How does health insurance work in the States?

[OzFreeBird]

Hi all

Over the last few months I've been reading many times about health care bill problems on FV. Most of the problems stem from overwhelming hospital bills or medical insurance.

Would someone mind explaining to me how health care works in the States? In Australia we have government funded (and subsidised) health care, which is calculated as a levy on each individual's taxable income (2 or 3% of taxable income I think). Most people also have private health insurance to cover choice of doctor and extras such as dentistry, optometry, physio etc. Every person, no matter how rich or poor, is entitled to public health care. This does not mean however you receive "quality" health care (if there is such a thing anywhere in the world). It seems that it is quite different in the States?

Thanking in advance

[geckoace]

we do not really have a public healthcare system. except medicare (for the elderly) and medicaid (for low income and other situations i think) and here in Maryland where i live (and i imagine lots of other states) we have women and childrens health services, so if you are lower income and under 18 the state covers you or if you are pregnant they cover you until you give birth and then you can apply for birth control only stuff.

Generally people get insurance through your employer and they pay some or all of the premiums and you are responsible for co-payments and deductibles. if you get it on your own you pay significantly more for the premiums.

We have HMOs which require you to see specific doctors and has much higher premiums but most things are covered except co-payments (sometimes it takes a fight and alot of paperwork though)

the there is the other kind (the name of which escapes me) where you have a set amount you are responsible for per year (deductible). then once you have reached your out of pocket maximum, it pays a portion of your bills beyond that. thats the cheapest way to go as long as you never get really sick.....sigh

i hope that makes sense maybe someone else can explain it better

[i.m.cheap]

Then there are people like our family... We are low income, but not low enough for any medical assistance except for Molly (age 10). We make less than $25,000 a year. My DH's employer does not offer health insurance, or any other benefits. We can in no way afford to buy our own insurance, it is much too expensive. We do without, and hope no one becomes ill.

[Michelle68]

This is one reason I work for a hospital system. Our insurance "only" runs $340/month for the family, as opposed to around $600/month at the last company I worked for. As Deb says, in the U.S. even if a company offers insurance for it's employees (and they're not required to do so) many times it's too expensive for the employees to have it.


--Michelle

[OzFreeBird]

Thanks for your replies, I'm still a little in the dark though....

For the average person who has an accident and ends up in an ambulance and then emergency and then in hospital for say 10 days (ie: a non-elective, life threatening incident), who pays?

100% you?

You and the government?

You, the government and your health insurance company?

[jamie79]

The government would not pay anything in a situation that you described. If you have no insurance then you have to pay for everything. If you have insurance depending on what kind most insurances would pay 80% of the cost and you would pay 20% of the costs after the deductable. People in the states loss their homes, jobs etc after a catestrophic health issue. There is Medicare for the elderly but it does not pay for alot of things and the things it does pay for it doesnt pay them fully. Also it pays doctors at a much lower rate then their charge so thats why alot of doctors dont want to take it.

[Michelle68]

Welll... it all depends on if the average person has insurance. If someone is in an accident and goes to the hospital, the cost of that hospital bill will either be paid by a.) if that person has insurance, the insurance company will pay for the majority of the bill though the person will still be responsible for "copays" or a deductible. Or b.) if the person does not carry any insurance then the person is responsible for the entire hospital bill, including medications, supplies, etc. This can be financially debilitating and any debt that's not paid can go on a person's credit record. Many times payment arrangements can be made with the hospital or doctors.

The government does not cover any of this unless, as Geckoace said, a person qualifies for Medicare (65 years and over) or Medicaid (they are below the federal poverty level).

--Michelle

[claimsgirl66]

The prior posts explained it quite well. The reality is alot of us get into or stay in careers mainly for the health insurance benefits....unsure if that is true in other countries. Also most private health insurers have separate deductibles. My employers increased the Emergency Room deductible to $1,000, (yikes!) and it does not count toward your regular annual out-of- pocket deductible. Guess it is not perfect any where.

[pkellyc]

And this is why we talk so much about heath care reform.
I believe in it. I know young people who go without health care.
Elderly who run out of their medication before the month is out and just go without it.
It's just a big mess.
My dd fell down a flight of stairs and went to the emergency room. (if I had only known I would have stopped her) She is now stuck paying a $900 + bill for a couple of bruises.
For those who go without, if anything should happen that would require hospitalization it could financially ruin them for the rest of their lives.

[Jellybeanz]

I have no health issurance since my divorce a few years ago, so I can tell you what happened when I had a tumor on my thyroid and lymph nodes that the doc thought was cancerous ( turns out it wasn't , yay !)

