Health care Canada vs US - Experiences, Truths, Myths (mortgage, home)

[StuckPA]

So exactly what Is the deal with the 'mandatory taxes' in Canada that supposedly allows everyone health insurance? For example I can't afford health insurance here so it's not taken out of my pay or worked into taxes,therefore I receive more money in my pay and pay less taxes in general. Does living in Canada mean I will be 'forced' to pay for health care through the taxes etc. even though I am young and do not utilize the healthcare system as much as others? And if so,how much more taxes do Canadians pay vs in the u.s. in general? I do know that taxes seem to be rising here more and more.

[Cornerguy1]

Of course a certain amount of your taxes will go for healthcare, just as a certain portion of your tax dollar will help fund schools. Your age or health has nothing to do with it, just as the number of children you have in the school system has no bearing on the amount you are required to pay to support the education system.



It's not as simple as "mandatory taxes", stuckPA.

First of all, you generally pay 2 types of income tax: federal and provincial.

Secondly, the health care system is administered by each province, so you have 10 different systems with 10 different funding models.

Thirdly, the federal government gives various amounts of money to each province in the form of transfer payments to help fund the healthcare system.

In a broad sense, here's how it works.

Each province funds its healthcare system out of its general tax revenue. That revenue is generated by income tax, sales tax, taxes on gasoline, etc, etc.

The province of Ontario has decided that people who earn above a certain income threshold should contribute a certain percentage in the form of a health care tax which is levied with your income tax.

For the 2005 tax year the Ontario Health premium is as follows:

Taxable Income less than $20,000 = $0
Taxable Income between $20K and $25K = 6% of the amount over $20K
Taxable Income between $25K and $36K = $300
Taxable Income between $38K and $48K = $450
Taxable Income between $48K and $72K = $600

The maximum payable is $900.


Income tax rates are roughly as follows:

Federal Income Tax

Income tax for $36,378 or less: 15.25% less various deductions and credits.

Income tax for $36,378-$72,756: $5548 + 22% of the your taxable income minus $36,378 --- and the usual deductions and credits

Income tax for $ 72,756-$118,285: $13,551 + 26% of your taxable income minus $72,756 --- and the usual deductions and credits

Income tax for over $118,285: $25,388 + 29% of your taxable income minus $118,285 --- and the usual deductions and credits


Ontario Income Tax

$34,758 or less: 6.05% less deductions and credits

$34758-$69,517: $2103 + 9.15% of your taxable income minus $34,758 --- usual deductions and credits

$69,517 and up: $5283 + 11.16% of your taxable income less $69, 517 --- deductions and credits



So if you have taxable income of $34,758 0r less in Ontario, your base income tax will be 21.3%. From that amount you will deduct various credits and the amount of income tax withheld by your employer throughout the year.


A married couple with taxable income of $34,000 is likely looking at paying in the neighbourhood of $2,000 -- $3,000 after credits and deductions are taken in to account.

[Evlevo]

The Canadian system is set up to make people healthy,

The US system is set up to make $$$.

I am in the US (and look enviously towards the Canadian system) and have Kaiser Permanente insurance, about the closest comparison to the Canadian system. My employer has a cafeteria plan (meaning they pay a set amount and you can choose from one of 5-6 plans and pay the difference - Kaiser is the cheapest) Everyone I work with complains non-stop about how long they had to wait for a procedure, how much of a hassle it was to go through your primary care doctor, etc. And you know what? Kaiser patients have been proven in studies to have the best health care in the country. I absolutely love the care, and would not settle for anything else.

When you "impulse buy" healthcare it is alot more expensive, and for the same reason that groceries cost a lot more at 7-11 than Safeway.

[lalla]

Hi All:

1- In Canada in general and in British Columbia in particular:

If i want to see a doctor and I do not want to wait, can I find a doctor whom I can pay from my own pocket OR doctors are not allowed to provide private services?

2- If I live in Canada and want to buy a health insurance in the US in case of need (a back up plan in case i want to receive a prompt healthcare, or in case there is difficulty of access to medical technologies in Canada?), what are your recommendations in this case?

