.  Doctor's fees are also paid for by the state 100%, including outpatient/office doctor's bills (except some very few things deemed not medically necessary, like cosmetic surgery, are billed privately).  I would never even get a bill.

We don't have universal pharmacare in my province (out of hospital) or allied health (physio, dental).  Plans for those expenses are often provided by employers, or paid out of pocket.  They are paid for by the state for over age 65, children under 25 without private insurance, those on disability and on social assistance.

*Canadians who've lived in-province for at least 3 months

ETA - I do pay an awful lot in taxes, though.

 

Edited December 15, 2020 by wathe

[wathe]

Thanks all.  It still seems weird to me that the White House wouldn't look after its own people.  I clearly have a poor understanding of American health insurance.

[livetoread]

9 minutes ago, wathe said:

 It still seems weird to me that the White House wouldn't look after its own people.

Ha, yeah, it's not just our health insurance that's hard to understand.

[Frances]

1 hour ago, wathe said:

I didn't realize that government employee health insurance would only pay for part of hospitalization expenses - I assumed it would pay for all.  Thanks for setting me straight.

Here, hospitalization is paid for 100% by the state for everyone*.  The only things I would pay for out-of-pocket would be "upgrades" - parking, in-room entertainment unit/TV, upgrade to private room etc.  Doctor's fees are also paid for by the state 100%, including outpatient/office doctor's bills (except some very few things deemed not medically necessary, like cosmetic surgery, are billed privately).  I would never even get a bill.

We don't have universal pharmacare in my province (out of hospital) or allied health (physio, dental).  Plans for those expenses are often provided by employers, or paid out of pocket.  They are paid for by the state for over age 65, children under 25 without private insurance, those on disability and on social assistance.

*Canadians who've lived in-province for at least 3 months

ETA - I do pay an awful lot in taxes, though.

 

I’m not sure any insurance here would pay for everything for a hospitalization. I’ve never heard of a health insurance plan here that doesn’t have deductibles and copays. Plus, there’s always the risk that not all doctors caring for you are even part of your health insurance plan. Out of network costs can add up very quickly. I have excellent employer provided insurance for which I pay very little, but I would guess that in a situation like his I would still hit my yearly out of pocket maximum both this year and likely next year as well. We’ve been fortunate to never even come close to it, but I think it is about $5k for our family in network and about triple that for out of network.

As for the White House looking after its own, I would assume he is a federal employee and would have the same insurance options as most other federal employees. Unless some people at the White House wanted to personally pay for his out of pocket health expenses, I don’t think there is a way around having insurance with deductibles and copays. At least he probably doesn’t pay very much for the insurance, as I’m guessing most of it is paid for by his employer, the federal government. Some people here pay thousands of dollars each month for insurance here and still have high out of pocket expenses.

 

Edited December 15, 2020 by Frances

[Tap]

7 minutes ago, Frances said:

I’m not sure any insurance here would pay for everything for a hospitalization. I’ve never heard of a health insurance plan here that doesn’t have deductibles and copays. Plus, there’s always the risk that not all doctors caring for you are even part of your health insurance plan. Out of network costs can add up very quickly. I have excellent employer provided insurance for which I pay very little, but I would guess that in a situation like his I would still hit my yearly out of pocket maximum both this year and likely next year as well. We’ve been fortunate to never even come close to it, but I think it is about $5k for our family in network and about triple that for out of network.

As for the White House looking after its own, I would assume he is a federal employee and would have the same insurance options as most other federal employees. Unless some people at the White House wanted to personally pay for his out of pocket health expenses, I don’t think there is a way around having insurance with deductibles and copays. At least he probably doesn’t pay very much for the insurance, as I’m guessing most of it is paid for by his employer, the federal government. Some people here pay thousands of dollars each month for insurance here and still have high out of pocket expenses.

