Any Americans on here?

[Anudawan]

Could you explain to me how health insurance works in the states?

naively I thought it was a bit like bupa here, so for instance we have a bupa family policy subsidised through work and it’s £45 a month. £200 excess.

i thought most employers covered it in the states? But we just got back from hols there and was chatting to a lovely couple by the pool and they said it was subsidised but they still pay out of pocket 1500 a month for it.

i know wages in America are higher, but is it enough to make 1500 proportionate to our £50? And then you still have to pay a portion of your treatment? Is this like excess- I didn’t want to ask them too many questions as it was a bit intrusive. They mentioned it re having a baby, insurance covers it but they still had 3k to pay.

all in all very confusing. Do all employers offer health insurance or is it like here when only some do?

Half of my uni class were American and we've had a lot of discussions about it (we were studying clinical masters). From what I gather their employer contributes a portion of the premium, not the whole amount. Also, it sounded like only larger employers had health insurance benefit and smaller businesses are under no obligation to offer it. The sums of money they were talking about were really eye-watering but every one of them said they preferred it to the NHS due to quick access and choice of interventions they could get cover for.

Assuming you're not in Medicaid or Medicare:

Your employer pays your insurance premium

You may or may not have to top up that premium

Every individual member of the family has a maximum out of pocket: ie each member of the family has to hit (say) $2,000 of expenses before the insurance company will cover

Some drugs you have to pay a portion of the cost, called a co-pay. Some are free (eg pill, statins, preventative drugs)

Each doctor's visit has a co-pay unless it's an annual physical, or otherwise covered eg if a child has a specific issue covered by the policy

Some doctors and hospitals are in-network (ie benefit from your insurance policy coverage) some are out of network (you'll have to pay out of pocket). Not difficult to find suitable ones in network

Different policy for eyes

Different policy for dental

Basically it's really complicated, deliberately. They make mistakes, deliberately. The burden is on you. Doctors fear litigation more than patient fatalities so they go overboard. The industry hypes up prices massively because insurers are paying so insurers hike up premia massively

The whole system is backwards, corrupt, not the best for the patient always. BUT, some of the world's best facilities and research and doctors are here. It's functional, basically, but immoral imho

as @Onlyonekenobe said, very complicated!

I would add, while many (most?) larger employers pay for the employee's coverage, many do not pay for family coverage. That can be very costly, more so if the plans offered are expensive. Finding a plan that covers 100% of costs after deductible is rare these days. Most offer 80% coverage at best, with an out of pocket maximum that can go quite high (think 8k per year or the like.

My experience has been that most companies I've worked for have offered paid family coverage to C Suite employees only. That coverage for me (and my spouse) costs the company $39,000 a year. For our part, we pay the first $4,000 of costs (deductible), then everything else is covered. IF we use in network doctors. If an employer does not offer health insurance it can be bought on the market place (Affordable Health Care act) for somewhat reasonable pricing. Again, may varieties on offer, with varying levels of coverage. Some cities, like San Francisco, have additional laws so employers must deposit money into a health savings account to pay for some out of pocket expenses - if they do not offer a health plan.

It is expensive and worrying for most of us. For those earning less money, having a big medical bill can have devastating consequences. What Drumpff will do to any of this is up for grabs, so all of this may be different in the coming months and years.

What’s Medicaid and medicaid?

is that different from Obamacare?

I guess I struggle to understand the difference between private here and the states

emergency care not covered here
maternity not covered here
physical GP not covered here (virtual is)
it seems a different model of operating seeing specialists like a paediatrician

so would some employers cover the whole premium for you and your family?

if your employer doesn’t offer healthcare would you then buy a policy on the open market like we would here if you wanted private health? I did google and it said the average cost was 25k dollars

I'm not American but I live in America.

My health insurance is through work and a premium is taken out of my paycheck pre-tax (I think it's around $70), then I have an excess, called a "deductible", of $2,000 per year which I pay for from money I have transferred into a Health Savings Account or 'HSA' (which is pre-tax again). My employer contributes $500 towards the deductible each year so the deductible is in fact $1,500 pre-tax for me. After that it's 20% co-pay (I pay 20%, insurance pays 80%) with a maximum out of pocket expense of $5,000 per year. My plan includes lots of preventative care for 'free' like annual health assessment, smear test, all contraceptives, vaccinations, breast examination, etc.

The above is pretty confusing but it basically means my maximum cost per year is:

Premiums: ~$800
Out of pocket expenses: $4,500 ($5,000 less employer contribution to deductible)
TOTAL: $5,300 pre-tax, or ~$3,000 post-tax

I should note that this is the 'best' health insurance available through my employer and there are cheaper plans where premiums are a lot less but deductibles are a bit higher.

My experience of health care here so far has been fantastic - high quality, efficient, easy access to specialist services, direct contact with the consultant, excellent aftercare). Much better than my experience in London where I also had private medical insurance (I gave up on the NHS years ago after a series of abysmal experiences). To have access to some of the best clinicians in one of the most expensive cities in the world for less than $3,000 a year post-tax is a bargain. I feel very lucky.

I should add that, while paying thousands of dollars a year towards healthcare, as many working people do in America, might seem like a big expense, jobs here pay considerably better, so people can afford it. I work in the same company as I did in London, in the same role, but got a 90% pay rise when I transferred here. Taxes are a bit lower too, so it's probably a bit more on a net basis.

