US Healthcare Costs

[Huw]

I'm a British male w/cf with an American girlfriend. We have
recently started discussing marriage and a future together, and as
a result are considering where we should be based. One of the
biggest factors in making this decision is healthcare provision.
Here in the UK, we don't have the issues of insurance etc which
people in the States face; everyone, regardless of health,
contributes to our health system via tax, so when it comes to
receiving treatment (for any condition) you have essentially
already paid. What my girlfriend and I have to now decide is
whether we could afford healthcare in the United States, which is
why I am posting at this forum; I'd like to get an idea of the kind
of financial undertaking this would be.

 

To give some information, I am 25 and in relatively good health.
At any one time, I will be on about 7 types of oral medication, 3
types of inhaled/nebulised medication, and usually I have 'home
treatment' IVs once a year. This is, I envision, the sort of
treatment I will require for the next few years (although,
obviously, with time I expect to deteriorate). Also, at some point
in the not too distant future I imagine my girlfriend and I will
want to explore IVF too. My girlfriend's insurance currently offers
her 80% coverage, and it is a plan I would be accepted onto once
married.

 

 I was wondering then if people from the forum could give
me an approximation of the costs they face or of those they imagine
I would based on the above information. Also, I appreciate I could
have periods of ill health, so I am wondering how much of a burden
unexpected hospital stays etc place upon people financially.
Obviously, financial matters are rather personal and not everyone
would be comfortable discussing them on the forum, so, if
individuals would rather, they are welcome to email me at <a href=
"mailto:emailhuw@googlemail.com">emailhuw@googlemail.com</a>

 

Many thanks,

 

Huw

 

[NoExcuses]

great question. My boyfriend and I have talked about whether we should have our life togehter in the States or in Europe as well. I lived in Europe for 3 months, and my boyfriend for 24 years (since he was born). So for me, it's a no brainer. I won't leave the US because I think that I receive the best healthcare in the world.

i'll tell you my experience here in the States - obviously each person's experience is different.

i work full time, and i pay $40/month for health care coverage. I have a $1000 deductable (out of pocket cost each year until insurance kicks in) and a $15 co-pay to see any type of doctor that I would like. I don't need permission to see a doctor - I can see anyone I want at any time.

I have an annual out of pocket cost (after deductable) of $1000 - which doesn't include prescription drugs. So if I'm in the hospital, I'll only be set back $1000.

I pay $10 for 30 days of a med at a local pharmacy, or $15 for 90 days of a med through a mail order pharmacy.

I have probably some of the best insurance in the US, so I may be an acception to the rule.

But that being said, even if I had less coverage, I would be happy to stay here in the States with our type of coverage.


1. My Vest was covered by insurance. Almost everyone outside the States has to pay thousands upon thousands of dollars for theirs.... that's a huge savings right there.

2. I have access to branded meds, without a fight. My doc doesn't put me on Colistin because that's all my national healthcare will cover - my doc can put me on any med, including TOBI, that he deams medically necessarily.

3. I can go in the hospital, and any one that I want, at any time. My doctor isn't dis-incentivized by national healthcare or slapped on the wrist for admitting a patient to the hospital because of how much it costs.

4. I can see any doc I want. I'm not restricted to a certain doc in a certain location based on where I live or what's available. I'm in LA, and I can drive to SF or SD if I want to see a different doc than the one that I have right now. Or I could see both if I felt like it.

5. Doctors are paid well here, especially specialists, so they're good quality docs. My understanding is that in some areas in Europe or Canada, specialists only make around $80,000 a year. Whether you like it or not, people work less hard when they're not paid well.


Now these above states are based on MY experience.... I don't claim to speak for any other American but myself. I realize that experiences vary. And so could yours.

I also realize that my above assumptions are based on info that I have received from my European boyfriend whose parents are both surgeons in Europe. I am not saying that the info that I have for Europe applies to EVERYONE in Europe or is the same everywhere. I'm just speaking based on my knowledge.... so if it's not your knowledge, don't freak out. Same goes with Canada.