 

The best insurance I had, was when dh worked for a Japanese company based in Geneva. We only paid a very small premium each month for 5 people. I don't remember the price, but it was well under $300 per month. They wanted us to have a comparable health insurance plan to what they had at the home company. We had a $1000 max for the entire family (including prescriptions) for a year. In network and out of network went toward the same OOP max. Copays were something tiny, like $10 per visit and almost everything was free. I had an appendectomy, was in the hospital for 5 days and never saw a bill. I miss that insurance!!! I can not even imagine what the company paid for that insurance, and for the premium to be so low for us.

Edited December 15, 2020 by Tap

[wathe]

11 minutes ago, Frances said:

I’m not sure any insurance here would pay for everything for a hospitalization. I’ve never heard of a health insurance plan here that doesn’t have deductibles and copays. Plus, there’s always the risk that not all doctors caring for you are even part of your health insurance plan. Out of network costs can add up very quickly. I have excellent employer provided insurance for which I pay very little, but I would guess that in a situation like his I would still hit my yearly out of pocket maximum both this year and likely next year as well. We’ve been fortunate to never even come close to it, but I think it is about $5k for our family in network and about triple that for out of network.

As for the White House looking after its own, I would assume he is a federal employee and would have the same insurance options as most other federal employees. Unless some people at the White House wanted to personally pay for his out of pocket health expenses, I don’t think there is a way around having insurance with deductibles and copays. At least he probably doesn’t pay very much for the insurance, as I’m guessing most of it is paid for by his employer, the federal government. Some people here pay thousands of dollars each month for insurance here and still have high out of pocket expenses.

 

Another concept that's different.  No "networks".  Or, the whole province is my network, I guess.  It all sounds very complicated.  And stressful!

Edited December 15, 2020 by wathe

[GoodGrief3]

It could be a lot of things, including wanting to use providers or therapies that are not in an insurance plan. MANY practitioners do not want to work with government plans, so it is full pay or go elsewhere. For my daughter's mental health care, we wanted to use certain therapists and doctors that opted against participating with our insurance. We also had travel expenses, that sort of thing.

[Frances]

16 minutes ago, Tap said:

The best insurance I had, was when dh worked for a Japanese company based in Geneva. We only paid a very small premium each month for 5 people. I don't remember the price, but it was well under $300 per month. They wanted us to have a comparable health insurance plan to what they had at the home company. We had a $1000 max for the entire family (including prescriptions) for a year. In network and out of network went toward the same OOP max. Copays were something tiny, like $10 per visit and almost everything was free. I had an appendectomy, was in the hospital for 5 days and never saw a bill. I miss that insurance!!! I can not even imagine what the company paid for that insurance, and for the premium to be so low for us.

I’m very fortunate right now to pay less than $50 per year for family health, dental, and eye insurance. My employer pays the majority of insurance costs. I think our in network health deductible is $750 for the family and copays are about $15. I definitely can’t complain at all about my current insurance, but I know most people here aren’t remotely as fortunate in their coverage and costs. I do have to clear everything through my medical home, though, or copays increase. And anything out of network would cost me significantly more. My husband did have outpatient surgery at no cost to us except the $250 deductible which was met at his first appointment with the surgeon. We’ve been fortunate to never have any hospitalizations, so I’m not exactly sure what that would cost us.

Edited December 15, 2020 by Frances

[Frances]

13 minutes ago, wathe said:

Another concept that's different.  No "networks".  Or, the whole province is my network, I guess.  It all sounds very complicated.  And stressful!

That can be both one of the most frustrating and scary parts of insurance here. Frustrating because you can find a doctor you like or need, but they are not in your network. So you either have to find someone else or pay more, sometimes way more out of pocket to use them. Scary because in emergency situations you often don’t think about whether or not every doctor seeing you or reading an X-ray or consulting is part of your network. And there are horror stories about people carefully checking before planned surgeries or procedures, only to find out later that one or more of the doctors involved were not actually in network.

