US Health Insurance Recommendations for Dependents

[biisis]

Perplexed Canadian here trying to figure out how health insurance works in your fine United States of America. While I'm happily covered by NYU's generous funding package, my spouse needs papers to get past the boarder and presumably also to live in this strange healthcareless land. The easiest thing to do would of course be just to add them onto the NYU student health plan. However, at about $10,000/year, and without access to the student health clinic where a lot of services are free, this seems like a supremely bad deal. Am I right in reading it that way? Does everyone pay obscene prices for medical insurance in the states? Why don't you just have federal health care?

 

To add to the confusion, I can't access the New York state health insurance marketplace website from out of the country, which rather significantly impairs my ability to do comparison shopping on insurance alternatives (assuming that we'd be eligible, I'm not even sure). Does anyone have any excellent health insurance plans/providers to recommend? Any advice on how to negotiate these strange waters?

 

Many thanks from the land of free hospitals and maple syrup.

[psych21]

Fellow international student here, who (somehow successfully) navigates the (very dumb) insurance world. Without employer sponsorship and without access to the Marketplace the NYU plan might be your best option (believe it or not...). Given your stipend as a student you'd probably be eligible for Marketplace plans, but shouldn't count on it until you can really apply. However, the Marketplace is closed now, and will only open again in November.

Federal health care and free hospitals seem to be curse words for some people in this country, I wouldn't say them out loud too often.

[TakeruK]

Fellow Canadian-who-is-confused-about-US-health-care-especially-for-dependents-here

 

Yes, adding a dependent onto your student plan is a supremely bad idea. For my spouse, we were paying $7200/year just for coverage (we paid about a thousand more with copays). The school even says this is a terrible plan, but I think something like less than 5% of all students on campus have dependents enrolled in this plan. The way it works is that the Health Insurance companies want to collect $X dollars from students and only pay out 60% of that in benefits. So, they determine premium rates by figuring out how much they are likely to pay, add their 40% revenue margin and then divide the remaining number amongst everyone enrolled. Thus, for a plan with a low subscriber rate (e.g. dependents), a small fraction of people with expensive bills will cost the company a lot, and so the rates are insanely high.

 

For the last 1.5 years, we were forced to use this plan because of insurance company refusing to cover my spouse due to pre-existing conditions. 

 

Luckily, you are starting this year and not last year! You should get your spouse enrolled in a "Affordable Care Act" plan, also known as Obamacare, or a plan from "the Marketplace" or "the Exchange", or "CoveredCalifornia" (only in California, of course). You don't need to be an American citizen to be covered (although perhaps this might also vary by state), for us, we just need to prove legal non-resident status (via our I-20 or DS-2019). 

 

The above person said something about eligibility based on income, and note they will consider each person individually when it comes to determining eligibility (again--may vary by state?). For us, there seems to be no income limit on eligibility, but there is an upper limit on how much income you can make before you are no longer eligible for the subsidies that reduce your costs (but they are very reasonably priced even without the subsidy--we now pay $220 per month for my spouse's plan). Instead, the criteria for eligibility was that one is not eligible if their school/work offers a subsidized plan (so I was not eligible as my school pays for a large portion of my student health plan). 

 

As the above person said though, the marketplace won't open again until November, so for the first few months, you should get your spouse covered under a private plan. Contact some of the major providers and you'll speak to a broker that will "help" sell you a plan. If you just treat buying health insurance as if you were buying car insurance, then I think it will make "more sense" how the system works (or doesn't work ). If you cannot get your plan through a private company for whatever reason, then it might be a good idea to sign yourselves up for the student plan and then drop out of it as soon as you can. For my school, I must stay on my plan for an entire year, but for dependents, I can add/drop dependents from my plan every 4 months. So, if this is the case at NYU, you might want to do this for your spouse until the Marketplace opens.

 

Here are some tips for choosing a plan, that we have learned the very hard way (i.e. paying much more money when we didn't need to):

 

1. Most plans do NOT allow you to see any doctor. PPO plans give you more options, but you really have to check with the doctor pretty much every single time that they are in your health insurance provider's "preferred network". If they are not, you may not be covered at all, or you may be covered at a much lower rate. Doctors sometimes drop out of plans unexpectedly, so you really need to check each time you make an appointment.

