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Thread: Health insurance in USA

  1. #1
    Senior Member
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    Feb 2010
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    North of the 49
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    Health insurance in USA

    Hey guys. I live in Canada and visit the US often and always talk a it moving somewhere warmer to help pain and not dealing with snow in winter but I know getting insurance would be hard to get and expensive for a paraplegic. I'm just curious what you Americans pay for insurance and what does it cover. I'm 34yo male T2 para non smoker if that matters. I'm not super serious about moving but never say never.

    Thnks guys guys and gals
    Duane
    Mark 9:23 - All things are possible for those who believe.

  2. #2
    From Canadian "snowbirds" I have met in my area, I think your Canadian insurance covers you when you are traveling in the USA. Is that not the case?

    If you are talking about moving as in becoming a permanent resident, then you are looking at a huge amount of money to pay for private health insurance as a person with a SCI. Most people on these forums are on Medicare and/or Medicaid, neither of which you would be eligible for for at least 5 years after immigrating, or have private insurance through their employer, for which they usually pay some, but not all of the fees. You are not going to find many people here who purchase their own individual health insurance policy.

    (KLD)

  3. #3
    I have my own health insurance policy (though Medicare has since "taken over" primary insurance) it's something like $120 a month and doesn't cover anything until I pay $5000 out of pocket annually. Then it covers 80% of healthcare costs and I pay the other 20%. I purchased the policy pre-Obamacare/ACA, so it's probably not available any more and it was also pre-SCI when they used to be able to deny coverage for pre-existing conditions.

    Assuming you're talking about immigrating to the US (which I'm sure is a huge headache of it's own), because of Obamacare insurance companies can no longer deny coverage or charge more for health insurance policies. Immigrants also appear to be covered, but I'm sure healthcare.gov has more nuanced information than I do.
    https://www.healthcare.gov/immigrants/
    http://www.hhs.gov/healthcare/rights...onditions.html

    I'm not sure the eligibility criteria for medicare, but it's probably safe to assume that you wouldn't be on it any time soon. Many/most of us are on medicare because it happens by default if you've worked a certain number of years and paid medicare taxes (and there's probably other ways to get it, but I imagine that's how most of us got on).

    According to CNBC "a hypothetical 40-year-old nonsmoker enrolled in an Obamacare silver plan would be looking at an average proposed rate of $389.49". http://www.cnbc.com/2015/06/10/surpr...git-hikes.html Subsidies are available and healthcare.gov can probably help you attempt to figure out what you might qualify for, but it's income based, and I'm sure moving to a new country your income would be uncertain.

    This "silver plan" (which I believe is the most common) will cover about 80% of your overall medical costs http://www.investopedia.com/articles...ance-plans.asp and you will pay the rest.

    If I was going to ballpark overall cost for ye olde average para (of which I only have myself as an approximation), you're probably looking at $30,000 a year or so in medical costs assuming some regular doctor visits and a few minor complications (who doesn't have a few of those, am I right?). Which means you can pretty much bet on hitting the out of pocket maximum at 20% (most recent figures for this are 6,600 per year out of pocket maximum before plan starts paying 100%, see link to follow). https://www.healthcare.gov/glossary/...maximum-limit/

    So if you got on a silver plan you would pay a minimum of $4668 per year (just your premiums assuming you never saw a doctor or got a prescription filled) and a maximum of $11,268 per year (for covered medical stuff, which probably doesn't count a lot of nonprescription things you may need). It's probably pretty easy to get to that maximum for anyone with a disability in this country. How much your doctor will get from an insurance company for a visit and how much a hospital will get for an overnight stay are incredibly difficult to predict (even for doctors and hospitals).

    It may be sunnier in parts of the lower 48 (and Hawai'i if you've got that kinda dough), but it's the land of the highest cost medical care in the known universe... Still our system is almost as good in quality measures as the one you fellas have over there in the wintry north... almost http://www.commonwealthfund.org/publ.../mirror-mirror

  4. #4
    Senior Member
    Join Date
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    Wow. A lot of good info guys so I really appreciate it. You confirmed my thoughts, I knew it would be costly but no idea it would be that costly. Our canadian health care does cover a "bare bones" amount and most companies and employers have extra "global coverage" we get depending on insurance and also buying travel insurance is also recommended. I was considering moving is why I asked. I'm in love with SoCal. As Canadians we can be out of the country for 6 months and still be covered so that is probable more than likey the road I will take. That's insanely expensive, but the care you get with private would be on a whole different level as our public insurance. I know a few Canadians who have spent time in US hospitals and can't believe the care and attention and even food you get. Not like that in the great white north. Probable finding a nice rental accessable home and making the trip south is much more wise and cost friendly. Just would awesome not to deal with snow and cold winter time.
    Mark 9:23 - All things are possible for those who believe.

  5. #5
    Get an RV with a lift, then you can see different parts of the country during the winter months (SoCal's not the only snow-free place in February). Plus an RV on the road is probably loads cheaper than living anywhere near southern california.

  6. #6
    I get my health insurance through my employer. Do they charge people with disabilities like SCI a lot more than they do ab people for individual health insurance policies? Thought under Obama care you could not be denied insurance but guess that doesn't keep them from charging us through the nose for being SCI either.


    Quote Originally Posted by SCI-Nurse View Post
    From Canadian "snowbirds" I have met in my area, I think your Canadian insurance covers you when you are traveling in the USA. Is that not the case?

    If you are talking about moving as in becoming a permanent resident, then you are looking at a huge amount of money to pay for private health insurance as a person with a SCI. Most people on these forums are on Medicare and/or Medicaid, neither of which you would be eligible for for at least 5 years after immigrating, or have private insurance through their employer, for which they usually pay some, but not all of the fees. You are not going to find many people here who purchase their own individual health insurance policy.

    (KLD)

  7. #7
    Your insurance company cannot charge you more because of a disability.

    I'm not sure about employers, a lot of them are effectively self insured, so whatever you cost them is what they pay.

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