[gardenmom5]

4 hours ago, wathe said:

American boardies, please help me make sense of this - it has left me scratching my head.  Reported in NYT today (excerpt),  "Crede Bailey, the director of the White House security office who was hospitalized for months with the coronavirus, had his foot and the lower part of one of his legs amputated as he battled the infection, a friend of his wrote on a GoFundMe page dedicated to his medical bills."

I know that health insurance is often linked to employment in the US.  But does this case make any sense?  Why would a director of the White House security office need a gofundme to pay for medical expenses?  Surely a White House security office director should have insurance through his employer?  Am I missing something here?

Insurance doesn't cover loss of income of other family members who are taking off to help the ill person.   getting insurance to pay out can be slow. 

(my sil was extremely ill and hospitalized in germany - that was months and months, with dh being dragged in to help her get it sorted out a year later.)

Insurance companies will often refuse to cover things that should be covered.  Or they'll limit how much of it is covered leaving drs, hospitals, and labs sending bills for the difference.  (they're generally not legally allowed to do that - but many do anyway.)

 

[Laura Corin]

1 hour ago, Ordinary Shoes said:

 We used to have worry about pre-exiting conditions, 

 

Macabre typo

[hippymamato3]

10 hours ago, prairiewindmomma said:

Even with hitting the out of pocket max he can still be responsible for copays for each therapy visit, co-insurances for meds, etc. Out of pocket max isn’t really that anymore.

Really? We never pay a cent once we hit our OOP max...which usually happens very early in the year.

[Katy]

9 hours ago, wathe said:

Thanks all.  It still seems weird to me that the White House wouldn't look after its own people.  I clearly have a poor understanding of American health insurance.

It isn't up to the White House.  All federal employees (except congress, senate, and the VP & president themselves) have the same federal health care options.  The strange thing is that federal government health plans are generally much better than what is available to the rest of the country. 

23 minutes ago, hippymamato3 said:

Really? We never pay a cent once we hit our OOP max...which usually happens very early in the year.

They may be mixing up deductible and OOP max.

[Scarlett]

I really like our plan through dhs work.  $3000 deductible per person, $6000 per family. Once we meet deductible the plan pays 100% with the exception of a small co-pay for expensive meds like dh's blood thinners.   For dh, myself and his 2 adult sons the premium cost to us is 240 bi-weekly (half of that is for the spouse--employer pays for dh's premium 100% --and the other half is the boys)  and that includes dental insurance.  It is a very simple and 'clean' plan in that we know we will spend $3000 a year on dh and after that we don't have to worry.  

Of course in the case of a catastrophic situation there are A LOT of expenses like lost wages for the patient and spouse who cares for patient, travel etc.

[Splash1]

I have a very medically expensive child.  On her initial hospitalization for her rare disease her PICU stay for 35 days and all the testing was over $1,000,000  the there were the ongoing medical expenses.  Her infusions every two weeks are about $84,000 and she's been doing these since 9/2012.  We have excellent, top tear insurance.  Our out of pocket max is $5000 once all the deductibles are met.  Every year we pay out approximately $10,000 in medical expenses then for the rest of the year we are covered at 100%.  We often have to fight to get things paid and it is exhausting but eventually it does get paid.  Then there are the other costs like transportation, lost wages, food that you need to eat out since you're not home,  My daughter's drug company refers you to an organization that helps with medication costs (her medication was/is the most expensive medication in the world at time of diagnosis) and if you qualify you get help paying copays up to certain dollar amount.  Then there are the therapies, and the evaluations, tests,   It honestly just goes on forever.  

I'd also guess that the people starting the go fund me page are trying to help.  The medical bills are staggering and you panic thinking they will bankrupt you. It actually takes a bit of time for it to all process.  Also a lot of people have very large copay and deductible plans.  My husband's company offers those with a health care savings account.  We don't opt for those type plans since we have ongoing medical expenses that make the lower deductible and out of pocket plans more appealing.

[sweet2ndchance]

9 hours ago, Frances said:

I’m not sure any insurance here would pay for everything for a hospitalization. I’ve never heard of a health insurance plan here that doesn’t have deductibles and copays.

