For a year: US health insurance or travel insurance?

[percysnose]

Next year, dh's job takes him to the US, and we're all going with him. My kids are nearly 3 and nearly 1. His job does not offer any healthcare, and he's been told he has to get it. Getting it from an insurance company will cost at least $6000 for the family. I've looked at the sort of cover backpackers get from Direct Line, and that offers healthcare 'up to £5million' for just a few hundred pounds for all of us under the traveller banner. My mum says we're not 'travellers' and would not be covered properly by this, we'd be staying somewhere for (a month or two under) a year. But surely backpackers are riskier?

A US friend doesn't know, but says most healthcare insurance doesn't cover most stuff anyway, and that it would always be cheaper to fly home, emergency rooms have to treat emergencies, and with insurance you have to pay the $3000 (or whatever) co-pay or deductible anyway. She says just get good travel insurance. None of us has any health problems at this point, but I am pretty anxious. dc2 has to have 1 year jabs there, would that be possible on a pay-per-appointment basis? My US friend does not have children and doesn't know much! But that's more than I know!

[annh]

Travel insurance is meant for emergencies and will not cover any routine work e.g. your smear test, any regular check-ups which your children are due etc. If you need to claim on it and the company find you have effectively lied to them, they will refuse your claim.

Healthcare is incredibly expensive in the US (but you probably know that already) and I don't agree with your friend'advice about flying home - what happens if something awful happens like all/some of you being involved in a car accident and suffering broken bones/internal injuries? You will be in no position to go anywhere.

Am mainly shocked that your husband's company think it is acceptable to expect him to take a job in the US with no healthcover. DH has worked in a number of countries and healthcover had been our number one priority, above relocation allowances or anything else.

[percysnose]

"Am mainly shocked that your husband's company think it is acceptable to expect him to take a job in the US with no healthcover."

Tell me about it! I think we've found one healthcare insurance co there for about $2000 for the family - children are free - it doesn't offer as much coverage (something like £500k for the whole family rather than £5m each) but will allow us to use the equivalent of a GP. Thanks very much for your advice, I've been all at sea and you've made me think about it more sensibly.

[annh]

You're welcome! I once spent some time working for a travel insurance broker and while I saw some blatant attempts at fraud during my time there, I also saw a number of cases being turned down for fairly flimsy reasons. Tbh, discovering that someone was using a travel policy while living permanently somewhere would have given them the perfect reason not to pay.

[percysnose]

When I spoke to Direct Line on the phone, though, they told me they were exactly the right people to go through. I would have been paying on a case by case instance for, eg, the kids vaccinations, anything routine I needed (I won't, in the 9 months), but it would cover emergencies, but like you say, you can't always repatriate for treatment, and emergencies like that are probably what we would be likeliest to need, as we're all in normal undrugged health right now.

The policy with a US health care firm I've been looking at now seems to pay only 20% of each thing and my friend says it doesn't give any emergency room care, whatever that means. It is so confusing! So furious we're expected to do this ourselves.

[Shanster]

If you are planning on being in the US for a year, you need real health insurance! I wouldn't even consider the travel insurance option. If you don't have a real insurance card, most doctors will insist you pay up front for treatment. Insurance is not cheap; my DH and DD are covered by DH's work policy, and I am covered by my work policy, but we are still out of pocket about $3000 a year just in the portion we pay, and that doesn't include co-pays or prescription costs.

[kickassangel]

ok, you might want to pop over to the 'living in america' thread here

most of us are pretty confused, as are most americans, but you do need proper insuranced.

the cover provided by dh's firm costs $1k per month & is pretty good.

we have a $15 co-pay on routine things (like injections, check ups etc) and a $500 deductible for 'big' things, PLUS paying 30% of further costs.

if you don't have any cover, you are only entitled to sufficient care to keep you alive, nothing more & as soon as you are 'stabilised' you are liable for the cost of care, or you have to leave. also, you can be sued for any damage to another person, which is also covered by med ins.

so, if you hit another car & they say it's caused whiplash/trauma etc, you need insurance to cover it, or you have to pay for their medical costs.

i think you need to re-approach your dh's firm - i've NEVER heard of anyone being sent to the states without helathcare cover as part of the package. even waitresses/hotel receptionists etc often get some level of cover as part of their job. anyone in a 'teacher' level job or better would assume tit's included.

[kickassangel]

it's included, not tits. sorry!