Thanks ALOT

[Moose Jockey USA]

1- In Canada in general and in British Columbia in particular:

If i want to see a doctor and I do not want to wait, can I find a doctor whom I can pay from my own pocket OR doctors are not allowed to provide private services?

There are many "emergency Clinics" and "Drop In Clinics" staffed by doctors that do not require you to have an appointment. They also do not require that you have a family doctor. This is common across Canada, especially in major urban centers. Surgeries and procedures are a different matter.


2- If I live in Canada and want to buy a health insurance in the US in case of need (a back up plan in case i want to receive a prompt healthcare, or in case there is difficulty of access to medical technologies in Canada?), what are your recommendations in this case?

In this instance you would be shopping for healthcare providers in the US much as if you lived in the US. Your Canadian insurance will not cover non-emergency procedures in the United States, and travel insurance at least is heavily recommended. For some procedures, if you have the money, and depending on which province you are from, it is quicker to have the procedure done in the US, if you can afford it. It's in situations like these where you have to go over your policy with a fine tooth comb and speak to both your Canadian and American insurance providers. We recently found ourselves dealing with a substantial health issue only to discover that our Canadian Health insurance would help us return to Canada for treatment, but not cover ANY of the cost associated with being treated here in the US.

[Cornerguy1]

If i want to see a doctor and I do not want to wait, can I find a doctor whom I can pay from my own pocket OR doctors are not allowed to provide private services?

Generally doctors are not allowed to provide private services.

The rationale is that if doctors were allowed to take money from both the provincial health plans and from private patients, then some doctors would be tempted to service privately paying patients first, and this would destroy the universality of health care.


In each province, however, there are certain medical procedures which doctors are allowed to perform privately. These procedures would likely be not covered under the provincial fee schedule, and would be deemed as discretionary procedures.

For example, facelifts, tummy tucks, and other cosmetic procedures may only be available on a private patient basis.

[Gio850]

I was fortunate to have Kaiser Ins. in California when my wife was struggling with cancer. She was ill for more than 3 years. The US law allowed her to continue her health ins. for one more year after her job ended. That law was called Cobra. After Cobra ended, my Kaiser ins. took over and paid everything for the duration of her illness, including all hospice costs. I felt that I was very lucky to have the Kaiser HMO.
Nobody expects such a tragedy to hit their family, (I for one, assumed we were invincible) , but that's what insurance is for. I feel sorry for people who get poor coverage to save on health costs, because they are taking a gamble.
I also heard about people in New Orleans losing their jobs and getting sick, both as a result of hurricane Katrina, and then saying they couldn't get medical help because they had lost their insurance and jobs and had no more savings. I think they should have had Cobra so maybe they just didn't know about it. Cobra isn't free, but it shouldn't have expired that fast due to lack of paying the premiums.
Unfortunately ins. premiums in the US do go up as you get older, as well as according to your medical conditions. Unless the laws have changed in the last couple of years, i don't believe it is illegal for the ins. companies to do this, and that they all do it. This could be a problem if you wish to, or need to, retire early. I'm not in the US now, but I believe the ins. premiums on a private policy between ages 60 and 65 would now be around $650 per month??? depending on the coverage.
Sorry, but the (visible) monthly premium in Vancouver, BC is the same regardless of age and regardless of preexisting conditions. It is $54 CAD and is without any yearly deductible or yearly copays...as far as I know, there is no lifetime max benefit either.
I'm not qualified to compare taxes but I think the important thing here would be to add together your taxes and your health costs in the two countries if you want to do a comparison.
Hope some of that was helpful.

[sunsprit]

USA age 60 male, full medical coverage with $15 co-pay per office visit, $1,000 yearly deductible for major medical, yearly dental and optical routine exam and eyeglass allowance, elective surgery not covered (such as cosmetic surgery, vision correcting surgery LASIK, etc), pharmacy coverage for listed meds at $15/perscription; limitation: must use a listed care provider if available, otherwise must get pre-approval which may not always fully pay for treatment: $279 per month.

