Help - USA Healthcare for Dummies!

TeaBagMania

Hmmm, sounds just like obamacare, and how’s that system working out in Ireland?

Just wait a few years it’s only going to get worse, they have their foot in the door and that means we pay more and more with each passing year. Just like we did with Medicare tax

I take it the E100 and E75 are co-pays?

iusedtoknow

TeaBagMania wrote: »

Hmmm, sounds just like obamacare, and how’s that system working out in Ireland?

Just wait a few years it’s only going to get worse, they have their foot in the door and that means we pay more and more with each passing year. Just like we did with Medicare tax

I take it the E100 and E75 are co-pays?

no, they are not copays. It is the charge you have to pay to access emergency care or talk to your doctor. There is no such thing as a co-pay in the medical sector in Ireland unless you have private health care.

You can generally claim it back in your taxes at the end of the year. If you are on medical card then you do not have to pay it.

The USC is a tax that came in to shore up the funds when Ireland had to be bailed out by the EU. It ensured continuity of free socialized healthcare for all citizens. It's a sliding scale, the more you earn, the more you pay.

But you have to remember that Ireland is for the most part a democratic socialist country where the healthcare and social safety net are well thought of my most of the citizens.

TeaBagMania

So you pay your USC then pay XXX Euros when you see the doctor, sounds suspiciously like a co-pay

Is the USC compulsory (like obumercare) or can you opt-out?

When my friends lived in Ireland there was a 6 month wait for an MRI, well, unless you paid for the “special supplemental insurance” then you went to the front of the line. I sign of things to come for us

él statutorio

TeaBagMania wrote: »

So you pay your USC then pay XXX Euros when you see the doctor, sounds suspiciously like a co-pay

Is the USC compulsory (like obumercare) or can you opt-out?

When my friends lived in Ireland there was a 6 month wait for an MRI, well, unless you paid for the “special supplemental insurance” then you went to the front of the line. I sign of things to come for us

This was most likely private health insurance.

iusedtoknow

TeaBagMania wrote: »

So you pay your USC then pay XXX Euros when you see the doctor, sounds suspiciously like a co-pay

Is the USC compulsory (like obumercare) or can you opt-out?

When my friends lived in Ireland there was a 6 month wait for an MRI, well, unless you paid for the “special supplemental insurance” then you went to the front of the line. I sign of things to come for us

It's mandatory.

As for the MRI...in certain cases that is true - but when I had a seizure in the middle of the street one day, i was in hospital and had a MRI within 2 hours of getting in the door of a public hospital as part of diagnosis. If there is any danger to life or dire medical need (ie cancer etc) then the full force of the medical system will be behind you - with the maximum out of pocket in 12 months being E1000 for everyone.

dave2pvd

caveatemptor1 wrote: »

So myself and my husband are moving to the US on L1a and L2 Visa very shortly. I have to admit that there are so many small cultural nuances that I don't understand and any help would be fantastic.
In particular, Im a bit bogged down in trying to understand healthcare. We are covered under his company's insurance scheme for medical, dental and optical. From what I understand, here are the terms for medical care:

- PPO scheme: Employee + Dependants coverage
- Hospital In and out-patient: 100% after deductible (80% (non-network))
- Out of pocket maximum: $3,000/individual - $6,000/family (Network)
- Deductible: $ 1,500/individual - $4,000/family (Network)
- Co-insurance: 100% (network) – 80% (non-network)
- Prescription drug: in network (i.e. coverage table)

Can anyone enlighten me as to what all of this means! Ive done a bit of googling and I think PPO is that you can choose any doctors from within the insurance company network. Other than that, im still in the dark!

Also, Im confused as to how it all works then if Im honest. In Ireland, we have a GP who refers you to other doctors. In the US, is this the case or do you have a series of doctors? A dermatologist, sports medicine for injuries, gynecologist for contraception, dentist, hygienist etc?
Its amazing how difficult it can be to find really simple, straightforward information but its fundamental information we need to understand!

Thanks in advance for any help!

caveatemptor1,

First off, that's a really good looking healthcare plan.

I've had to vet quite a few offers my company has had over the years. When you see the low deductible and 100% coinsurance details, you're being offered a pretty comprehensive medical plan.

Some points:
* Copays DO count toward deductibles now. Thanks Obama.
* If you have to go out of network, or your insurer refuses to cover something 100%, negotiate. I recently worked my physio bill down to 22% of the original because that's what the insurer had been reimbursing the practice.
* What does the plan above cost? Is it fully covered? For both of you? I doubt it. My plan is similar. My company pays in $500/mo. I pay ~$100. And I'm the only one covered.
* If you are contemplating having a kid, get AFLAC first. First, as in before pregnancy. It can amount to paid short term disability, and voila, more maternity leave for you.
* Vision and dental will be a different plan, but possibly the same provider. Dental is good for covering routine and preventative, but beyond that it can be a mixed bag. I'm billed ~50% of any procedure.
* Research hospitals, medical practices, emergency care centers, specialists, etc. There's fantastic healthcare in many cities in the US (note: cities), but there's also some really crappy patient care. even at the big, well known hospitals.
* Your US healthcare may not cover you when abroad. Supplemental insurance is a good idea for such travels.
* Obamacare has made for lots of angry old white guys. Anger has a detrimental effect on a person's health and well being.

