Go Ahead- Explain US Health Care To A French Guy!

by Kelly · 5 comments

in Notes On Culture

While my husband has always been interested in moving to the United States, this vacation has only reinforced his desire to do so. Add that to my, shall we say extreme, desire to move back and you find us checking online job offers and brainstorming timelines.

One of the issues that most concerns my husband about moving back to the United States is health care, or rather how the health care system works. He doesn’t understand it and I’m having a hard time explaining it to him. My last job with American benefits was about twelve years ago, when I was single and childless, footloose and fancy free. I honestly can’t remember anything about the plan other than it was with an HMO (Kaiser Permanente) and I thought that it was fairly good.

My mother tried to explain a bit about how the health benefits work at her job, but as a single woman with no dependants to cover, what she was able to tell him wasn’t very useful. Add the fact that, as a computer geek he’s hard-wired to look for concrete data and you have a recipe for frustration. He keeps asking: “But what’s the minimum it could cost per month? What’s the maximum?” Saying “It depends” just isn’t cutting it anymore.

So I’m throwing the questions out to you, dear readers. What do you think a foreigner should know about health insurance in the United States? Do you have health insurance? If so, what is your plan like? Does it cover just you or your whole family? How much do you have to pay, both in employee contributions and out of pocket? If you don’t have health insurance, why not?

Go ahead, I dare you to try to explain the US health care system to my husband, a French guy. And next Sunday, I’ll do my darndest to explain the French healthcare system, with its low payments but staggering amount of debt, to you.


1 L@SpillingBuckets April 20, 2008

I have health insurance through the my job at the local University. So this isn’t totally the same as most companies(academia isn’t corporate), but it is still “American Healthcare.”

Until January 1st of this year it was 100% free for me with healthcare totally covered by the University. Then this year they said costs rose too much, so I have to pay a little each month.

With the new plans we had four options, and each one had a slightly different amount that I would deduct monthly from my paycheck (pre-tax) with different benefits.

There was a high deductible/low monthly payment plan, a mid deductable, and a low deductable. There was also one (the most expensive) co-pay plan. I am sinlge without dependants, but for slightly more a month you can cover a spouse or a whole family. I think most companies have this flexibility. For me dental and vision insurance is still 100% included.

So, to explain to your husband… each company has different options, and many companies have several to choose from. Some are more pricy than others, but it really depends on the company itself and what it is willing to offer. And you can opt out of the company plans and buy your own insurance if you wanted to.

If you need to see a doctor quite often then you should choose a low deductable or co-pay plan. But if you are healthy and your kids are healthy and you don’t see doctor’s visits as coming up very often, then go for the cheapest plan you can get.

There isn’t one maximum price or minimum price here. And there are probably 100’s (if not 1000’s) of options to choose from. That’s what’s nice about the US system, you can choose the best plan for your family’s needs and shopping around gives you lots of great choices.

Unfortunately for your husband there won’t be “hard data” to look at until you have a job and see what benefits they offer or you call a specific insurance provider and see the plans they offer as buy-your-own.

Does this help at all? What exactly is it he doesn’t understand?

2 Kelly April 20, 2008

Thanks for the comment. I think the hardest thing for him to grasp is the fact that I can’t actually give him any numbers, because of course we don’t have any specific job offers from specific companies with specific health plans. So I say “Well, it could cost nothing, or it could cost thousands” and he wants to know which one, or where it would fall in the middle, and it’s frustrating for him that I can’t answer him.

3 Mrs. Micah April 21, 2008

🙁 It’ll be over $1500 and less than $2000 for just the insurance for us. Plus a deductible of up to 2,400 more and then some copays after that. So about $4000 estimated…plus copays after that. Of course that’s just two adults. And it’s without a company helping out.

4 Anonymous April 22, 2008

There are two situations. Or you have to buy health insurance yourself, or your employer buys it for you. The most expensive scenario is if you have to buy it yourself. This is the case if your employer doesn’t provide benefits, usually if you are part-time, or if you are self-employed. The costs vary in general, and they vary by state. Usually you have a few options. You can get an HMO plan, a POS or PPO plan, or a deductible-based plan. In an HMO plan, probably what you had with Kaiser, you have a network of doctors of every type. Going to the doctor will always cost you only a co-pay. Depending on the plan you buy, the co-pay will be something like 10, 20 or 30 dollars. In an HMO plan, you will always need a referral from the primary care physician in order to see a specialist.
The other extreme is a deductible based plan. In a deductible based plan, you will have a high deductible, and probably low monthly payments. There will be few limitations on which doctors you can see. But when you go to the doctor, you will pay full fare. Full fare with a discount from your insurance, because your insurance will let them charge less than they normally do. But full fare. So maybe $110 for a normal doctor’s visit. Once your health costs have reached a certain level, the deductible, the insurance will pay a certain percentage of the costs, let’s say 90% of the cost. Typically there is also a yearly maximum, so once you have paid x amount, the insurance will pay everything else. A PPO or POS is in the middle. You usually will have a network of doctors you can see, and you pay a co-pay for some services (maybe well doctor visits) and then you have a deductible for other services, like surgery. After you have reached the deductible you will pay a percentage of the costs, as in a deductible based system.

When I worked for a non-profit, they paid for my whole health insurance costs. So I paid 0 in insurance and only paid if I went to the doctor. Most companies pay a portion of insurance costs, and you pay a portion. Right now we are getting insurance from my husband’s work. We pay around $130 for the two of us each month just for the insurance coverage (his employer pays the rest). It is a PPO plan, so for routine doctor’s visits we have a co-pay of $30, and we have an annual deductible of $600.

There are health care savings plans that you can pay into each year before taxes (but you have to use all the money in the given year–use or lose). You can also deduct medical expenses on your taxes IF you itemize.

Liz Pulliam Weston has written about which type of insurance plan you should buy and why. Basically she tends to say that since it is insurance, you want to pay as little as possible every month, and have a high deductible, because the point of insurance is that it is there in emergencies. Not when you have $600 worth of bills, but when you have $100,000 worth of bills. People make their own decisions, though.

I sympathize with you. My husband is not American and this is very confusing for him, too. Basically there is no way to know exactly what you will have to pay, because it depends on the plans available to you (each employer will likely have only a couple of options). But for us as I said it is $130 per month deducted from my husband’s pre-tax pay. Then for most doctor’s visits it is $30 each. If we need surgery we have to get to a deductible of $600 before it starts to work in a they pay 80% we pay 20%. At that point I believe we have to pay up to $1000 of medical expenses and after that everything is covered. So the maximum would be around $3000 per year plus doctor’s visits.
My mom does not have medical insurance through her employer. She is thirty years older than I am and is a cancer survivor. She is paying $850 a month for a deductible based plan. So as you can see, the costs are very different based on situation and if your employer covers you.
Good luck!

5 Starrparis April 22, 2008

Hi Kelly and Eddie,

Lisa here. The answer really is “it depends.” When you do get the job offer call me and I will help you choose a plan. Most employers offer a cafeteria style plan. Because our health care is unregulate you are at the whim of the employer. You can have contributory or noncontributory plans. No deductible or considerable annual individual/family deductibles. Hi/Lo/No co-pays. The health care savings funds that anonymous mentioned break out into 2 sorts: out-of-pocket expenses and employee contribution for premiums expenses. Both can save you quite a bit at tax time. I spent 15 years negotiating health plans. A single payer plan is the only fair and equitable solution but I don’t know if we’ll ever have it. As you know, I have experience with the French system, too. Bon chance!

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