How did you deal with health care changes?

[LuvIllinois 1]

So now that this is all really happening, I can't help but worry about losing my OHIP now. My husband has good coverage through his employer but this is something I have never had to think about before, as I'm sure most of you can empathize with. How did you deal with it???

[raymaga 25]

I hear what you're saying... loud and clear!!!!

I have been away from Canada and living in the U.S. for 7 years and I STILL think about the health care situation here in the U.S. almost on a daily basis.

I lived in B.C. and had health insurance for about $50.00 a month for myself and went to the doctor and/or hospital FREE any time I needed to. Then, when I moved to the U.S., I went on my husband's employer's medical insurance and had to pay "co-pays", "deductibles", etc. It freaks me out so much!!!!

I hope my husband and I will be able to retire to Canada in 6 years and then not have to worry about health care coverage any more.

[joevegas 67]

Absolutely hate the health care here...pay over 400 bucks a month,$4000 deductable...co-pays and all that #######,and thats with my spouses insurance plan,we pay over $800 a month between us,Yet there are people that will fight you tooth and nail over universal healthcare..half the people cant even afford to have health care in this country...absolutely hate it...

[canada_socks 97]

My fiance doesn't even know what he pays for insurance in the States. I'm paying about $100 a month for the healthcare that isn't covered by OHIP through my work benefits. I went to the hospital and even with that extra coverage, I still had to pay $200 for semi private room (I would have stay in a ward but I have anxiety issues, and my hospital has semi privates designed as private with a shared washroom). My fiances insurance covers eyecare and dental as well. I think he only pays like $25 out of pocket to see his doctor, and he can see his doctor the day he calls (where I often have a 3 month wait to see my doctor).

I have mixed feelings on the healthcare difference, but after my recent stay at the hospital, I kind of look forward to seeing the differences in the two.

[Kathryn41 3,205]

You will need to undergo a change of 'mind-set' about health care in the US. For many here health care is something you put off until you are really sick and need to see a doctor. It is 'reactive'. In Canada, a lot of focus is on preventative health care so people see a doctor before they get sick as well as when they get sick. It is 'proactive'.

Health insurance decides what your health care will be like. There are different types of health insurance plans and you will need to see what type your husband has. Some are managed health care plans that restrict you to seeing only certain doctors and using certain hospitals. Some allow you to see any doctor and use any hospital but require pre-approval for any or some treatments. Some will have different rates for an 'in network' doctor vs one not in their 'network' of approved doctors. Some have limits on how often you can use a medical service or have a specific test. Some require a co pay plus a deductible for both the family and the individual before they cover more than a certain percentage of the costs. Some no longer have a deductible but have a higher copay amount which off sets having no deductible. The deductible basically means how much you have to pay out of pocket in any given time period before they will cover the costs. I have a chronic medical condition, see a doctor and a specialist regularly, have a number of tests regularly - and have never come anywhere near to reaching the deductible limit.

Premiums are deducted from your husband's paycheques. For a doctor's visit you will pay a co-pay that can vary from $10 to $70 dollars or more depending on the health insurance plan your husband has. Specialists generally have a higher copay and must often have both a referral from a doctor and an approval from the insurance company before you can see them or have a procedure. If the insurance won't cover them, then they won't see you. Some doctors don't accept some insurance plans so you have to pay all of the associated costs up front.

There is a co-pay for hospital visits, although if you are admitted to the hospital the co-pay may be waived. The hospital will charge you a certain amount every day for your visit which will include the room, food, nursing and such. Each doctor will charge you separately so if you are hospitalized you will get a number of separate bills. Some of those doctors may not be 'in your insurance company's approved network' of doctors so you will have to pay more for their services.

Each year your husband will be given the opportunity to review a variety of medical insurance options. The trend is for them to provide less and less coverage for higher and higher premiums. The new health legislation has made it a requirement that certain medical procedures and tests such as mammograms, etc. are now covered 100%. That mean that you won't have a co-pay for that test, although you may have a co-pay for the doctor's visit. Almost all tests will also have a co-pay - some that you will pay up front and some that will be charged to you later.

Health Insurance plans have an annual enrollment period. This is the 30 day window of time during which your husband will be allowed to make changes to a plan in any given year. Make sure he adds you as soon as he can - marriage is considered one of the exceptions to the annual enrollment period and most plans will allow you to be added within 30 days of marriage. If you mis the window, then you have to wait for the annual enrollment period. Make sure you get your SSN before you get married - asap - because some plans will not allow you to be covered without it and by the time you get it afterwards your 30 day window has closed and you will not be able to enroll until the annual enrollment period opens up. Some Canadian VJers have been caught by this - and in one case became pregnant and had the child all without coverage because they couldn't get the SSN in time to get enrolled during the 'Life Event's window and had to wait. You don't want to be in that position.

