OK, I know many of you are from the US and so I'm putting this question out there to help me understand your medical system. Where do you get insurance? How much does it cost? What happens if you end up sick and don't have insurance? Do you have to pay out of your pocket for medical care? What if you need a surgery and don't have coverage... then what? I've thought a lot about the differences between your health care system and what we're accustomed to here in Canada but I'll admit, I'm confused about it and hoping you guys can enlighten me
You can either purchase it through an insurance company, or through your employer (in this scenario usually the employer and employee are actually splitting the cost of the insurance), or some employers pay for health insurance for their employees. There's also Medicaid (provided by the government) which is free (or rather, paid for by taxes) and covers medical expenses for people with low income. I had Medicaid when my girls were younger and the only thing I had to pay for was $1 for prescriptions. Then there's Medicare, which is similar to Medicaid, but instead of providing coverage for low income families, it's for seniors with any income. Many seniors have supplemental insurance in addition to Medicare. ExplainMedicare.com. It depends on age, gender and other health factors. Women generally have to pay much more than men since pregnancy and especially the resulting birth costs so much. We pay a little over $1000 a month for health insurance for our family of five. We actually have 2 plans... one for my husband and children and one for me. Each of our plans have a $2800 deductible, which means that the first $2800 of medical expenses are paid for by us, then 100% of medical costs (visits, surgeries, prescriptions, etc.) are paid beyond that each year. Last year, when I had my gallbladder removed, was the first year since we first got health insurance in 2007 that our medical expenses were more than our deductible. You do have to pay out of pocket, however a hospital/emergency room cannot deny care to anyone who has a life threatening emergency. I'm not sure, but I think emergency rooms have to see everyone who comes in. Then those people are sent a bill. If the surgery is necessary and you don't have health insurance and/or the means to pay for the surgery, you will receive the surgery and then be sent a bill. The hospital will work out a payment plan with those people based on their incomes and expenses. If the surgery is not necessary, and you don't have health insurance, you will need to pay for the surgery up front. I have a friend who does not have health insurance, and he is saving up to pay for surgery on his shoulder.
$1000 a month??? Dear Lord!! That would sink me and fast. How on earth do people pay for it when the economy is as desparate as it is? I suppose that's where medicaid comes into play? So the deductible of $2800, starts with the first time you seek medical attention and you pay for expenses up to 2800 for the year (which includes prescriptions)... anything beyond that is covered by the insurance company? Are you guys able to claim your medical expenses on your tax returns? What prompted me to ask this question was a couple things actually: 1) As I've been studying, my texts continually refer to early medical intervention and in many cases in the US, it doesn't seem to happen because of the costs encountered for seeking out medical attention (prenatal care comes to mind, etc) 2) I have a very close friend who used to serve in the US Armed forces. His career as a paratrooper ended when, on his final jump, he landed on rocks making a mess of his back. No surgery was ever done at the time to fix the problem. When he was forced to medically retire, he was given a total run around by the DVA... "oh we have you listed as dead, prove you are who you say you are", etc. After fighting with them for months, he let them win and gave up going through all their jargon. He lives with the pain every day of life but he continues to work around it when he can (he just completed a 4 week job in January working 60 hours a week without a day off but he paid dearly when he got back home). He recently went to the hospital because the pain in his back was astronomical (the very fact that he went to see a doctor at all tells me something wasn't right... he NEVER goes to the doctor). They did x-rays and the doctor said he didn't understand how he is able to walk (yeah right, he had been working like that for 20 years now). They sent him home with pain meds. He does need to have surgery to remove excessive amounts of scar tissue around his spine and repair his vertebrae but I know he doesn't have medical insurance. What an awful feeling that must be... knowing you need to have a major surgery and knowing you can't afford to have it done (he isn't working because of the state of the economy and how it has affected the construction industry). I have another friend who I went to school with who also served in the US forces and is medically retired as well. He's in a position to help the first friend receive the benefits he should be entitled to from the DVA but he's all but given up fighting with them... how sad the way your vets past and present are treated (that's a whole other topic for another thread). Here in Canada, we pay higher taxes but everyone is entitled to the same healthcare (even those who make hundreds of thousands of dollars annually are still entitled to free health care). We have what looks like a debit card that we present the hospital when we need medical care... it doesn't cost out of pocket. Some treatments which aren't deemed as essential (like circumcisions (in some cases), abortions, etc) do cost the patient out of their pocket. We pay out of out pockets to see a dentist or optometrist. The down side to our system is a longer wait to see specialty medicines (although, you are seen on an urgent need basis... the more urgent you are triaged at, the sooner you are seen). I really can't complain a whole lot about waits though... anytime we've needed to see a specialist, we've gotten in fairly quickly for which I am very thankful.