It may have changed as this was almost 20 years ago now but when my then-infant daughter had meningitis and was hospitalized in a civilian hospital for several days, Tricare paid the entire bill, both the ER visit and the hospitalization in the PICU. We didn't pay anything out of pocket.

After we were out of the military, we also had an Aetna federal employees plan that paid for a hernia surgery and several ER visits, one that required a 24 hour stay, completely. No out of pocket costs.

My current dh is disabled and on state insurance and required brain surgery a little over a year ago. We didn't have to pay anything out of pocket for it but it did take a lot of making sure all the bills were submitted correctly and to the correct department and all other kinds of headache inducing legwork to get it all squared away and paid for by his insurance.

Dh's grandma is a mail carrier and has federal employee insurance and when I was helping her sort out the bills from her double knee replacement, the only thing she paid for out of pocket for was out patient rehabilitation. They would have 100% paid for in patient rehab but she had to pay a deductible on out patient rehab. And she refused to do in patient even though it would be paid for. It was weird.

Maybe we are the exception, or we've just been lucky, but there is insurance out there that pays 100% for hospitalizations.

[YaelAldrich]

From what I read because of his amputations, he's going to have to renovate much of his home and get a car that will allow him to drive in addition to the medical expenses that his family will incur.  I feel for him; especially since he is still a fan of the administration that helped our country to this very point.

[73349]

Medical debt is a primary cause of bankruptcy in the US.  (I saw an article the other day that said that GoFundMe is now effectively one of the US's top medical "insurance" companies in terms of the number of people who rely on it. IDK about accuracy.) Actually being in the hospital costs most Americans thousands of dollars a day--you are charged for the room, charged by each doctor, charged for lab work and imaging, charged (with a huge markup) for each dose of medicine and IV bag and bandage and... insurance doesn't cover anywhere near all of it.

In our household, we have comparatively good employer-sponsored insurance from DH's job (at a Fortune 500 company). As required by law, basic check-ups (1 annual visit, a mammogram for me, childhood vaccinations) are included. It costs us several hundred dollars a month, + we have an annual deductible of... I want to say $6k (might be more), and it still only pays 80% of most costs after that. This doesn't include dental care (separate insurance) or vision (separate insurance, and we spend a few hundred dollars a year per person for glasses).

Not all practices accept our insurance, but most do; if I want to see someone who doesn't, I think we're on the hook for 100% of the cost. Rural/small-town residents are at a disadvantage because they might not have anyone nearby who accepts their insurance.

I spent one night in the emergency room in 2016 (with different insurance) and it cost us twelve thousand dollars after the insurance paid their part. I did not get a correct diagnosis, only enough tests to make sure I didn't need surgery or anything.

By the way, Americans: If you need to buy non-employer-sponsored insurance for 2021, do it TODAY--it's the deadline in many states. https://www.healthcare.gov/apply-and-enroll/get-ready-to-apply/

Edited December 15, 2020 by Carolina Wren

[scholastica]

10 hours ago, wathe said:

Another concept that's different.  No "networks".  Or, the whole province is my network, I guess.  It all sounds very complicated.  And stressful!

Stressful is right! I feel like I have PTSD from dealing with insurance over the years with four kids. Any time someone needs out of the ordinary care, I have major anxiety/small panic attacks  over how it will go with insurance now and what we will have to pay. And I understand how it all works! I’m having a devil of a time explaining it to my 23 yo.

[wathe]

This has all been very eye-opening.  Thanks again, everyone.

[J-rap]

I agree that health insurance and other related expenses can vary a lot.  For example, we have really great insurance that covers a broad network including specialists 100% -- but only after reaching the $13,500 yearly deductible, which we meet every year.  We build that into our budget.  That's apart from any dental care, eye care, etc.  

It generally does NOT cover any adaptive devices except for the most basic, like a wheelchair.  It would NOT cover any home remodel, even if that remodel is necessary - like a roll-in shower or handicapped ramp, or any railings and handles needed in order for him to try and live independently.   So if the person in the original OP is requiring the home to be adapted to adjust to his needs -- nope, that will all be out-of-pocket.