 

[anonymous]

As long as someone in the family is working and gets health insurance for both through work an amazing lot of stuff is covered in the US. What is different when you are married is how much home care is covered. In the US, if you are married it is very difficult to get home care for help with IVs or personal care. I don't believe that is true in the UK. Also disability pay in the US hinges on the number of quarters you have in the US social security system. So as a UK citizen this could be a real issue for you if you become disabled in the US. If no one can work in the family (like if your wife needed/wanted to quit to care for you if you become too disabiled to work) there is basically no support at all for the nonworking caregiver and very little for a noncitizen disabled worker.

I believe (but you would know better than me) that your care in the UK (including home care) would remain the same even after you marry. And that your disability allowance would be forthcoming if needed. Also I believe there is a caregiver's allowance in the UK for spouses who stay home to care for ill/disabled family members (tho I don't know how that works if the caregiving spouse is a noncitizen).

Whatever you decide, congratulations on finding each other and on your upcoming marriage.
-LisaV

 

[anonymous]

Insurance coverage in the US varies widely. At one end, you have people who are employed by large companies with low deductibles, low copays, and great insurance, including coverage for IVF. At the opposite end, you have people who cannot afford health insurance or cannot get it through their work because it's too costly for their employer/them and therefore, go without, hoping they'll be lucky and stay healthy. Most of us fall in between. Like Amy's insurance, mine does not require pre-authorization to see specialists so I can see any doctor I want, for any reason. My dr copays are $25 per visit, including specialists, assuming I stay IN NETWORK. If I'm in network, my meds are $10 for generic, $25 for brand formulary, $40 for non formulary brand name drugs, & 50% of cost for high end injectible drugs. Mail order is 2 times the copay for 3 months supply. I have a $500/year deductible with 20% coinsurance for most everything else. Max out of pocket, in network is $3000 excluding drugs. OUt of pocket is different. It has a SEPERATE $1000 deductible, with 40% coinsurance and a max out of pocket, excluding drugs, and a max out of pocket out of network of $6000/person. In and out of network are seperate; therefore, worst case scenario, my max out of pocket for ONE person is $9000/year plus drug copays which can easily add up to the thousands as well. For a family, max out of pocket would be double that or $18,000/year. My insurance is considered "good" insurance for a small employer. I am thankful for it, but as you can guess, with a family of 5, all of whom have varying medical issues, we spend on average anywhere from $6,000-12,000 out of pocket on medical care/year NOT including our health insurance which we pay $40/week for (and that is not a bad deal considering my health insurance costs my employer a total of $1200/month!) Like Amy says, it's nice to have access to great doctors and not have insurance dictate who I see/what meds I take, what treatment options I choose; however, unfortunately, reality in the US is that medical care is costly and insurance companies are forcing us into "managed care" that's almost as restrictive as some countries with socialized medicine. Most of us are forced into some sort of managed care. The end result is that a small few have GREAT insurance, many have decent coverage, others have horrible coverage and many have NO coverage. If you're in the "GREAT" coverage category, you're lucky... FOR NOW. Unfortunately, every year medical costs rise and most insurance companies pass on increases in the double digits. The coverage of today is vastly different (worse) than the coverage of 15 years ago (trust me I know, I shop insurance for our company.) Now just how that compares to the coverage you currently have, I don't know. But, I would think long and hard and do a lot of research before giving up your current health care for US health care.

Also, lest I get flamed, I am HAPPY I live in the US and I DO understand this is how capitalism works; however, I think thanks to our government (Republicans and Democrats alike), the democratic capitalistic nation we think we live in is gradually becoming a society of the RICH and the POOR with little common ground. Just my opinion.