Your insurance company will send you a 'statement' showing what the costs charged for the visit, test, etc. by the doctor are, what they will pay, what is approved as 'in your plan' or 'what is not approved' , the rate of coverage and the amount that you still have to pay. I would strongly advise you to become familiar with these statements and match them up to the receipts you receive from your copays along with any invoices that you receive from medical care providers. They are notorious for being riddled with errors and you often end up either denied for something that is covered in your plan, or being charged more than you should be by your plan. Interestingly enough, the errors never seem to be in 'your' favour.

The main focus of health care in the US is to make money - profit- for the insurance companies. Providing patients with health care and doctors with reimbursement for services is secondary. The insurance company can overrule your doctor's prescription and tell you that you can't have that drug or that operation - even if the doctor says it is necessary - because it is too expensive and would bite into their profits. They will dictate what products and what prescriptions you are allowed to use and if you do not follow their directives, you will pay financially.

The medical care itself is on par with what I experienced in Canada. The waiting times vary depending on where you are. For me, I haven't been able to get an appointment with my primary care physician for over 2 years now because he is always booked. I end up seeing the Physician's Assistant, Nurse Practitioner or another doctor at the clinic instead, If it is an emergency they can get you an appointment that day - or you can go in and wait until they have an opening - usually about 3 or 4 hours wait. If it is not an emergency then you may be able to get an appointment with 'someone' the following week. I have to make appointments for an annual physical (something many American's don't, in fact, do) 6 months in advance and it took me 3 months wait before I was able to see my endocrinologist. The average waiting time to see a medical practitioner once you are in the office is in the range of several hours. They will take your co-pay first.

The one thing I do like is that since you pay for the tests, you are able to get copies of test results from the doctor or the hospital as well. You have to ask for them, but they will give you a copy (some hospitals will charge you for copying costs).

As you can probably guess, this is one of my biggest gripes about the US - how so many Americans believe they actually have a good, working system here that provides them with decent medical coverage! If you are rich, you can buy good medical care. If you are poor, forget it. If you are middle of the road, then expect to spend a good portion of your annual income on medical concerns even if you never get sick.

Edited July 21, 2011 by Kathryn41

[Inky 1,110]

my 15 min surgery cost over 5,000$ USD. When I had to go to emerg 3 days later for fluids it cost 3,000$ ( didn't use an ambulance just drove there. )

it is CRAZY expensive! and my jobs insurance costs 850$ for just myself with cobra because of not being a US citizen..

[bigbigblake 2]

It sounds like your jobs are providing some very bad health plans. You need to tailor your health plan for you. If you very rarely go to the dr, go for a co-pay low deductible. If you have chronic issues or health problems then your better off going for a high co-pay (4000ish) with low to no co-pay. You will quickly pay this off and can not be charged for anything above the deductible. You can even supplement this with a HSA account (health savings). They are usually deducted pre-tax, and must be spent before the end of the year. This would cover deductibles, medicine, everything. If your guaranteed to use it, then its great tax break.

There are tons of options, and sadly it is restricted via your Employer and the choices they make. If they choose to have a shitty insurance provider then you are going to pay for it.

My issue is not with Insurance, but with prescriptions. The cost of prescriptions is just bullshit, and most insurance plans will not cover it. You usually need a seperate plan just for prescriptions if you use them a lot.

Luckily I see a Dr once every year or two, so it doesn't affect me much, but my wife says the service is great compared to Canada.

[Udella&Wiz 325]

my 15 min surgery cost over 5,000$ USD. When I had to go to emerg 3 days later for fluids it cost 3,000$ ( didn't use an ambulance just drove there. )

it is CRAZY expensive! and my jobs insurance costs 850$ for just myself with cobra because of not being a US citizen..

A lot of the time I think we haven't been aware of what Dr's visits actually cost when we were back in Canada.

There are so many health plans that employers offer - you need to educate yourself on what your spouses (or you won) company offers. Their HR departments will always have detail explanations of what is covered by your plan.

I find the care here is much better then Ontario (more options available to me) and of course there are many Drs to choose from. I have chosen all demale doctors because that's what I am comfortable with - back in ON, I was justs luck to have a GP at all - and he was hardly ever available - and office visits were 5 minutes - never any time to discuss any concerns or ideas.My old dr back in ON never investigated my endometriosis or ovarian cysts - here the care has been top notch and my condition is now well under control.

I love being treated like a customer they want to keep rather then just another body to get in and out.