I coped and pasted Medicaid and Medicare info below for you. I'm old and so I'm on Medicare. It works really well.

"Medicaid is a government health insurance program available to people with very limited income and resources. Medicaid does not pay money to you. It sends payments directly to your health care providers. Medicaid can pay for medical services in your own home or if you live in a residential care facility that takes Medicaid residents".

"Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and ALS Lou Gehrig's disease. It started in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS).

My husband's former employer (he is retired) pays his entire insurance premium and 60% of the cost of my insurance coverage.

Preventative care is covered at 100% with no copay (mammogram, colonoscopy, smears, etc.)

A doctor's office visit has a $15.00 copay

Prescriptions can be anywhere from $0 to $20.00

Eye exams are covered but glasses or contacts are not

Dental: 2 cleanings per year, fillings, root canals are covered but nothing "cosmetic". I've paid for implants out of pocket

So for this level of coverage I pay $700/month. But keep in mind that there's no equivalent of NI tax here.

As you can see it varies from person to person. I am very satisfied with both the cost and coverage and level of healthcare I receive. I don't consider it prohibitively expensive. It all runs pretty smoothly, I never see a bill (medical providers deal directly with the insurance company).

I live in the US as well and did some reading about all of it when I moved here. My company offers a reasonable amount of customization for insurance so I opt to have a little more per month deducted from my pay so that I can have the things I want (such as coverage for ambulance/medevac, since I also have horses and ride competitively). We don’t have a deductible/minimum amount and have very little copay; that’s one of the things they pride themselves on offering. So most medications and visits are free, and requesting something specific or seeing a specialist have small fees ($15-20). I’ve had numerous visits, two surgeries, and one hospital stay and everything was covered.

I know people hate to hear it, but the standard of care and treatments here blows the NHS standards out of the water. No comparison. And they actually do things like give you four treatment options, explain each one and the potential side effects, and then ask which one you would like(!).

Medicare and Medicaid are (I believe) the government coverage for the elderly (Medicare) and the poor/disabled (Medicaid). In spite of the propaganda claiming that poor Americans have no medical care, from what I’ve seen through volunteering those who are quite poor are automatically enrolled in Medicaid and heavily encouraged to make use of their gov healthcare.

The other option is the healthcare marketplace site, which is what I think you’re calling “Obamacare” (I don’t think they call it that anymore, he’s been out of office for a while). That’s for people who don’t have insurance through their employer and I believe they submit their tax return and the government subsidizes their insurance if they qualify. That’s the one where people can choose their coverage and some opt to cheap out with $4 per month insurance and then get upset when it doesn’t cover much.

That’s what I remember from my research when I moved here.

if your employer doesn’t offer healthcare would you then buy a policy on the open market like we would here if you wanted private health?

Yes, and it can be expensive (from what I understand; I've never done it) unless you qualify for some type of subsidy.

And as mentioned above there are Medicare and Medicaid (govt funded for over 65, disabled, low income, etc)

The people often hit the hardest are the "squeezed middle". They are not low income so don't qualify for subsidies but they're not high earners either and health insurance premiums take a huge bit out of their monthly budget.

My insurance is around $11 per pay period (every two weeks) and to cover DH is about $125. That covers medical, dental and vision. My deductible is $600, so the first $600 is on me. Then they pay 80% until I reach $2000 more out of pocket and then they pay 100%. I am 64 years old and never heard of anyone being put in a “ward” until I came here. There used to be semi private rooms, for two patients, but now everyone gets private rooms. Even when my son was born 35 years ago. Yes, even people without insurance. And in every state I’ve heard of. Uninsured bills are usually picked up by the state, or written off by the hospital. Mammograms, smears, colonoscopy are all 100% even if I haven’t met my out of pocket. Vision pays for an annual eye exam for $10, and something like $100 towards glasses or contacts. Dental pays something like $1500 a year, and discounts services.

they actually do things like give you four treatment options, explain each one and the potential side effects, and then ask which one you would like(!)

Sounds funny but it's true!

You do need to speak up and advocate for yourself though; you're expected to be proactive in your own care and treatment. If (for instance) you want to avoid surgery you need to emphasize that and ask for alternatives.

Doctors coming out of med school in the past 10 to 15 years are all in on "shared decision making". I've found that some older relatives aren't comfortable with this and would prefer the paternalistic approach of being told what to do.

The average annual health insurance premiums in 2024 are $8,951 for single coverage and $25,572 for family coverage.

https://www.kff.org/report-section/ehbs-2024-section-1-cost-of-health-insurance/

People in very good jobs may pay much less as part of their salary package. Its like on MN everyone seems to earn over £100k, and in the same way, everyone on this thread pays way less for their insurance than the average.
US citizens pay more for their healthcare than other countries, but overall have worse outcomes e.g. maternal death.

I’ve heard it is better for like clinical trials and more experimental procedures and medication, I’ve seen quite a few children with childhood cancer (social media) get to America for treatment that’s not offered in the UK.

so my private health with work when I retire the policy will end with my employment, is that the same in the us or would your employer still cover you?

does insurance cover emergencies like needing an ambulance? I’ve heard they are very expensive