[wathe]

1 hour ago, Katy said:

It isn't up to the White House.  All federal employees (except congress, senate, and the VP & president themselves) have the same federal health care options.  The strange thing is that federal government health plans are generally much better than what is available to the rest of the country. 

They may be mixing up deductible and OOP max.

Federal employees here have really, really great supplementary insurance as part of their benefits package.  I don't know why I assumed the US would be similar.  Clearly I have no idea!

[Laura Corin]

6 minutes ago, wathe said:

Federal employees here have really, really great supplementary insurance as part of their benefits package.  I don't know why I assumed the US would be similar.  Clearly I have no idea!

I don't know how Canadian salaries compare to US ones, but I've always assumed that many UK salaries can be lower because the individual post-tax liability for health care expenses is so small: living in Scotland, I pay out of pocket for glasses (but not periodic eye tests), and at a highly-subsidised rate for dental treatment (but not check ups).  I also choose to pay for physiotherapy privately because I want to get quick treatment in order to maintain my level of fitness as I age; I could wait for NHS physio.

Edited December 15, 2020 by Laura Corin

[wathe]

6 minutes ago, Laura Corin said:

I don't know how Canadian salaries compare to US ones, but I've always assumed that many UK salaries can be lower because the individual post-tax liability for health care expenses is so small.

No Idea.  From what I read on this board, it would seem that teachers are much better paid here.  I get the sense that quality of life, and what's affordable and what isn't for most people is similar (other than health-care, obviously!)

Quality of life might not have been the best word choice.  I mean general affordability of life-style.

Edited December 15, 2020 by wathe

[Laura Corin]

6 minutes ago, wathe said:

No Idea.  From what I read on this board, it would seem that teachers are much better paid here.  I get the sense that quality of life, and what's affordable and what isn't for most people is similar (other than health-care, obviously!)

There are a couple of sets of data here:

https://en.wikipedia.org/wiki/List_of_countries_by_average_wage

 

[Happy2BaMom]

1 hour ago, sweet2ndchance said:

It may have changed as this was almost 20 years ago now but when my then-infant daughter had meningitis and was hospitalized in a civilian hospital for several days, Tricare paid the entire bill, both the ER visit and the hospitalization in the PICU. We didn't pay anything out of pocket.

After we were out of the military, we also had an Aetna federal employees plan that paid for a hernia surgery and several ER visits, one that required a 24 hour stay, completely. No out of pocket costs.

My current dh is disabled and on state insurance and required brain surgery a little over a year ago. We didn't have to pay anything out of pocket for it but it did take a lot of making sure all the bills were submitted correctly and to the correct department and all other kinds of headache inducing legwork to get it all squared away and paid for by his insurance.

Dh's grandma is a mail carrier and has federal employee insurance and when I was helping her sort out the bills from her double knee replacement, the only thing she paid for out of pocket for was out patient rehabilitation. They would have 100% paid for in patient rehab but she had to pay a deductible on out patient rehab. And she refused to do in patient even though it would be paid for. It was weird.

Maybe we are the exception, or we've just been lucky, but there is insurance out there that pays 100% for hospitalizations.

We are on Tricare Select (non-HMO version of Tricare, due to where we live). DH is retired military and he also worked for the federal gov't for several years, so I'm familiar with health care options we had available.

Both Tricare & most state/federal insurances offer far more comprehensive care than what is available to people through their employer or on the open market. But even Tricare has changed a lot. We pay a premium now every month, and for an in-network hospital, we have to pay either $250/day or 25% of hospital charges, PLUS 25% of all separately billed services. God help us if we can't get to an in-network hospital, as then daily charges go to $1,035.