[SapphireDreams 71]

my 15 min surgery cost over 5,000$ USD. When I had to go to emerg 3 days later for fluids it cost 3,000$ ( didn't use an ambulance just drove there. )

it is CRAZY expensive! and my jobs insurance costs 850$ for just myself with cobra because of not being a US citizen..

That actually sounds a bit discriminatory, no? I have been eligible for the same insurance as all of my co-workers and I'm not a citizen either.

I've also had 3 different jobs in the US and I've never encountered this before ever.

I'm probably in the minority among Canadians but I absolutely love US healthcare - truth be told however that I also have really amazing insurance through my husband's job. And, that's the huge difference between having a good experience and terrible experience with US healthcare. So that's why having a job with good insurance is almost just as important to some as the salary and job itself.

We don't pay a lot monthly, our co-pays are very low ($15) and most of our services/visits are covered 100%, sometimes 90%. When we have a baby, it will be covered 100%, which I was actually pretty shocked about. We do have to stay in-network, but living in NYC makes it very easy since there are a lot of Drs here.

The one big thing here is that going to the Dr. here is a lot more like a business transaction than it was in Canada. In Canada, there was never a bill or money exchanged. I always found most Dr. offices in Canada very basic. I had a GP, but rarely went to see her when I was sick because it was impossible to get an appointment the same day or next day, so I was often seeing random Dr.'s at walk-in clinics anyways. The benefit though was never having to worry about receiving a bill at the end of it all. I would say my experience in Canada was average at best. I never had any major issues, so I never really had to wait for anything. I have been to sub-par Dr.s in the US, but have just never went back because I have the option to shop around, which I really like.

Earlier this year I got pneumonia and I am SO grateful to the US healthcare system because I received top notch healthcare, was able to see my own Dr. same day and she spent at least 30 minutes thoroughly examining me, I made follow up appointments no problem, she called me multiple times at home to ensure I was getting better - it was unlike any care I've ever received in Canada. I felt very well taken care of and can only imagine what that experience would've been like in Canada seeing random Dr.'s at walk-in clinics. I will gladly pay my monthly premiums, higher prescriptions and co-pays for the service I receive here.

To be honest, I never really thought I'd ever have this opinion. I was very pro-socialized medicine and while I know the service I receive here is not equal across the country, which as a Canadian makes me sad, I do see the benefits to the private system and am lucky enough to be in a position to receive them.

The first place you want to start is to have your husband/fiance ask his HR department for information on their different healthcare offerings. There are usually different variations for people who see Drs alot, vs. people who don't and then go from there. Unfortunately, a lot of employers only pay a small portion of spousal premiums, so you'll need to look into that too.

I know my post is really long, but I just wanted to say that it is possible to have a great experience with the US system, despite high premiums and costs. Sure, it's not cheap, but you get what you pay for.

[SapphireDreams 71]

A lot of the time I think we haven't been aware of what Dr's visits actually cost when we were back in Canada.

There are so many health plans that employers offer - you need to educate yourself on what your spouses (or you won) company offers. Their HR departments will always have detail explanations of what is covered by your plan.

I find the care here is much better then Ontario (more options available to me) and of course there are many Drs to choose from. I have chosen all demale doctors because that's what I am comfortable with - back in ON, I was justs luck to have a GP at all - and he was hardly ever available - and office visits were 5 minutes - never any time to discuss any concerns or ideas.My old dr back in ON never investigated my endometriosis or ovarian cysts - here the care has been top notch and my condition is now well under control.

I love being treated like a customer they want to keep rather then just another body to get in and out.

I agree with you 100% I also had a lingering issue that my Canadian Dr. would never investigate that a Dr. here noticed right away and treated on the spot. Funny enough, she treated it with a prescription drug not available in Canada due to pharmaceutical company red tape! I lived with the issue for 4 years and with one visit to a Dr. in the US it was gone! Crazyness.

I also have chosen all female Dr's here and it's a great perk.

[Flames9_RN 358]

Busy painting the condo, so not a lot of time to chip in,lol In the USA it all boils down if you have great health insurance. If you do, its great. If you don't, and get sick, well what do you pay, your rent or ur health care bill??? And it depends where u live and ur Dr. Not all Dr here see their pts right away. Seen a lot of crappy Dr here, benefit of being a RN,lol And I'm not saying Canada's system is perfect either. My dads been waiting for a new type of pacemaker since March. Here he would have had it done long ago! of course he hasn't had to pay for any of his heart operations (besides taxes,lol) One really has to sit down and educate themelves with the different types of health plans in the USA, HMO, PPO, etc etc.