That's through my wife's group health plan. On the open market for me singly, I can get similar coverage for around $325 per month with a higher annual deductible (which is OK by me). Of course, there's plans available for much more with low deductibles, but I have no justification to get "first sniffle" coverage.

USA open market medical insurance rates vary by coverage, deductibles, and each state's insured pool statistics. States that mandate insurance specific coverage requirements can drive up costs for insurers, hence increased rates for the insured; ie, full pregnancy & natal coverage for my wife, even though she's not capable of becoming pregnant (and a little old to be starting a family, too) is required by our state for all females of (potentially) child bearing age.

This is significantly more expensive than the Canadian system cost, but I receive prompt medical attention and diagnostic tests as needed on demand in non-emergency situations. Should I need cancer treatment, or a hip replacement, or similar major medical treatment, I'll receive it promptly.

[Gio850]

To Sunsprit --That was good of you to look up the insurance rates in your state for private policies while you are fortunately covered by your wifes work policy.

I will be returning to the US shortly, and I am very interested in checking out the company that you are quoting, as I was paying much more than that 2 years ago for Kaiser Ins., although I'm a few years older than you.

Please post more details of the $325 per month policy that you have found...what state...what ins. company...and if you don't mind, post the link to the site, so that I can look it up for my own age and health conditions.

For anyone considering a move to Canada, I suggest you don't go there if you are in need of a hip or other kind of joint replacement. You will wait...I have heard it is at least 2 years?? Canada doesn't consider joint replacement an emergency and you will suffer a lot if you need to wait that long for it. There have been other problems lately that make the BC news broadcasts, mainly emergency room waits.

[sunsprit]

To Gio850 ... thank you for the kind words.

Unfortunately, I don't have the name or contact info for the insurance company for that $325/month policy. That rate was quoted to me last year by an independent insurance agent in Cheyenne, WY, and I don't remember which insurer he said was writing that policy for a self-employed individual (me). I was shopping then for new medical coverage and the "benchmark" was adding me at full cost to my wife's employer provided policy coverage. My previous medical insurer was leaving the Wyoming marketplace and had cancelled all policies.

The insurance rates are not set by the states, they're set by each individual insurance company and the package that they're offering ... which will have many variables as to deductible, covered medical expenses and state requirements.

I know that I could obtain comparable coverage in Colorado for less money than Wyoming because Wyoming has laws regarding malpractice which the insurance industry views as unfavorable to doctors and the practice of medicine. It's been a "hot" issue in the state legislature the past few sessions as it's perceived to be keeping a lot of doctors out of Wyoming.

Also, I know from prior shopping that KaiserPermanente is one of the most expensive and costly medical insurance providers in the business. That's because their policies are full service with only a per visit minimal charge, and it's "first sniffle" coverage. Great deal for people with families who demand a lot of routine medical care for minor stuff all the time. Kaiser operates their own hospitals/clinics ... for example, in Denver they have several facilities with general and specialists on staff in-house.

In my case, however, my wife and I are very pro-active about managing our health and rarely require professional medical services. We use homeopathics for most of the minor stuff that has many people heading to a doctor's office, and use them sparingly. (by the way, the homepathics as needed for minor ailments seem to work better for us than conventional medicine. My angiogram proves a better cardiovascular system function at age 60 than many 20 year olds today. I recently applied for a new independent rep line and the DM thought I was around 45. At 60, I'm planning on another 10-15 years of full time rep'ing ... working by choice, I could have "retired" years ago. As far as I'm concerned, working less than a 60 hour week at something I enjoy this much is "retirement").

So, my insurance shopping is for a major medical coverage policy with a large annual deductible and a reasonable lifetime "cap" for services. I figure a couple of million bucks is adequate for a cap, which limits the ultimate exposure of a health insurer.

It's not an easy marketplace to shop for major medical coverage, especially as a single purchase. You will have to shop the wares of many independent and captive agents to obtain your "best" deal in any given state for your needs. The pricing can and will vary widely. Don't forget outfits like BCBS, they may have a great rate for you (they did for me when I was in Colorado).

Happy insurance hunting .... this can certainly be a major factor in determining where to locate in the USA when you return.