All I can think of for now, I'll add to the list as new ideas come in.

caveatemptor1

Hi dave2pvd, thanks so much for your response.

dave2pvd wrote: »

* What does the plan above cost? Is it fully covered? For both of you? I doubt it. My plan is similar. My company pays in $500/mo. I pay ~$100. And I'm the only one covered.

I don't actually know the number but it is a 30/70 split between my husband and the company and yes all dependants are covered. Nice to know its a pretty comprehensive plan - Yes we have separate packages for dental and optical.

dave2pvd wrote: »

* If you are contemplating having a kid, get AFLAC first. First, as in before pregnancy. It can amount to paid short term disability, and voila, more maternity leave for you.

I have absolutely no idea what AFLAC is. I had a look on their website and there is no mention of maternity cover (maybe short term disability cover would apply as you say), can you elaborate any further? It seems targeted at accidents and long term illnesses rather than maternity/planned hospital admittance. It sounds like it could fill the gap for paid maternity leave if it was covered and would be a good option if that were the case.

Thanks again!

dave2pvd

caveatemptor1 wrote: »

I have absolutely no idea what AFLAC is. I had a look on their website and there is no mention of maternity cover (maybe short term disability cover would apply as you say), can you elaborate any further? It seems targeted at accidents and long term illnesses rather than maternity/planned hospital admittance. It sounds like it could fill the gap for paid maternity leave if it was covered and would be a good option if that were the case.

Thanks again!

http://forums.thebump.com/discussion/8434341/talk-to-me-about-aflac-maternity-coverage

Give AFLAC a call at some point. If they're still doing this, it's a no-brainer. AFLAC are basically an insurance company.

él statutorio

dave2pvd wrote: »

* If you are contemplating having a kid, get AFLAC first. First, as in before pregnancy. It can amount to paid short term disability, and voila, more maternity leave for you.

Damn, I wish I knew that about 8 1/2 months ago.

caveatemptor1

I will do, thanks for that!

dave2pvd

caveatemptor1 wrote: »

I don't actually know the number but it is a 30/70 split between my husband and the company and yes all dependants are covered. Nice to know its a pretty comprehensive plan

OK, just guessing here, but it's probably ~$1,200/mo for both of you. So, $360 deducted pre-tax every month. So real cost more like ~$250 in taxed dollars.

There will be other plans avail that will have lesser coverage. They will prob offer less than 100% coinsurance and have considerably higher deductibles. Hard to see a compelling reason to take the lesser options though (IMO). But that all depends on your financial situation and what you think the future may hold.

Oh: it's essential to verify all this free 'advice' you're getting on boards.ie! Talk to the HR guru and get them to confirm/refute what is being said.

TeaBagMania

dave2pvd wrote: »

* Obamacare has made for lots of angry old white guys.

So you’re turning this into a racial issue now, what’s the color of one’s skin have to do with any of this?

DM addict

dave2pvd wrote: »

Oh: it's essential to verify all this free 'advice' you're getting on boards.ie! Talk to the HR guru and get them to confirm/refute what is being said.

I definitely recommend talking to someone from your HR. I was overwhelmed with this when we moved over, I spent a chunk of time on the phone to the relocation people and talked through/weighed up all the options. It will vary depending on how complex your health needs are. Best of luck with it!

caveatemptor1

DM addict wrote: »

I definitely recommend talking to someone from your HR. I was overwhelmed with this when we moved over, I spent a chunk of time on the phone to the relocation people and talked through/weighed up all the options. It will vary depending on how complex your health needs are. Best of luck with it!

My husband had a chat with HR yesterday and they have confirmed pretty much everything I have been told here. Thanks to all for helping me understand, it's a minefield!

spideog7

dave2pvd wrote: »

* Copays DO count toward deductibles now. Thanks Obama.

I'm not sure that's true, when your deductible is gone you still have to pay the full copay. They may count as out of pocket though.

I have not seen the AFLAC thing before, it's only available through your employer so it depend on whether or not they offer it. It sounds a little too good to be true. I'm not sure how they make money, are they purely gambling on the fertility of the participants?

dave2pvd

spideog7 wrote: »

I'm not sure that's true, when your deductible is gone you still have to pay the full copay. They may count as out of pocket though.

I have not seen the AFLAC thing before, it's only available through your employer so it depend on whether or not they offer it. It sounds a little too good to be true. I'm not sure how they make money, are they purely gambling on the fertility of the participants?

spideog7, with my plan, copays count towards the deductible. It's possible some plans don't.

