If Your Knowledge Of The US Healthcare System Has Been Gained From ER Or Scrubs, Think Again!

For many expatriates coming from countries where healthcare is free at point of need for everyone, it can be a very harsh awakening to realize that there is a price tag on everything that relates to your health in the USA.

As a British expatriate transplanted to Northern Virginia eighteen years ago and starting my family here, I have had an intimate experience with the medical system. Navigating this system is number 1 on the list of frustrations facing expatriates.

It is important to understand that there is no basic universal right to healthcare in the United States. For most people, the only way to receive medical care is either to pay for it out of pocket or to enroll in a health insurance plan.. The best plans are usually company-sponsored and health benefits are considered to be one of the key incentives for employees. Unfortunately with health care costs spiraling, companies are cutting back on funding and as a result there are literally millions of people who are either uninsured or underinsured.

If cost is not a consideration, you can go to any doctor, whether general practitioner or specialist. You will be responsible for paying in full, but bear in mind that costs can run into thousands of dollars very quickly. Shop around because costs can vary considerably from doctor to doctor.

Prescriptions costs can also mount up very quickly so it definitely pays to contact different pharmacies to compare prices or offers. Generic drugs (medications) are a lot cheaper than brand names so always ask the prescribing doctor if there is a generic equivalent. I have just paid $433 for one non-generic medication; however, the doctor gave me a discount coupon for $50 which was applied immediately to the price. It is always worth asking.

We have been very fortunate having been relatively healthy, always having had medical insurance and never having had any significant medical costs refused. "Managed Care" health cover has become very popular and this is the type of policy we have been offered over the past few years, but costs can still be prohibitive and there are many variables which will affect the coverage: choice of doctor, need for referrals to see a specialist, medical conditions excluded etc.

As well as paying the monthly premium, there are co-payments and deductibles! A co-payment is the amount you may have to pay each time you see a doctor. It may be a nominal amount (for example $15) or it could be a percentage of the actual cost of the visit. A deductible is the amount you may have to pay out before any insurance payments are forthcoming and this could be around $2,000. Let me give a very simplistic example from our experience:

Take a family of four with an annual deductible of $2,000 and no co-pay:

In January you make an appointment with the doctor, you show up with your insurance card and the doctor bills your insurance company for the cost of the visit (say $145). The insurance company then informs the doctor that the patient is liable for this cost and then informs you that your deductible has not yet been met. The doctor sends you a bill for $145 which you pay and your deductible has now been reduced to $1,855. You also have to fill a prescription which costs $55. You pay the $55 and your deductible now stands at $1,800.

In February, you may need a follow up appointment and a series of very expensive tests for which your insurance is billed $2,200. You will have to pay the balance of the deductible ($1,800), but the insurance will now cover the remaining $400. The insurance may only cover 90 of the cost, ie $260. It is clearly preferable from a cost perspective to meet the deductible early on in the year rather than later.

It can be incredibly confusing and it is imperative that you fully understand what is covered and what is not before you choose a plan. With such a complicated system you absolutely should keep meticulous records of visits, prescriptions, payments paid and received etc as billing mistakes do happen and it can be very time consuming and soul destroying to go through all the records. There is a term that is used a lot in describing health plans, "consumer oriented", which in our case has meant more out of pocket expenses, but you must be an educated consumer to avoid unnecessary costs.

About The Author Anna Hall has lived as an expatriate wife in the USA for the last 18 years. Her children were born in the USA and she has recently been through the complicated process of finding a college place for her eldest child. Educated to degree level in the UK, Anna now has time to set down her experiences, good and bad, of life in the USA and she is in the process of writing an ebook, offering advice to those planning a move to America for further information see: http://www.livingandworkinginamerica.com