[nooka]

I think that your husband should refuse to go without health insurance to be honest. Have you check what else they will not be paying? Moving country is very expensive, and I'm assuming that you will be renting - what about furniture etc? We moved to the US with dh's company and they really screwed us, left us thousands of pounds out of pocket. I'd be wanting to have everything written down and checked by a lawyer in your situation. Have they got the right visas for you all for example (it will be a L1a or L1b)

Healthcare insurance is expensive, and the cheaper packages will have lots of exclusions, but the US system is also very expensive and in nine months you can have a whole crop of minor things that here would mean popping to your GP and getting a prescription, but in the US you'd end up having scans and seeing specialists that easily add up to thousands, because the system is set so much on erring on the side of caution because of law suits. For example dh had an ear infection and had to see an ENT specialist at a cost of $1500 (he would have had drops from the GP in the UK).

Your children will need jabs but that's usually a non-pay service - the cost is more that she may need a doctors report (we had to have them in New York, but it might well depend on the state).

Travel insurance will only ever cover for accidents, and is likely to be invalid in any case - you'd really need to check the fine print. Again bear in mind the potential cost - I broke my jaw on holiday in the States and the bill was $20k (which was covered by insurance) I had several X-rays, a CAT scan, one simple operation and an overnight stay, so fairly minor treatment really.

Travel insurance is relatively cheap because it only covers accidents, excludes any pre-existing conditions, and where the cost of treatment is high ships you home for NHS treatment in any case.

[percysnose]

Oh dear, my head is swimming now, really. I looked at the affordable health insurance plans and the deductibles are all the same as the ones on the travel insurance (ie no emergency room treatment unless you are admitted, etc). It is because the move is so expensive that we really can't afford to pay $1000 a month or whatever it costs for insurance. It's just terrifying, it seems that anything we do will bankrupt us. I've spent a lot of time in the US before I had children and if it was just me I'd be totally blasé about it, but children makes everything so complicated. For minor illnesses, the price of flying my children home, while an incredible hassle, would seem to be cheaper than any plan. There is just no way my husband will refuse to go. What I think may happen is that we will go over with travel insurance (which has the $5m emergency cover) and from there try to negotiate with an insurance firm face to face, telling them about that safety net and asking them to adjust accordingly. There's no question that we'd go over for 2 weeks with just travel insurance, and wouldn't even think twice about the consequences. With back up British insurance, I would hope that we can get something reasonable in place. But my US friend was telling me a single ER visit cost her $5000, and as she was not admitted her insurance would not cover it, and she had good insurance. No policy I've seen would! I certainly don't want to insult Americans, but I think this system is totally insane. I don't mean for visitors, I mean for them.

[CMOTdibbler]

I've been looking, and it seems that there are some travel insurance policies that will cover you for living in the US for one year (even when working).

If you go to an insurance broker here and tell them exactly what you are doing, they will be able to find you a policy. The good thing about going through a broker is not just that they can scour the market, but that they are responsible for getting all the information from you re exclusions etc so your cover is a bit more solid

Don't just take out a travel insurance, as they usually only cover a 45 day stay, and they will reject if know you were planning on being there longer

[annh]

Percynose, what kind of company does your husband work for? I'm still shocked that they are not paying for healthcare. Have they ever sent people to the US before? You say that the move is so expensive and that just sounds so wrong. If your husband's company want him to move, they should be footing the bill for removals, short-term accommodation, visas, healthcare, car rental etc. We have moved so many times and each time, although all the major costs like above were covered, we still ended up a bit out-of-pocket. I was never hard-nosed enough to claim things like membership of the International Womens Club for example which some of my more "assertive" expat friends did or buying endless plugs, converters and bits of cable to make TVs etc work. However, you should not end up in a worse financial situation because your DH is doing a good job for his company!

[titchy]

I'm shocked his company isn't providing this either - it's fairly standard, and actually shouldn't cost the company that much. They should have this sort of thing on their general employee travel insurance. He needs to go back and hassle them - they may not even be aware they have it.

Otherwise he'll need an assurance from them that they will pay for any treatment. tbh you coudl well sue them for the cost of any treatment and would probably have a good case for doing so.

Who is the company? dh works in this field so may be able to check if it's a large firm.