My wife availed of the AFLAC short term disability and basically extended her paid leave by 2 weeks. But yes, it was only offered through her work place. You're right - they make money by gambling. Insurance companies aren't too far from casinos/bookies offices in that regard. Probably have better actuaries though.

spideog7

dave2pvd wrote: »

You're right - they make money by gambling. Insurance companies aren't too far from casinos/bookies offices in that regard. Probably have better actuaries though.

I did a google search and couldn't find much more about it, I'm sure they have clever people working out the numbers but on the face of it the maternity benefit strikes me as a loosing bet 9 times out of 10. My wife doesn't have any maternity leave so I'm intrigued.

ceadaoin.

spideog7 wrote: »

I did a google search and couldn't find much more about it, I'm sure they have clever people working out the numbers but on the face of it the maternity benefit strikes me as a loosing bet 9 times out of 10. My wife doesn't have any maternity leave so I'm intrigued.

It's so shocking that a country like the U.S. lags so far behind when it comes to workers rights/benefits. No maternity leave is just inconceivable to the rest of the developed world.

dave2pvd

ceadaoin. wrote: »

It's so shocking that a country like the U.S. lags so far behind when it comes to workers rights/benefits. No maternity leave is just inconceivable to the rest of the developed world.

The FMLA act guarantees maternity leave to most US workers. It's not great, but legally, there is maternity leave in the US for most people.

In some states, companies with <50 employees are not covered by FMLA (not mandated to offer maternity leave). The prospective employee has a choice: don't work for them.

I work for a company with <50ppl. We offer leave, both paid (2wks for maternity) and unpaid (up to 12wks) as per the provisions of FMLA. Any small company that doesn't offer this isn't worth working for, IMO.

ceadaoin.

dave2pvd wrote: »

The FMLA act guarantees maternity leave to most US workers. It's not great, but legally, there is maternity leave in the US for most people.

In some states, companies with <50 employees are not covered by FMLA (not mandated to offer maternity leave). The prospective employee has a choice: don't work for them.

I work for a company with <50ppl. We offer leave, both paid (2wks for maternity) and unpaid (up to 12wks) as per the provisions of FMLA. Any small company that doesn't offer this isn't worth working for, IMO.

I can't imagine returning to work just 2 weeks after giving birth. I think I was still a sleep deprived blubbering mess at that stage! Better than nothing I suppose.

DM addict

dave2pvd wrote: »

The FMLA act guarantees maternity leave to most US workers. It's not great, but legally, there is maternity leave in the US for most people.

In some states, companies with <50 employees are not covered by FMLA (not mandated to offer maternity leave). The prospective employee has a choice: don't work for them.

I work for a company with <50ppl. We offer leave, both paid (2wks for maternity) and unpaid (up to 12wks) as per the provisions of FMLA. Any small company that doesn't offer this isn't worth working for, IMO.

C'mon, 12weeks unpaid should hardly qualify as maternity leave. It's a paltry amount of time - imagine going back to work with a 3 month old infant. Twelve weeks unpaid leave is paltry - only four countries in the world don't offer paid leave (USA, Swaziland, Liberia and Papua New Guinea).

http://womenandtech.com/infographic-paid-maternity-leave/

And don't forget that if you've already had to take time off work for serious illness of self/family member, that is going to come out of your twelve weeks - the FMLA covers 12 weeks per 12 month period for ALL forms of medical and caring leave.

dave2pvd wrote: »

In some states, companies with <50 employees are not covered by FMLA (not mandated to offer maternity leave). The prospective employee has a choice: don't work for them.

I work for a company with <50ppl. We offer leave, both paid (2wks for maternity) and unpaid (up to 12wks) as per the provisions of FMLA. Any small company that doesn't offer this isn't worth working for, IMO.

It's great that you're in a position to make the choice to only work for companies that offer this. But choosing not to work or refusing a job offer is simply not a feasible choice for many women.

spideog7

"Small" companies with fewer than 50 employees within a 75 mile radius don't have to abide by it. Plus it's completely unpaid so if it's as easy as you say to just get another job why not just quit for a few months instead?

Meanwhile FMLA offers 26 weeks unpaid leave if a family member is injured on active duty, yet another indication of this country's odd fascination with the military.

At any rate we've gone somewhat off topic.

dave2pvd

I'd like to point out that I'm neither condemning nor condoning what the US does with regard to maternity leave. Happy to discuss the issue further, just not on this thread.

caveatemptor1

I have to admit, as a young married couple who intend on having kids in the next few years, the maternity leave thing does concern me, but we will find ways to make it work if we plan ahead. There are pro's and cons to any life decision and this is just one of them!

él statutorio

caveatemptor1 wrote: »

I have to admit, as a young married couple who intend on having kids in the next few years, the maternity leave thing does concern me, but we will find ways to make it work if we plan ahead. There are pro's and cons to any life decision and this is just one of them!

Our 2nd kid is imminent (was due on Sunday) like you said we'll make it work. It'll probably mean less trips home but if that's what it takes then so be it.

InTheTrees

él statutorio wrote: »

Our 2nd kid is imminent (was due on Sunday)

Congratulations!

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