You have a lot of folks in the middle that can't afford the $1000 a month and make too much to qualify for Medicaid. Medicaid is mostly for low income children and pregnant mothers anyway. And if you do use Medicaid you typically don't get to see a doctor unless there is some issue the regular practioner doesn't deal with. Also Medicaid users can be treated as ignorant. In other words, Medicaid is low-class health care. Oh, and that $1000 a month is on top of all the expenses you pay each time you visit the doctor. I had great insurance through an employer and a well-baby check-up used to cost over $100. I've used both Canadian and US Healthcare systems. I'm still trying to get used to going to the doctor without thinking about how much we have to pay. Medical out of pocket costs are different for each country too. An ER visit without insurance in the USA can cost thousands. My son had an ER visit in Canada last year before he received his medical card. He had many tests, was hooked up to an IV, and was seen by many doctors and the bill was only a couple hundred and they didn't require payment before they helped my son. Dentists and optometrists cost much less in Canada too. I visit the dentist for a check-up for my daughter every few months. They don't do much, but they only charge about $25. And they even waived that cost one time because we had to wait. Now if you want to talk about the cost of food, then Canada is way more expensive. But for medical care Canada wins.
Yep. That's how it works. Some medical expenses are tax-deductible, but not all. It's very, very, very rare for a woman to be denied Medicaid if they are pregnant. The income level for that is significantly higher than the income level for regular Medicaid. The same is true for children: my children are on Medicaid, though DH and I don't qualify. He and I could get insurance through his work for $350 a month. But it's not worth it to us. We put $300 in an HSA (health savings account) instead. It won't be enough if we have a catastrophic illness like cancer, but it is more than enough for anything routine can't afford at the time. Though, usually we still pay out of pocket (meaning we don't take anything out of the HSA). I think I can count on one hand the number of doctors visits we've had between us (not counting for pregnancy) in the last 10 years. But when one has to pay out of pocket, one is more inclined to take care of oneself (researching and looking for home-remedy-type cures).
Huh? I'm not following... I had Medicaid for a few years and I never had an issue seeing whichever doctor I wanted to see. If I needed to see an ENT, I called and scheduled the appointment. If I wanted to switch doctors, I did it like anyone else without anything beyond the usual hassle of transferring records. Sadly, this is 100% true.
Medicaid patients are often seen by doctors in training or NP or Midwives and only see the doctor when their regular practitioner refers them. I've seen it that way in two states anyway. I used to do Medicaid billing and I worked with Medicaid and non-Medicaid clients the same way. But it isn't always that way.
<Can you see the wheels in my brain working over time?> What if you don't qualify for some kind of insurance (I'll use Actressdancer as an example while I try to explain myself lol) and you end up with diabetes or some other long term health care issue? And I think of my dh and I as I say this... he has been a diabetic for 14 years (a non-compliant one at that) and has been seen by multiple specialists because of it. When he was in an accident 8 years ago and saw 21 different doctors (I kid you not) and was in the hospital for 5 1/2 weeks... I can't imagine what I would have done if I had been given a hospital bill for that one :shock: Speaking of which... what happens if I go to the US, have no coverage, I need to be treated in the emergency room for a serious illness, I'm sent a bill but choose not to pay it? What do they do in those cases (I'm sure thy must run into it along the lines)?
It's OK. Even though I am not an advocate for universal health care, I think are system is pretty screwy. You will pay out of pocket. Chances are, your DH would try to be declared disabled, in which case Medicare comes into play. It's a long drawn-out process that usually takes years, but it's worth it to get the medical bills paid. Then again, he wouldn't be allowed to work more than a few hours a week (being disabled and all), so there are gobs of other issues that come in to play. They sue your socks off. Some hospitals are better than others at working with people on a payment plan, but I had that happen 15 years ago. I was an on-campus college kid with no car and no job. I had to visit the ER (I actually could have seen a regular doctor, but they I would have had to pay up front... which is why our ER's are over-crowded: deferred payment). When I got the bill and I tried to set up a payment plan, they turned down my offer of $50 a month. They would take no less than $100. I sent $50 checks and told them that's all I could afford and they sent my checks back uncashed. Two years later I was in court. I had to borrow money from three relatives to pay the settlement.
Don't go to the US without travel insurance. If you have a pre-exisiting medical condition is it very difficult to find insurance and if you do find it it is very expensive. Lots of people go into great debt and some go bankrupt due to medical debts.