I've never heard of a private insurance company paying 100% of hospitalizations, or, if there are, I can't imagine what the monthly premiums are. A friend of mine and her husband (they are each self-employed) pay $1,400 / month in premiums for a health care plan that covers most services at 75%. Another friend of mine needed surgery last year and some f/u care. It was cheaper for him to fly his family of four to Costa Rica and stay for a week, pay out of pocket for the surgery, and fly home than it was to pay his portion of expenses for his US-based insurance.

Edited December 15, 2020 by Happy2BaMom

[wathe]

4 minutes ago, Laura Corin said:

There are a couple of sets of data here:

https://en.wikipedia.org/wiki/List_of_countries_by_average_wage

 

Interesting.

I suspect our wage range is narrower, though - low wage earners a better paid, high wage earners less.  I don't have a any data to back that up, it's just a general impression

[Laura Corin]

2 minutes ago, wathe said:

Interesting.

I suspect our wage range is narrower, though - low wage earners a better paid, high wage earners less.  I don't have a any data to back that up, it's just a general impression

That might be so.  These data are for income rather than salary, but would tend to agree with that idea:

https://en.wikipedia.org/wiki/List_of_countries_by_income_equality

[wathe]

Generally replying to all:

Things like time off for care givers and home renos and special cars wouldn't generally be paid for by health insurance here either (although sometimes they can be) .  But I got the sense from the gofundme page that ICU bills and other direct medical expenses were "staggering" in this case, and that prompted my question.

US health insurance is way more complicated than I realized, with huge gaps in coverage apparently.

 

[hjffkj]

Medicaid is the only option if you want 100% coverage but then your stuck in a low paying job if you want to keep that Medicaid.  When we were growing our family dh actually asked his employer not to give him a raise once because I was pregnant and it would have disqualified us for Medicaid by $10.  Then we wouldn't have been able to afford insurance and would have had to pay for all my care out of pocket.  Even if we could have afforded the monthly premiums the deductibles would have been so high we would have still been paying a large chunk of it.

[hjffkj]

2 minutes ago, wathe said:

Generally replying to all:

Things like time off for care givers and home renos and special cars wouldn't generally be paid for by health insurance here either (although sometimes they can be) .  But I got the sense from the gofundme page that ICU bills and other direct medical expenses were "staggering" in this case, and that prompted my question.

US health insurance is way more complicated than I realized, with huge gaps in coverage apparently.

 

yup

[Scarlett]

1 minute ago, hjffkj said:

Medicaid is the only option if you want 100% coverage but then your stuck in a low paying job if you want to keep that Medicaid.  When we were growing our family dh actually asked his employer not to give him a raise once because I was pregnant and it would have disqualified us for Medicaid by $10.  Then we wouldn't have been able to afford insurance and would have had to pay for all my care out of pocket.  Even if we could have afforded the monthly premiums the deductibles would have been so high we would have still been paying a large chunk of it.

This happens a lot sadly.  Thankfully you were smart enough to foresee that.  

I have friends, the husband who has a very very bad heart and should certainly be disabled who continues to work in order to have insurance coverage even though that insurance has not covered enough to keep them from having to move in with her mother.  The wife works too and his medical needs are all consuming.  Her sister has tried to talk to her about just letting him go on disability and then they would qualify for our very low cost with good coverage state insurance.  I suspect the life insurance he has through his group plan is another thing that keeps him working.  But at this point they will be so in debt if he dies it won't be near as beneficial to her as they probably hope.  Although I guess life insurance proceeds are not subject to the debts of the deceased.  I think.

[73349]

12 minutes ago, hjffkj said:

Medicaid is the only option if you want 100% coverage but then your stuck in a low paying job if you want to keep that Medicaid. 

And Medicaid, though a federal program, is very hard to qualify for in some states.

Here's the chart for qualifying in North Carolina: https://files.nc.gov/ncdma/documents/files/Basic-Medicaid-Eligibility-Chart-2020.pdf

[hjffkj]

4 minutes ago, Carolina Wren said:

And Medicaid, though a federal program, is very hard to qualify for in some states.