[Udella&Wiz 325]

We recently changed our plan from a premium plan which covers everything at 100% to one with a higher deductible

Our reasoning was that we could either pay through the nose - and I do mean OUR portion was $10,000/yr (or $384/pay) for family coverage or we could go with a plan that has some deductibles and some things are covered at different percetages...but we pay a fraction of what we used to pay. We have instead chosen to put the difference in premiums away in a new savings account for emergencies...we talked about it with a few of my husband's coworkers and they said it was a perfectly manageable choice.

100% coverage is great until you realize you seldom see the full benefit - unless you get cancer or have a baby.

I know we're lucky because we both have great jobs, we're at a stage in our lives where we can afford premium care if we want and have choices - some people are not at that stage or that lucky.

It will p*$$ you off sometimes because you'll be used to walking in, handing over your Healthcard and that's it - to begin with I felt very unsure - I would get asked if I was PPO, HMO, ..I don't know - FU! I couldn't remember what was paid when, who needed referrals, who didn't blah blah - you'll get the hang of it

Don;t worry - the Drs office will remind you to pay...lol

[Flames9_RN 358]

We recently changed our plan from a premium plan which covers everything at 100% to one with a higher deductible

Our reasoning was that we could either pay through the nose - and I do mean OUR portion was $10,000/yr (or $384/pay) for family coverage or we could go with a plan that has some deductibles and some things are covered at different percetages...but we pay a fraction of what we used to pay. We have instead chosen to put the difference in premiums away in a new savings account for emergencies...we talked about it with a few of my husband's coworkers and they said it was a perfectly manageable choice.

100% coverage is great until you realize you seldom see the full benefit - unless you get cancer or have a baby.

I know we're lucky because we both have great jobs, we're at a stage in our lives where we can afford premium care if we want and have choices - some people are not at that stage or that lucky.

It will p*$$ you off sometimes because you'll be used to walking in, handing over your Healthcard and that's it - to begin with I felt very unsure - I would get asked if I was PPO, HMO, ..I don't know - FU! I couldn't remember what was paid when, who needed referrals, who didn't blah blah - you'll get the hang of it

Don;t worry - the Drs office will remind you to pay...lol

One has to know whast type of plan they are in, and watch the terminology!! case in point. I called up a dentist and asked they accepted Delta dental. They said yes!! Cool! So I went in, had a check up. They gave me an estimate on the work. My wife, says, holy moley that $$$$$. Turns out, yes they accept Delta dental, but they are OUT OF NETWORK!! meaning they could charge whatever they wanted, and I had to pay the difference!! Soon found a dentist that was in network. Ended up paying $1000, vice many thousands more the other dentist quoted me!! So one has to know the diff between ppo, hmo,lol The system can be pretty frustrating, as Health insurance companies like any other insurance company are in business for 1 thing---to make money!!!! good times. Seen many of my pts stressed out in the hospital, as they have no clue how they are going to be able to pay their hospital bill!!

Time magazine had an interesting article few yrs back--medical holidays to India!! You do the basic stuff in the USA. It gets sent to India, and you have the surgery there. far less $$$$$$$ and u get a holiday,lol Of course, not an option if your having a heart attack,lol

[Udella&Wiz 325]

One has to know whast type of plan they are in, and watch the terminology!! case in point. I called up a dentist and asked they accepted Delta dental. They said yes!! Cool! So I went in, had a check up. They gave me an estimate on the work. My wife, says, holy moley that $$$$$. Turns out, yes they accept Delta dental, but they are OUT OF NETWORK!! meaning they could charge whatever they wanted, and I had to pay the difference!! Soon found a dentist that was in network. Ended up paying $1000, vice many thousands more the other dentist quoted me!! So one has to know the diff between ppo, hmo,lol The system can be pretty frustrating, as Health insurance companies like any other insurance company are in business for 1 thing---to make money!!!! good times. Seen many of my pts stressed out in the hospital, as they have no clue how they are going to be able to pay their hospital bill!!

Time magazine had an interesting article few yrs back--medical holidays to India!! You do the basic stuff in the USA. It gets sent to India, and you have the surgery there. far less $$$$$$$ and u get a holiday,lol Of course, not an option if your having a heart attack,lol

How funny - I was just considering a ####### job and butt implants in India.

Just kidding

All kidding aside - yes 'In network' are the magic words - everyone will say they accept your insurance, but that Doctor may or may not be within your ins company's network.

Don;t worry though - most Drs are 'in network' for many, if not all insurance plans...but you can easliy check by going to your insurance company's site and looking up the Dr. It's on YOU to find out so you don;t get any rude surprises.

We've changed insurance twice in 3 yrs and each time - our current Drs have always been within the new network.

[SapphireDreams 71]

I don't think it's available in every city yet, but www.zocdoc.com is an amazing tool for finding doctors. I have used it to find all of of my current doctors and it's been a huge saving grace for me.