[percysnose]

Fifteen thousand dollars to cover the whole move, which will include buying a car (and selling at the end) all flights, insurance, a bit of furniture for the rented accommodation, etc. I think he needs to speak to them, too, because the policies are impenetrable. Would rather not mention company - if it were me I would gab like anything, but think he'd be annoyed by the details, they're smallish but well known, and usually employ from within America - it's complicated - so aren't used to this. I really wish we could tell them where to go, but as you know, circumstances difficult for everyone right now!

Anyway, I am much more clued up and wary than I was before I came here. Thank you all for excellent advice.

[EldonAve]

do their regular US staff not get health cover then?

[annh]

Oh God, that isn't anything like enough to cover the move! You will use that amount on just buying the car and paying for flights. Presumably they are paying for the actual accommodation or your mortgage here however? You will need to consider the costs of shipping stuff from here, even if you rent fully furnished over there, you will still need clothes, toys, dishes, stuff to make you feel at home. Of course, none of your electrical stuff will work, hopefully the house will come equipped with oven etc. but it won't have hairdryers, PC, music systems. Unless you are lucky, you will also need not one but two cars. Americans don't do walking or public transport . Seriously, if your husband takes the car to work you absolutely need some way of getting to playgroup, library etc.

The last time we moved, we did it as a fixed-price relocation so I kind of know what I am talking about and yes, we did lose money on it and would never have considered doing it except that it got us back to the UK, into our own house which had been rented and we knew that would be our final move so subsidising the move somewhat was like an investment in our future. But unless your husband really needs this move in terms of promotion or just hanging onto his job, I would really think hard about whether it is the right thing to do.

[CMOTdibbler]

My company are US based, and anyone who is working over there (or indeed who goes to work in, for instance, China, temporarily), always gets health insurance on the company scheme. I believe the agreement to be that what the locals get is your minimum, and that you don't lose benefits by working abroad (so I know people that keep their UK holiday allowance over there).

We aren't a huge mover round of people (I know people in the oil industry and they have whole departments for relocating staff) - only maybe 20 temp moves a year, but it seems pretty straightforward.

If their US staff get health insurance, then you should def get that too

[kickassangel]

there are limits on what a company can pay for without the employee having to pay income tax though - it's so people don't get 'bribed' to move, or make a clandestine profit on it without paying tax. i think in the UK the limit is about 9k punds, and about the same in the US (I think you can lciam both before paying tax), so that sounds about the amount you've been offered.

hwoever, there are ways to pay for things without it being taxed, e.g. dh's co paid our hotel bill when we first arrived, as it came under 'living expenses whilst travelling' so they paid, and it never appeared on his pay slips & therefore wasn't taxable. i think med stuff is doen the same.

if they haven't doen this before, it sounds like they just aren't very organised about it. getting the right visas is the most important thing. then get med stuff sorted. then worry about the housing & cars etc. are they paying to cover your rent/mortgage on top of his normal salary?

would you consider dh going, and the co paying for you to visit him a couple of times? not nice, but possibly much easier. personally, i would think twice about going if this is the deal.

[percysnose]

Nothing is covered! The rental place is furnished (inc television, kitchen things etc), but without beds, dining table and a couple of other large things. We're taking our PCs but will have to rebuy small things. There's no way we can afford two cars, but the kindergarten is right next to his workplace, so we'll all go together. I would love to stay in this country, but it would break dh's heart, and this move is totally essential for promotion or even staying in the game. We just have to bite the bullet for one year and take the hit. But it does mean that we're going to be taking the absolute barest insurances we can find there and crossing our fingers. I think I'll visit home at least once and try to binge on British health care!

[mathanxiety]

Childrens routine innoculations are absolutely not a non-pay service! Expect to pay a small fortune. My DD recently had a series of age 14 innoculations and boosters that came to over $600, plus the $120 fee for the visit. Two other DDs also had shots this summer, and the bill came to over $1000. Luckily the children are covered by decent insurance. You will find that your auto insurance will cover bodily harm to you and others you might injure -- you will be required by law to have auto insurance if you get a car, and there are different deductibles which affect the cost of the insurance but also affect how much you have to pay before they cough up any money.
You will need a broker to sort out your insurance -- do not deal directly with an insurance company. You will be dealing with nothing but a very smooth salesman. The broker will also sort out the auto insurance, plus renters insurance for the place you will be renting, and explain levels of coverage. Get a second hand car, btw. Cars cost a lot less in the US than the UK, generally, and people change cars far more frequently. Any health insurance policy you take out will probably have a PPO (preferred provider option), which is a list of docs who have a financial agreement with the insurance co to accept the insurance. So you will have to choose a pediatrician or family practitioner from the list and then phone them to make sure they are taking new patients. Be prepared to have all your medical records from the UK with you when you go. If you use a doctor outside the PPO, you will pay more. Be careful. Small household appliances don't cost a fortune, but the places where you can get your hands on them tend to be outside urban areas, in the almost inaccessible suburbs (public transport is virtually non-existent in the US). Stores to shop in are WalMart (quite an American experience) and Target for small appliances, bedding, toys, cheap kids clothes. Go on Craigslist for all the other stuff, like the furniture, and Ikea is of course great. You can usually hire a truck or van from Uhaul for a day if you want to make just one trip. You will need IDs all sorted before you do this, however.