The cost of food here alone is absolutely unreal... it's the very reason why people don't eat a healthy diet and then end up with the diseases and disorders that they have requiring them to be in the hospital or requiring frequent medical interventions. It has been my experience (from a nursing perspective) that we admit people into our hospitals for 'minor' illnesses when by comparison in the US, I understand that people are MUCH sicker when they go to the hospital (or so I've been reading anyway). In Canada, I'll be the first to admit that we tend to run to the doctor a lot more than what we probably need to. I remember as I was growing up, having cotton balls and some kind of ear drop put into my ears when I had (frequent) ear infections... Mom didn't run us to the doctor all the time (my brother and I took turns with cotton balls, one week it was him, the next it was me). Now people get an infection and rather than try the tried and tested remedies from years ago, off to the doctor they go.
Not sure if it's the same but if you offered a payment to someone you owed a debt to here and they refused the payment suggesting it wasn't enough, they consider it paid if it ever landed itself in court I would never do that anyway... I just wondered what they do in those cases. On a good note, my dh just got his benefits from work... THANK GOD !! Here I am reading how much you guys pay for your isurance and we fret over the cost of our prescriptions each month (which are high for a one income family)... someone kick me please :lol:
Not the same here. They can demand a minimum payment (businesses can, not individuals, I don't think, but I am not certain). Embassy mentioned another important point: pre-existing conditions. :roll: A friend of mine was diagnosed with HIV after getting insurance through work. After years on that insurance, the company went out of business. He had to find new insurance, but couldn't... his HIV was now a pre-existing condition. And if you have one, even something like diabetes, it's pretty much impossible to get insurance coverage.
Canadians don't know how good they have it. I've heard many complain about the costs of prescriptions or dental care. I had a relative post all over Facebook that she was so upset because she didn't have insurance for a few months. I asked her why she didn't have the provincial health card. She does. She was just talking about prescription drug and dental coverage from her husband's job. I've noticed that doctor's offices aren't as nice here in Canada though. Waiting rooms aren't as nice. Rooms to see patients in are smaller.
Me, too. We're in that lovely group of people who can't afford healthcare but don't qualify for medicaid. My kids have state insurance, but it leaves a lot to be desired. Even docs will tell you they'd get better care on Medicaid. I have nothing... I don't go to the doctor. I had to go two years ago, but waited so long (coul't stand the pain any longer) it took two rounds of antibiotics to clear up an ear infection. I went to a low-income minor medical clinic and saw an NP. Other than that, I haven't been since my post-delivery check -up with dd7. I had insurance then.
Well there is MediCAL, MediCAID, and MediCARE ( which is for older folks). I was on MediCAl while pregnant w/ dd#1 , we made , as a married couple, just over $10,000 a year after taxes. mediCAL paid 100% of everything. With dd #2 , dh had a great job with benefits and we paid $200 a month for medical/dental and everything was 100% paid after dect. of $500.00 , co-pay was $10 doctors. Now we pay $400 a month ( before taxes) , yearly cap of out of pocket is $3000.00. We have a PPO not an HMO and love it. Our monthly payment includes, dental, health, vision, life ins., mental health help, free lawyers ( if we need to sue or someone sues us) and a few other add ons. My mom has 0 health ins but her doctors charges $20 for a visit and give her free heart meds (samples) and her other 2 medication fall under Walmarts $4 fill. Her doctor is great and I know other doctors that do this. When she needed dental implants they gave her a 0 interest rate and a low monthly payment ($100.00) and waived alot of fees. I have paid cash for dentists and I was up front when I came in and said I have no insurance , not a lot of money , I know I need work, can you help me out? @ said no, 3rd said yes and we were with her for over 10 years ( until we moved out of state). If you ask and shop around you can get fees waived and hospitals around here also have charities set up to help pay for needed surgeries.
ABSOLUTELY !! We are spoiled in a sense and I'll admit it. We have high costs each month for prescriptions but the majority of it (my dh) it's because of non-compliance that led to the need for more medications. I was diagnosed on November with diabetes and I've been busting my gutt to lose weight, to get my blood sugars back under the radar and hopefully live that way for a very long time. I didn't want to be on meds (and still don't) BUT I'm not liking a blood sugar in the 7 and 8 range (while that isn't high, long term it will lead to damage and right now it's high enough that I feel like trash when theyre up like that).
That's true, too. There is a doctor here who can charge as little at $25 for a visit. How does he do it? He refuses to take insurance. Accepting insurance is VERY costly for a physician. Which, of course, drives up costs. Now, this guy is just one guy and he doesn't do any testing (like blood work), etc. He also gives out a lot of samples. People like him are going to be uber busy if the MO lawmakers have their way. They are trying to require a prescription for cold and allergy medicine!!!
Um. As a Canadian I know we have it good. I wouldn't want to have a system that makes us pay for everything. I also know that alot of Canadian employers work hard to make sure the extras get covered by health coverage through an independent insurance company. That means when DH is working we only pay $25 a year per person for insurance to cover dental. Dr visits are free~ downside we have a Dr shortage they all left to the States for better pay
and quicker access to the meical technology they need in order to accurately diagnose the issue at hand