Here's the chart for qualifying in North Carolina: https://files.nc.gov/ncdma/documents/files/Basic-Medicaid-Eligibility-Chart-2020.pdf

Oh I know.  It is ridiculous.  We have been fortunate that the two states we've lived in DE and MD, have been relatively easy to qualify.   No asset limits and because of our family size the income limit is pretty high.  It actually allowed dh to switch careers last year.  We didn't have to worry about him taking a pay cut because it was still enough to live off of since we qualified for Medicaid so didn't need to factor in insurance premiums.  

 

[73349]

1 hour ago, wathe said:

No Idea.  From what I read on this board, it would seem that teachers are much better paid here.

Tangentially--A lot of people point out that the US education system spends more money per pupil than most, but I think that would cease to be true if the American system didn't have the cost of health insurance for teachers/staff/admins included.

[73349]

I've been coughing for months. After not getting successful treatment from other doctors, last week I contacted an ENT's office and got an appointment in only two days. I felt like I'd won a prize.

I've heard a few stories of Americans overseas being shocked at how easy it is to get health care. In one of the videos on Dr. John Campbell's youtube channel, he interviewed someone who had injured his knee and needed it looked at while somewhere in Asia (Taiwan, maybe?). So the man went in to see a doctor, who told him he'd need an MRI. The American was like, okay, how do I arrange that? Obviously he was thinking it would be a few weeks and a significant sum and a provider on the other end of town. But the doctor answered patiently, You go back down to the first floor, and they do the MRI, and then you come back up here to me. Oh.

There's a story I saw I think on Twitter of an American woman who was concerned about a breast lump while she was working temporarily in Denmark. She asked at work how to get in to see a doctor. Um, walk into the clinic across the street and tell them what's going on. But, like, what about a referral? And an appointment? And how much do I pay up front? You can get an appointment if you really need to be seen at a certain time instead of waiting your turn if someone else is being seen... but... you can just walk in there right now. Without money.

Kind of mind-blowing.

Edited December 15, 2020 by Carolina Wren

[wathe]

4 minutes ago, Carolina Wren said:

I've been coughing for months. After not getting successful treatment from other doctors, last week I contacted an ENT's office and got an appointment in only two days. I felt like I'd won a prize.

I've heard a few stories of Americans overseas being shocked at how easy it is to get health care. In one of the videos on Dr. John Campbell's youtube channel, he interviewed someone who had needed his knee looked it while somewhere in Asia (Taiwan, maybe?). So the man went in to see a doctor, who told him he'd need an MRI. The American was like, okay, how do I arrange that? Obviously he was thinking it would be a few weeks and a significant sum and a provider on the other end of town. But the doctor answered patiently, You go back down to the first floor, and they do the MRI, and then you come back up here to me. Oh.

There's a story I saw I think on Twitter of an American woman who was concerned about a breast lump while she was working temporarily in Denmark. She asked at work how to get in to see a doctor. Um, walk into the clinic across the street and tell them what's going on. But, like, what about a referral? And an appointment? And how much do I pay up front? You can get an appointment if you really need to be seen at a certain time instead of waiting your turn if someone else is being seen... but... you can just walk in there right now. Without money. Kind of mind-blowing.

Wait times can be a problem here (usually for more chronic issues), and referrals are needed for specialists (there is gatekeeping).  There is definitely griping about that.  For example, you would wait a long time for an MRI of your shoulder for rotator cuff problem, or for back pain without neurological deficit.  But, once you access the service, (MRI, specialist etc), it costs nothing out of pocket.  Cataract surgery, joint replacement surgery - those all have long waits.

Truly acute issues get handled quickly.  If you get emergency sick (appendix, ruptured aneurysm, trauma), you get very well cared for immediately, at no cost OOP.

If you get very sick sub-acutely (say, cancer) you get care, in a timely fashion, no cost OOP.

Semi-acute but not very sick (say grumbling gallbladder, but not acute cholecystitis) do tend to wait.

Preventive and primary care are also no cost OOP, and access is very good for most people (there are provider shortages in some more rural and remote communities).