[Michael2016]

Hi,

as in Europe health care is free and paid by the government, I still don't understand the American system.
Can someone explain some of my questions to me please?


1. If you buy insurance from the marketplace (obamacare) you do not pay a tax penalty. If you buy a equally good insurance somewhere else, do you pay the penalty? Who says if the insurance qualifies for the prevention of the tax penalty or not?

2. I see deductibles as part of every/most insurance policies. E.g. first 5k you pay yourself, after that the insurance pays. Do I need to submit each and every expense to the insurance myself, or, do the providers like hospitals, pharmacies etc . report this automatically to the insurance and once you reached your deductible they will automatically start paying the bills?

3. Most policies say that you need to call them before you consume a service. How about emergencies? Am I supposed to first call my insurance to ask to which hospital I should be brought in case of emergency , not the nearest one?

There are many other confusing things about american healthcare which we are not used from Europe, but above questions are the most striking ones. Thanks.

[airics]

The penalty is gone in 2019

[NLVgal]

I will explain, but not typing on a phone. My new computer arrives tomorrow.

[Cold Warrior]

1. American citizens pay a penalty if they don't have insurance and they file a federal tax return. Next year there is no penalty. If you can buy the policy, it qualifies.

2. Deductibles vary greatly from policy to policy. Policies also have co-pays. Typically, you pay the copay, which is quite small, for each office visit or prescription refill. The insurance company issues you a card which you present at the doctor's office or pharmacy. If you have a major medical problem, you may be required to pay up to the deductible each year. Either way, you present your insurance card to the service provider and they bill the insurance carrier first and then you.

3. In an emergency go straight to the emergency room or urgent care center.

[lvmensch]

Michael - It is not all that complicated. What you need is a competent health insurance broker.

You are well off so you will likely chose a policy with little up front fee.

There are effectively two branches to the policies. The cheaper are plans that require to use in network providers. That is use a doctor who acts as a gate keeper and directs you to resources in the network.

The second type is plans that allow you to use any practitioner. They cost more but are much more flexible.

There are numerous variants. So find a reasonable broker and talk to them. You can also wander around for a couple of days and check out the view of 4 or 5. If you pay attention you will end up well educated. Some of these brokers are quite good.

If you want some starting suggestion DM me. Or better yet DM NLVgal. She has been in the business a long time and knows more than I do.

[Michael2016]

Thanks a lot for all the feedback, and the insurance broker makes well sense LVMensch! Sounds more clear to me now! I will be waiting for NLVgal to get her computer and wait for her valuable comments!

[cb at sea]

Any hospitals or doctors that accept your insurance will file claims for you. You may have to pay a deductible "our of pocket" for most services...but not all. Certain "wellness" tests/yearly appointments or procedures are covered at 100%.

You do need a professional to help you find the right policy for you. If you can afford it, you will want a private policy...not a "market-place" policy.

[Tek_Freek]

And research good doctors until you drop. Check for where they went to school, references from patients, ask on CD, check places like Yelp. My wife did this for quite some time and we've been pretty lucky. I dropped one doc who insisted on calling me a liar, and a second one who seemed to be milking my "heart condition" which turned out to not be one. My wife is happy with hers, but hers is cutting back to 3 days a week and is reluctant to give her meds that we know work for her.

For me communication is a problem. I am partially deaf and someone with a heavy accent might as well speak gibberish. That includes heavy southern, northeast, and a few foreigner English as a second language speakers. And people who talk fast. A sentence from them is one long sound with no discernible words. Even when I wear my hearing aids.

Or the mantra so many here chant: "Fly to California".

[JonathanLB]

Anyone have any advice on the "concierge" type of doctor service? I don't really get how that works exactly, like if you just carry a general insurance but then you pay some monthly or annual fee for access to the concierge doctor? I heard there is a lot of that in Las Vegas, I am pretty sure my dad has something like that but I'm sure it works differently. I have always had the cheapest, worst health insurance to keep the costs low because I've been to the doctor in the last decade about once, but I figure once I'm 40+ it may be worth the money to have the best service available. I just don't really get how that whole system works, especially since I'm on Kaiser right now, so when I was in Vegas it was borderline useless (no Kaiser). Here, though, it's pretty great because I have had to use the nurse's station twice and I just popped in, there's no charge, and took care of something simple, then left and that was that.

[Michael2016]

Originally Posted by Tek_Freek

And research good doctors until you drop. Check for where they went to school, references from patients, ask on CD, check places like Yelp. My wife did this for quite some time and we've been pretty lucky. I dropped one doc who insisted on calling me a liar, and a second one who seemed to be milking my "heart condition" which turned out to not be one. My wife is happy with hers, but hers is cutting back to 3 days a week and is reluctant to give her meds that we know work for her.

For me communication is a problem. I am partially deaf and someone with a heavy accent might as well speak gibberish. That includes heavy southern, northeast, and a few foreigner English as a second language speakers. And people who talk fast. A sentence from them is one long sound with no discernible words. Even when I wear my hearing aids.

Or the mantra so many here chant: "Fly to California".

Oh, so when you talked to my wife and me it must have sounded gibberish to you. So sorry, we will try to get a Nevada accent asap!