Understanding and Education myself on Healthcare Benefits

[Kris & Crystal 47]

This isn't the usual healthcare post. I've already been added to my wife's health, dental and vision plans. My visa has already been approved.

 

I'm just trying to educate myself on how healthcare works in the US. I'm in Scotland so have had access to some pretty good NHS/Socialised medical care.

 

My wife works for the State of California:

 

• https://www.calpers.ca.gov/page/active-members/health-benefits/plans-and-rates
• https://www.calhr.ca.gov/employees/Pages/dental-benefits.aspx
• https://www.calhr.ca.gov/employees/Pages/vision-benefits.aspx

 

• She has her health care with: Kaiser Permanente (HMO) - https://my.kp.org/calpers/plan-information-2/
• She has her dental care with: DeltaCare USA - https://www.calhr.ca.gov/benefits/Pages/open-enrollment-dental-premiums.aspx
• She has her vision care with: The only plan available - https://www.calhr.ca.gov/benefits/Pages/open-enrollment-vision-premiums.aspx

 

My questions are:

 

1. How does this level of healthcare coverage stack up and compare to others, good? bad? What's the average?
2. Are there any gotchas I need to be aware of? I've read horror stories about people having health insurance in the US and still being a billed a fortune for procedures.
3. Anything else I should know? I've been looking at videos and reading what I can to try and educate myself on how heatlhcare works in the US.

Edited November 8, 2019 by Kris & Crystal

[USS_Voyager 1,972]

25 minutes ago, Kris & Crystal said:

How does this level of healthcare coverage stack up and compare to others, good? bad? What's the average?

I have not read the link, but generally health insurance for state employees are very good. I work for the state of Iowa. I don't know what you mean by the "average"? Average cost? Coverage?

 

26 minutes ago, Kris & Crystal said:

Are there any gotchas I need to be aware of? I've read horror stories about people having health insurance in the US and still being a billed a fortune for procedures.

There won't be any gotchas if you ask in advance. Generally, for the common stuff, there won't be any surprises. You need to educate yourself about the common terms such as: premium, co-insurance, co-pay, deductible, ... For the large stuff like you have a surgery or something, call and ask. Call the hospital/physician office AND the insurance company "Hey I am going to do this procedure, what am I looking at total cost out-of-pocket? "

[yuna628 9,676]

37 minutes ago, Kris & Crystal said:

 

My questions are:

 

1. How does this level of healthcare coverage stack up and compare to others, good? bad? What's the average?
2. Are there any gotchas I need to be aware of? I've read horror stories about people having health insurance in the US and still being a billed a fortune for procedures.
3. Anything else I should know? I've been looking at videos and reading what I can to try and educate myself on how heatlhcare works in the US.

My husband also works for the state. He was given a list of potential plans to choose from. Most will be the same: low deductible, higher cost - no deductible, highest cost - or high deductible lowest cost. You would have to explore your benefits booklet to understand what coverage you have. 

Your insurance cards will generally explain co-pay fees with the amounts for specialists, primary care, urgent care clinics, labs, ER, or radiology clinic.

 

It was all very confusing to my husband at first, and while his first instinct was to choose the cheapest plan, he ultimately decided in the long run, it was better to pay the highest for the best care. He now understands why that was a very good choice, as one ER visit from him, two hospital stays from me and surgery cost our insurance 40k+50k. We on the other hand, owed very little - a few hundred dollars, mostly co-pays. It gave us both a great deal of peace of mind. We can also go see any doctor in any state we want provided they participate. 

 

On the whole, working for the state, usually offers the very best types of insurance plans you can get in each tier. Delta for dental is a decent insurance, better than many out there. As for vision insurance, I'm often skeptical about the use of it. It can be very fussy and limited in coverage, but if you've got it, you've got it.

[SmallTownPA 72]

Find out who the provider is, call their 800 number or use whatever POC they use.

 

The brochures they give you are not the best source of information.  Call and ask.