Oh yes, the health insurance situation is bloody awful for Americans, but they're all so paranoid about socialism that they can't see how they are being oppressed. The 'healthcare system', also often referred to as the 'healthcare industry' is run according to a profit model and not with the aim of providing healthcare to people who are in need of it (i.e. everyone). It is not seen as a right, but a responsibility, partly because bad health is still seen by some, I believe, as a judgement of some kind from god.

[EldonAve]

there is a free vaccination program in the US

[kickassangel]

you don't need to get any innocuations done in the US, get stuff done before you leave, then catch up when you get back.
you will only need med ins for accidents/illnesses etc, but expect to pay at least $100 per visit.

[nooka]

We didn't have to pay for vacs. But we were insured anyway, so it might just have been no co-pay I guess. Are you going somewhere on the East coast to be thinking about flying home with sick children? Otherwise I would have thought it would be the last thing you would want to do, spending many hours on a plane with an unwell child, aside from the fact that the airline might refuse to fly you (and flights to the UK from smaller places are expensive).

Going to a broker and getting the best quote possible is the best idea I think. Certainly all the Americans I know shop around a lot and there is a lot of variation of prices, coverage etc. It is all very confusing too. I have to say that skimping on insurance seems very foolhardy to me. Better to compromise on a smaller place to live, less furniture etc etc because if you do need any sort of healthcare you may be completely buggered, and stressing about your health or your children's health is really really horrible.

The other thing to check is where you are going as different states have different options - for example some have non-profit hospitals and plans that you may be able to access and they will probably be cheaper. A lot of things vary from state to state (tax rates for example, you usually pay federal + state and then sometimes plus city too).

[percysnose]

It's certainly not our intention to skimp on insurance, and we're living way out of town just to be able to afford accommodation big enough for the four of us, in the city he works in the prices are unbelievable. The furniture is going to be Ikea, the bedding is going to be Target. I see what you're saying, but there just isn't that much money. From the insurance plans I've looked at, vacs are never included, so thank you so much for the links to vaccination plans (but if we have to pay a few hundred dollars that's still going to be less than the difference between the plans I've seen and an amazing plan that covers all.

The reason the travel insurance has been persuasive is that it covers for up to £5m, and I cannot find an affordable (ie less than $6000 for the year) US one that covers more than $1m between us. That means that if the worst happened - car crash, us all hospitalised for 2 months - we would owe hundreds of thousands of dollars by the end. For injuries and illnesses we could travel with, it would be cheaper to come home. The travel insurance companies say they cover up to 18 months. And I think the best thing to do is look at further insurance when I get there, but definitely to have that £5m travel insurance. Thanks also for the broker advice. Have heard so many stories about people with insurance having huge deductibles from their cover and their cover just not covering, eg my friend's $5000 ER visit. If we're ill, we are rather ruined anyway. If one of the kids turned out to be a diabetic, if something chronic turned up, I would just bring them home.

[annh]

On the basis that you have said this is a move your husband really needs to make in order to progress in his career, then I think you have to accept that this year is going to be a loss-leader and be prepared to subsidise the move to a certain extent (which is what we did but that was to get back to the UK, into our own home, in time for start of schools, etc). It doesn't sound like there is a lot of room to cut back on any of the relocation expenses but I really don't know if I could face a year of uncertainty about healthcare in a foreign country so maybe that is where you have to be prepared to put your own money? Anyway, good luck with the move, come back and let us know how it goes!

[percysnose]

Thanks! I'm going to print this off and give it to him to read. Not only is it tremendously helpful, but it will also help him to feel very guilty about the huge upheaval and consequences. Which is always nice.