How does the US healthcare system work? (NTR)

acia · December 2010

In Canada, we don't pay anything for healthcare - if you go see a doctor or need a procedure/surgery done, you just show them your healthcard and that's that.

We're moving to Atlanta in a few months because DH got a job at Emory, and I was told they have good healthcare for university faculty - which, as naive Canadians, we took to mean that we wouldn't have to pay anything. Now I'm realizing that we'll probably have to pay something, and I'm trying to budget how much it's going to cost us.... Is there any way to figure this out ahead of time, or do you just pay as you go? Do you pay per visit/service? Like would I pay for DD's immunizations, pedi appointments, etc.? What if I needed a physical or a prescription filled? How much would this cost? If someone can give me a brief explanation of how it usually works, it would be so helpful!

(Oh, and they explain some stuff here in PDFs- I just have no idea what any of the terms mean!)

aglenn · December 2010

It looks like you will have a choice of several different plans so it is going to depend on which one you pick. There is a link for an "interactive health plan comparison" tool which will let you put in what you expect to need in terms of health care and compare how much you would be paying on each available plan. I'd start there.

xmasbabymama · December 2010

It's so complicated and it is different for every company and there are a variety of policies at many companies.

Basically you pay a premium for health insurance. It is usually deducted from your paycheck. Employers select an insurer and purchase a plan. Employers also usually subsidize some of the cost of healthcare as a policy can cost around $10-20,000 a year. I pay about $450 a month for family coverage, my employer kicks in another $800 or so. I have really good health insurance

Then your employer selects the plan options. I have a copay when I visit the dr - $15/$30/$100 for Primary Care/Specialist/ER. Then I have a deductible and an out of pocket maximum. If I choose in network (a doctor that accepts my insurance), most services are covered at 100% after I satisfy my deductible ($200 per person/$400 for the whole family). If I choose a doctor that is out of network (dr. does not accept my insurance) (I almost never do this), I am responsible for a certain percentage of the bill until I reach my out of pocket maximum ($1500). THe maximum usually includes $ spent on the deductible, but I don't really know, I don't do this.

Prescription coverage is also different at each company - there are different costs for generics vs. name brand for 30 day prescriptions vs 90 day prescriptions.

But that is just my plan. Every company has a different one and often, there are multiple plans within companies. Your DH should really set up a meeting with HR to go over this and ask you to come as well, Since you are from Canada, this is a total change for you and you will have a lot of questions that we in the US would just understand. It's really complicated.

hersheykiss · December 2010

Emory does have wonderful plans for the staff and families. I don't know what the cost is going to be, but our healthcare is $600/month. Emory is a large university so the cost may be a lot lower since they can get more people on the plans. Basically you will pay a flat fee whenever you see the doctor, usually around $25-30/visit. Vaccines and preventative care (yearly physicals, well baby check ups) are usually free, but it depends on the plan you have. I would call the healthcare company and ask them specifically.

Also, I used to live in Atlanta, if you can get doctors associated with Northside Hospital, that is the best hospital in the area. They deliver more babies per year in the US than any other hospital.

AutumnBride929 · December 2010

I don't even know what core means. I've only ever seen in-network and out-of-network. But, if your provider falls in the "core" category (whatever that means), you would pay, for example, $25.00 for each pedi visit (co-pay). This is just the first option at the bottom I clicked on so they're probably not all the same. I'm scared to tell you anything incorrectly beyond that because, honestly, insurance confuses the hell out of me and I've been in the US healthcare system my whole life.

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