The medicaid for low income doesn't apply to all states. Everyone said "go apply for medicaid". By the way, I was unable to work for the second half of last year from the symptoms( sent my entire immune system and metabolism out of whack) .

Well to make a long story short, I looked into applying and was stopped short by the requirements. I would have fared better if I had been from another country and came here and applied. I would have only had to wait 90 days and I would have been eligible. Nobody could believe I couldn't get it. I do think some states do allow a person to use it temporarily below a certain income level. Mine was $0.

I got my surgery thanks to a doctor who found a special vocational program and got me in it on certain conditions I fulfilled after the surgery. The vocational program is wonderful btw. Our health care system sucks though. :-)

I never really knew how valuable health care was till I didn't have it....... We need a national health care system or people are going to die!

I had a friend whose cousin didn't have health insurance and she had some sort of colan cancer I think. She waited for six months before some sort of charity was located that helped her have a surgery. She has one of those bags now, but she is alive.

This can happen to anyone , trust me. As health care cost rise, more and more families will be forced to do without health insurance to be able to eat. I think it will take a large majority of people affected though before we really start hearing enough noise to force change. Even the AMA backs a national health care program I believe...........

Sorry for the long reply, it's really a touchy subject. It's horrifying to be told you have cancer and you don't have health insurance. I know there are places that people suffer far more, but the money the US wastes could easily pay for everyones healthcare. That is the shame of it all......

Okay, off my soapbox .

[OzFreeBird]

Yes this is the bit I don't understand...the States is (supposedly) the most wealthy nation on the planet and a "superpower" (whatever that means these days) yet it doesn't look after its own citizens? Doesn't make sense to me and seems to be very false economy by the parties in power;- you can't run a country's economy effectively if everyone is either sick, or broke, from being sick.

Do men and women employed in the armed services receive free medical care and health insurance?

[Michelle68]

The armed services do receive free health care IF they go to a hospital or doctor on the military base, I believe. Sometimes the health care provided at some of the Veterans Affairs hospitals is not always the best. In fact, there was recently a big scandal which broke regarding the care many veterans back from the war in Iraq have been receiving (or not receiving) at these hospitals.

As far as a universal health system which covers all citizens, unfortunately there are many who believe that this would be a form of "socialism" and are adamantly against it. There are many facets to this problem...insurance companies and pharmaceutical companies who have very deep pockets and hold many of those in power in those pockets. The rising cost of malpractice insurance having to be paid by doctors. The high costs of hospitalizations. Whatever the reasons for it, it's the average citizen who pays the cost, whether they're insured or uninsured. The system we have now is obviously very broken and not working and the fact that many people go without insuance and die because they can't afford treatment is very, very wrong. Something has to be done to change things.

Okay, now I'll get off of MY soapbox.


--Michelle

[Buckeye5]

Medical costs habe been killing us. My DH works for a billionaire dillare electric company, a national one. He has been there since Jan. of 1984. We pay 20% of the total cost for the insurance and the company pays 80%. It costs us approx. $250 a month. Then, we pay $1000 deductible and then 15% of the rest of the medical bills and this includes prerscriptions. this does not cover eye or dental, those are separate plans. Last year, DD had back surgery we paid $6000, that was our share. DH just emergency back surgery was in the hospital 4 days, so far I have already received 2 bills from this that we owe already $2500.00. My gripe in my state is that if we were on welfare with a medical card, we would have 100% coverage, seems srong to me, because we work we pay out the butt for medical etc. and if we didn't we would pay nothing. Lopsided and stupid for one of the richest nations in the entire world. Just think how many people in the United States works and they wither cannot afford health insurance because it is so ridiculously expensive or it is not offered to them. It makes me very angry. Do you know how many people file bankruptcy in the US because of medical bills, remember though, that health and insurance is a BIG MONEY MAKER for US corporations etc. It is all called capitalism and greed, in my opinion. Our medical bills have absolutely stressed us out and there have been times that we have not seeked medical attention because of the worries of the costs.

[i.m.cheap]

Instead of health care for US citizens, our tax dollars and the lives of many young soldiers are being wasted in Iraq. I support those in our armed forces, but not the current administration or the war in Iraq. Just my opinion.

[wanderlusting]

Do men and women employed in the armed services receive free medical care and health insurance?

Yes, military members and their dependents get free medical care. If the military hosptal/clinic is unable to treat you, we get a referral to a private doctor which is covered by the government. Even though DH doesn't get paid anywhere near what he could make working as a civilian, having free healthcare is worth it. When military members retire (in at least 20 years), we get the equivilant of health insurance and/or get treated at military hospitals for the rest of our lives. Children dependents get this until they are 18 or 24 is they are a full-time student.