 

[Allisa35]

I know everybody's insurance plan varies, but mine is a pretty good one (in my opinion anyway). It is an HMO. And believe me, I've heard some horror stories about HMO's, but I haven't had any problems with mine thus far (knock on wood). My husband just recently changed jobs but it is still through the same insurance company. At his previous job, $100 a month was deducted from his checks. At his job now, $210 will be deducted per month, which is a bit high. We do have to have a primary care physician (PCP) who then would have to refer us to see a specialist. My CF doctor is considered a specialist. I do have a good PCP who deals with a lot of CF patients, so I don't have any problems getting referrals. We pay $20 for office visits to PCP or specialist. I think it is $200.00 for ER, though I've never had to use the ER. I think it is $250 per hospital admission, but again, luckily, I haven't been admitted for 20 years. We have no deductible. We may have a out-of-pocket, but I'd have to look. We do have to use a specific hospital. I think it is paid at 100% after the admission fee. I think they would pay a portion is we used an out-of-network hospital. They pay 80% for durable medical equipment, but again, it has to be purchased through an approved company (and I have never had to purchase anything, yet). For prescriptions, we pay $9.00 for generic, $18.00 for listed brand-names, and $36.00 for non-listed meds. We do have a mail order pharmacy. You can get a 3 month supply for $36.00. I have to use this pharmacy for my Pulmozyme, which I really hate. We have had some problems with them regarding my husband's meds, but that's another story. All in all, there are apects about my insurance that I love and aspects that I hate. But I am thankful to have it.

Just another note, my husband had applied for another job where the insurance would be $190.00 a check ($380.00 a month). Needless to say, he wouldn't be able to take the job because we can't afford the insurance premium.

I know places are different. Some have great insurance and others have crappy insurance. If your soon-to-be-wife has good insurance here, I wouldn't hesitate to use it. I guess I need to pull out my book and refresh my memory as to what we have regarding out-of-pockets and such.

 

[anonymous]

i don't want to start anything but our son's consultant said the treatment for cf is better in the uk on the whole because in the usa you will only get what the insurance company will pay for. janet uk

 

[anonymous]

janet, i think it varies widely. like allisa said - some have horrible insurance and some have great insurance.

i think it comes down to if you are going to have crappy insurance in the US, the UK is a better option. if you have good insurance in the US (that will pay for anything), the US is a better way to go.

I think it's just so individual it's difficult to give a black and white answer.... people's situations are just so different.

 

[anonymous]

ooopsie that was me, amy

 

[anonymous]

amy, you might be right there. i requested a vest and was told they would'nt supply one on the nhs on cost grounds. we certainly can't afford one. from what i've read on these boards peeps are generally in favour of them. sorry to hi-jack your thread huw, are you welsh? you spell your name the welsh way!!!!!! janet uk<img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[anonymous]

Hi Janet, Welsh origin yes, but based in London.

As it stands at the moment, I think I'm having to face up to the fact that I've never been left wanting for anything healthcare wise here in the UK, and it seems such a gamble to give all that up and undertake potential financial hardship for the same end result. Fingers crossed the missus will see it that way too...

 

[anonymous]

hope you don't mind me saying huw, i think it would be wise to stay in the uk,after all you have already been paying your ni contributions in the uk. you would never have to worry about the financial implications of having cf. i hope you can work something out with your girlfriend. take care, janet uk<img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[Huw]

I think I coming to the conclusion that I agree with you Janet. It
makes me feel very impotent, having cf decide these things for me.
Were it not for the cf, I would love make the move, yet because of
it my options, and those of my girlfriend, are limited.

 

[anonymous]

my husband and i are had dreams of retiring to spain or somewhere else on the med (will retire in approx.15 yrs) in the not too distant future. of course it would be really good for our son too. (he's 8 now) i can't see it happening though, we want to stay where he will get the best care. take care janet uk<img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[NoExcuses]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>anonymous</b></i>

you would never have to worry about the financial implications of having cf. i hope you can work something out with your girlfriend. take care, janet uk<img src="i/expressions/face-icon-small-smile.gif" border="0"></end quote></div>

man i would have huge financial implications of having CF in the UK.

If i didn't have my Vest, my health would be in dire straights. And paying cash for the Vest would put me in deep financial doo doo....