S/O Medical insurance

[Pippen]

I was just reading in another thread about someone who seems (to me) to be paying an outrageous amount for medical insurance. It's not really standard here. About the only reason you would get it is because if you wanted a room in a private hospital with nice fluffy bath robes and a selection of wine with your dinner. Even then you may end up in a public hospital if you are acute and the specialist would still be the same person anyway as they contract to the local health boards and the public system sends the overflow of certain cases to the private hospitals anyway if they have a backlog of cases like non urgent surgical to clear.

So what do you actually get in your area if you have insurance compared to if you don't?

[Acadianna]

I'm in Texas (U.S) and have health insurance through my employer -- for which I get, well, health care.   

My employer offers three levels of insurance.  The employer pays enough to cover the lowest level, and we can pay extra to get either of the two higher levels (which have lower deductibles/out of pocket requirements; the plan may also pay a higher percentage, but I don't recall offhand).  As a continuing cancer patient, I get the highest level, which is cost effective for me.  After I meet my deductible and out-of-pocket minimum, the plan pays for all my health care expenses, except for fixed-co-payments when I have a doctor visit or when I buy medications.  Of course, people also pay extra to cover spouses and/or children.

[WillyNilly]

This is a very heated issue in the US.

In the US there is no default coverage.  Many people are covered by an employers policy.  Almost everyone has to pay at least part of that plan, ranging from $50 a month to $500 or so.  If a person makes a low enough salary they might qualify for public health coverage, but its got to be pretty low.  Many states will cover children.  And senior citizens can get public coverage.  All of that coverage usually still requires people to pay a "co-pay" for Dr's visits and many have annual deductibles that have to be paid by the individual before coverage kicks in.  But hundreds of thousands of us have no assistance and must pay 100% out of pocket.

I don't qualify for any public coverage so I am uninsured, as my employer does not offer coverage. I could buy a policy for about $300-500 a month that would grant me 1 check-up a year and emergency services only.  No preventative care, no illness coverage, etc.  For that I'd need to spend $500-1100 a month.  So I have nothing.  If I get sick and want to see a Dr I have to pay out of pocket, usually $150-400 for a typical office visit.  An emergency room visit would cost $600 to $2000 (or more if major stuff was needed).  If I am in an accident or get a terrible illness I would probably have to sell my home and declare bankruptcy. I generally pay for 1 check up with my ob-gyn annually to the tune of $180.

We do have some new laws ("Obamacare") slowly being rolled out that will change things for millions of people, including requiring coverage and (hopefully, supposedly) vastly reducing the cost of individual plans.  These laws are very polarizing and discussing them in too much depth would probably be considered political and probably not a good topic for the forum.  In fact this whole thread might be too political...

ETA: Actually if I (or any uninsured person) get a minor illness I do have the affordable option of a walk-in clinic.  These are first come first serve offices that can diagnose and write scripts for minor things like UTI's, upper respiratory infections, strep throat, skin irritations, ear infections, fever, etc.  The local walk-in in my area charges $80 as a base fee, plus more for any lab fees for tests they might run.

[kareng57]

We have public health insurance in Canada, same as in the UK.  Some provinces charge premiums, others don't - but there's "premium assistance" for those who can't afford it so they pay little.  There can also be minor differences in coverage between provinces for things like ambulance services.

Many people pay their premiums through payroll deductions at work, sometimes with the employer covering part.  And many employers offer "extended" coverage which pays for a private or semi-private hospital room (as opposed to a 4-bed room), prescription drug coverage, eye exams etc.

No one gets turned away for lack of insurance; if it's someone who lacks insurance for reasons such as poverty, the hospital social workers will get involved.  And it's true that sometimes ER patients arriving by ambulance will be diverted to another hospital, but that would be because the ER is congested at the first hospital - not because of an insurance issue.

[Gwywnnydd]

For most of the physicians in my area, you must have insurance or you can't become a new patient. Even if you can find a GP who will let you self-pay, you'll be paying much more than the next patient with insurance.
I get subsidized prescription costs with my insurance, and many preventative events (flu shots, annual check-ups and screening tests, etc.) are free to me.

[cass2591]

Pippen, one more political post (and yes, insurance is a huge issue in the US) and you're out of here. I'm sure you're aware of that and if you aren't, educate yourself.

Thread locked and I am getting increasingly irritated at the political posts, which includes insurance, on this forum.