Moving to US with chronic illness

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My husband has a tentative offer to transfer to the US office of his work. I'm fairly confident I could find work out there but I'm confused about healthcare.

I have a chronic condition that is protected by law in the states (ie insurers have to insure me & will be capped by Medicaid in 2025.

But I'm so confused about whether I could be on my husband's healthcare, will I need my own and how to check which medicine I'm eligible for before going out there.

Help!

You might not be eligible for Medicaid for some years (if at all): www.medicaid.gov/medicaid/eligibility/index.html

I would approach potential health insurance companies (or the one your husband's company uses) to see what the costs would be for coverage for you and your condition.

You'll also need to check what kind of visa DH is on as that will affect whether you're allowed to work.

I would check whether you are covered under your husband's work medical insurance when he transfers, and take it from there.

I’d say usually yes I’d expect you’d be covered by your husband’s insurance. He would choose the family package instead of the single person package basically.

However definitely double check that before you commit to anything!!!

Then you need to get the information on the insurance and look at it carefully. The costs for medication can still be very high despite insurance.

Maybe ask questions on something like a fb group for your condition once you know which insurance it is

I am in the US and you would not be eligible for Medicaid. Medicaid is for basically the impoverished and some children. You have to be a citizen or a lawful permanent resident. If your husband's employer covers family then you would have insurance for a fee. (It is not a small fee.) Be advised that American insurance has deductibles and copays. Each company has it's own pharmaceutical formulary. Not every med is available.

@OhcantthInkofaname thanks for the advice (and everyone). Can you ask ahead of time about what medicines are available and associates costs / deductibles. We only want to stay a couple of years so wondering if it's worth taking the hit.

Thanks everyone - realised I don't qualify for Medicaid after posting!

So, thanks to the ACA (affordable care act), you cannot be denied insurance based on pre-existing conditions. Your husband’s employer must offer insurance to the employees if they have 50 or more FTE employees, which I assume they do if they are large enough to be moving people around the world. Most workplace health plans permit spouses and children to be added at reduced prices than if they were to get their own plans through the marketplace. My employer covers my premiums in full and I add my husband for $400 a month. We then share a deductible and the MOOP. In order to remain competitive and retain good employees, most large companies offer a plan that covers spouses and at pretty good rates. Ours also puts $1000 a year into my HSA, which I think is an excellent benefit. Check the full benefits with the employer.

As part of the offer package, the company should provide an outline of the plan, which insurance company they are using, and the associated costs to the user (monthly premiums, deductibles, MOOP, etc). You can then check on the website for that insurance company if they cover your medication.

Without insurance, my medication is $1005.69 per month. I have already met my MOOP for this year so I don’t pay anything. But if I hadn’t, I’d only pay $10 a month.

You won’t receive Medicaid. Sounds like your husband is being transferred on an L visa so you wont even be a permanent resident, just temporary visa holders. You have to be a US citizen (or in some circumstances a permanent resident) to accesses Medicaid and also below a certain income. That won’t apply to you as the embassy won’t even issue a visa for someone where the job is paying so little they can’t afford to live.

@BritWifeInUSA thank you so much, this is so comprehensive. This defos gives us a jumping off point and I now know what MOOP means! My medicine is £80k a year (lol) so it might still be out of reach for us but great to be armed with this info!

Generally speaking I would expect you to be covered by your spouse but ask - there are a few companies that don't cover spouses or make them pay 100% of the premium. If that's not true you're protected by both the ACA and HIPAA (the older law that stopped group plans from rejecting anyone for preexisting conditions).

Permanent residents are eligible for Medicaid though they may have to have lived here a certain number of years. Eligibility varies by state. states are required to have medicaid for 4 classes, all linked to income: pregnant, children, disabled, and elderly. The ACA expanded this to all people under a certain income level if states accept the expansion. But it is always income linked even if your disability would be qualifying, and in some states that income would be quite low.

Some other non-citizen visas may also be qualified residents for Medicaid purposes, but this gets complicated.

Since your disability exists prior to US entry and you don't have 40 quarters of employment, you wouldn't qualify for SSDI. If you later develop some other condition, or it worsens and makes you unable to work, you might. This is important because receipt of SSDI makes you eligible for disability Medicare.

If you came to the US you would be relying on your husband's insurance or the marketplace.

If you go to GoodRx you can see list prices of medicines, though this does not always correspond to what your insurer/PBM (pharmaceutical benefits manager) pays the pharmacy, and of course not what you pay out of pocket, which varies quite a bit. For example, I pay $8 for a month's supply of any generic (there are some that actually cost less and I just pay that) and 20% of the cost to a max of $100 for any brand name on the formulary. (90 month mail order supplies are the equivalent of 2 months retail pricing.) So generic meds can be quite inexpensive but brand name drugs add up. For some popular and expensive drugs, the manufacturers offer coupons that lower the cost. I use Ozempic for diabetes and the coupon takes me to $75 for a 3 month supply.

OP

Have you considered getting insurance in the UK that has world wide cover?

I'm no expert but I'm sure there will be specialist insurers.

the Human Resources department at your husbands company can send you a link to the prescribers medication formulary. It will be a list of drugs that are automatically covered. They may be covered at different levels of copay depending on the plan. If your medication isn’t on the list, then you have to get the insurance company to approve it.

i’m On a ridiculously expensive specialty medication and have to get it approved annually. I honestly had no trouble getting it approved. The medical need was clear. My doctor filled out the paperwork. I signed some forms. The insurance company sent the approval. I was also able to enroll in a non-means tested copay assistance program because the copays on specialty drugs on often very high.

OP
Have you considered getting insurance in the UK that has world wide cover?
I'm no expert but I'm sure there will be specialist insurers.

That would only work for short term travel, not for actually living there.

You need to speak to their relocation specialist. You will be covered under your husbands policy as a spouse. Assuming it sa decent sized company it will be fine but do look at the cost.

I'm thinking health insurance not travel insurance.

Many years ago I had a boss who lived between the UK and the US and I know he had a policy that covered him in both places.

Check if they provide expat health insurance for seconded employees and their families. That’s what we were on when we did a stint in the US and it covered everything.