 

2. Unlike Canada, you will basically have to pay some amount every time you get treated for anything. Your total health cost will not just be equal to your premiums! My student plan, which is pretty decent, means I pay $15 plus 20% of most doctor visits. This means every time I see the doctor, it costs me about $30-$50 out of pocket. Every time I see a specialist, it costs about $50-$60. Plan for this! 

 

3. Related to the above, be careful when picking health insurance plans. You really have to treat it like car insurance . That is, it might be better to get a plan that covers fewer doctor visits and pay e.g. $2000 per year plus $50 every time you see a doctor instead of a plan where you pay $3000 per year plus $20 every time you see a doctor. 

 

4. Doctors will actually try to "upsell" you on treatment and services sometimes. Really. And doctors offices sometimes have a financial manager that can help you figure out a payment plan for big procedures. Unfortunately, the reality in the US is that many people here feel like it's basically your fault and your responsibility if you get sick! 

 

Fortunately, the ACA really changed a lot even for non-Marketplace plans so people entering grad school this year will hopefully have an easier time!

 

If you have further questions about specifics you can reach me by PM if you don't want to reveal private details in a public place

[biisis]

Many many thanks for your sagely words!

[juilletmercredi]

Why don't you just have federal health care?

THE ETERNAL QUESTION

The answer: Because death panels and we have the best healthcare in the world do you want to mess that up?!

...no, really, it's because rich Americans believe people should die in the streets before they fork over a couple of extra dollars to cover cheap preventive care.

Okay, I'm bitter.  My suggestion was going to be to use the new health exchanges set up by NYS as well.  You may want to purchase just one semester of NYU's coverage (or purchase a "catastrophic insurance" coverage plan for the first few months, which is terrible coverage at low prices - although many of those plans are going by the wayside due to our new health care laws).

To add to TakeruK's comments

1. In order to find out whether new physicians take my insurance, I usually check online.  Most doctors have websites these days that state it; you can also use ZocDoc.  In addition, every insurer I've ever had (three as an adult) has an online directory through which you can search for doctors that are covered by your exact plan.  Theoretically you should check every time you make an appointment, but in my experience the doctor's office staff always informs me if my insurance is no longer covered because they want to get paid.

2. One of the very distasteful things about U.S. healthcare is that you pay when you walk through the door.  Many doctor's offices are now collecting payment before the doctor even sees you.  I had to get surgery and my specialist cost me $40 a pop, and they always charged me before he showed his face.

The ER was $50, and I've been on plans where ER visits were $100 a copay.  You also pay a set copay for medicine you pick up at the pharmacy; it's set in tiers.  My old plan's tiers were $10/$25/$40, so the cheap generics were $10 and the expensive brand-name medications were $40.  I have no idea what my new plan's tiers are and I hope to not find out.

Another thing to note is that most health insurance plans DO NOT automatically cover dental care and vision care - you usually have to purchase them separately.  They are pretty cheap compared to medical care - my school-sponsored dental plan was $250 for the year and covered 2 cleanings and some percentage of some emergency dental care.  Crack a tooth, you can probably get it repaired for a discounted price; lose a tooth completely and need dental prosthetics, and you have to pony up.  Same with vision.  I actually don't have vision coverage right now because my medical plan only covers eye emergencies - like if I physically injure my eye with something sharp, but my university also does not have add-on vision coverage.  If your husband wears eyeglasses, that may mean paying out of pocket for glasses - which is what I have to do.  I actually need new glasses now but I'm trying to wait until August when I start my postdoc and thus my new vision plan.

I've been with three different health insurance companies - Cigna, Aetna, and Blue Cross/Blue Shield.  Aetna is the best, IMO.  Of course, it depends on what plan you get, but I find their customer service reps reasonable and friendly and helpful, and their coverage was good.  I hated Cigna.  They were the ones with the $100 ER copays.  BCBS is *shrug* in the middle.  Decent coverage, no complaints.

[biisis]

Haha, thank you for the recommendations and the levity. I'll definitely check out Aetna. And try to stock up on all forms of medical care and prescription medication before I leave the country, like a camel preparing to traverse a long and thirsty desert. 

[TakeruK]

I would also second the recommendation on Aetna, they have been our school's plan provider for the last 2 years but next fall, the school has decided to switch to United HealthCare--we'll see how that goes!