California - Medical Insurance new immigrant

[Pat2021 43]

Hi everyone,

 

As a new immigrant to California, especially from Europe with standardized "free" healthcare, the US system is very daunting to me.

• Is it reasonable to compare it to private health-insurance here in the UK where I can claim some treatments (like dentist / optician) back via receipt?
• I was wondering if there are any guides out there that explain how it works in detail and what to take into account?

 

So far from what I've researched, I have a few questions.

I've seen "Covered California" as an option in California.

• Am I eligible for it? I read something about "Public Charge" not being allowed to take any benefits, but I'm coming on an IR1 Visa so not sure if it applies?
• For the calculator - what counts as "Household size"? We will be living with my wife's parents - do we include them / their income?
• Is it a generally good health care plan before I find a job?
• Can I switch off it once I find a job or is there some cooling-off period?
• I've seen something about enrollment being open now - does that mean I need to join right now?
  • We're arriving in the US in second week of January, so should I wait until then or join now for coverage start 1 of January? Can I join if I'm not physically in the US yet?

 

My wife / sponsor is moving back at the same time as me and her job allowed her to transfer over to the US branch. As such, she will get a healthcare packet.

• Does it make sense for her to enroll both of us as a family plan, or is it better for her to do single healthcare and I go with "Covered California"?
• Her job's branch is in NY, so her healthcare is NY centric - meaning that it mostly covers NY service providers. Is this relevant / important? It's "UnitedHealthcare", however, they also offer "Kaiser Permanente" for CA residents.
  • Is this plan sensible for someone in California or will we have issues finding covered treatments? I've heard Kaiser is not great.
• As she will be moving it counts as "life change" and she can enroll me onto the plan - however will there be an issue in me leaving the plan if for example I'll find a job and get a better plan? Would we have to wait to the next "enrollment period"?

 

I know it's quite a few questions, we still have a few weeks to decide. Thank you in advance

Edited November 29, 2022 by Pat2021

[Loren Y 2,755]

1 hour ago, Pat2021 said:

I've heard Kaiser is not great.

Not sure about everything else, but as a Nevada resident, every time someone transfers to Nevada from California, the first thing they gripe about is how they miss Kaiser and how great it is. This is from many people over the 18 years I have worked at the same company. I have never seen anyone say Kaiser was bad. Just throwing that out there, I have never had Kaiser, but I know a lot of people who had it, and say it was great.

As a note, arriving in the US is a life event for insurance companies, and triggers a 31 day period where you can enroll in healthcare. I have confirmed this with many companies ( Blue cross/ Aetna, etc) so you should have a month after arriving to sign up for healthcare.

[Crazy Cat 41,837]

2 hours ago, Pat2021 said:

Hi everyone,

 

As a new immigrant to California, especially from Europe with standardized "free" healthcare, the US system is very daunting to me.

• Is it reasonable to compare it to private health-insurance here in the UK where I can claim some treatments (like dentist / optician) back via receipt?
• I was wondering if there are any guides out there that explain how it works in detail and what to take into account?

 

So far from what I've researched, I have a few questions.

I've seen "Covered California" as an option in California.

• Am I eligible for it? I read something about "Public Charge" not being allowed to take any benefits, but I'm coming on an IR1 Visa so not sure if it applies?
• For the calculator - what counts as "Household size"? We will be living with my wife's parents - do we include them / their income?
• Is it a generally good health care plan before I find a job?
• Can I switch off it once I find a job or is there some cooling-off period?
• I've seen something about enrollment being open now - does that mean I need to join right now?
  • We're arriving in the US in second week of January, so should I wait until then or join now for coverage start 1 of January? Can I join if I'm not physically in the US yet?

 

My wife / sponsor is moving back at the same time as me and her job allowed her to transfer over to the US branch. As such, she will get a healthcare packet.

• Does it make sense for her to enroll both of us as a family plan, or is it better for her to do single healthcare and I go with "Covered California"?
• Her job's branch is in NY, so her healthcare is NY centric - meaning that it mostly covers NY service providers. Is this relevant / important? It's "UnitedHealthcare", however, they also offer "Kaiser Permanente" for CA residents.
  • Is this plan sensible for someone in California or will we have issues finding covered treatments? I've heard Kaiser is not great.
• As she will be moving it counts as "life change" and she can enroll me onto the plan - however will there be an issue in me leaving the plan if for example I'll find a job and get a better plan? Would we have to wait to the next "enrollment period"?

 

I know it's quite a few questions, we still have a few weeks to decide. Thank you in advance

Good Luck!  Every health care plan in the US is different>  I suggest you study terms such as:

Monthly Premiums

DEDUCTIBLES

Exclusions

Stop-Loss  Maximum

Lifetime Maximum Benefits

Co-Pays

Network Providers

Out-Of-Network Providers

Private Pay

 

Yes, it can be overwhelming to someone who has never experienced US medical insurance

 

 

 

Edited November 29, 2022 by Crazy Cat

[SalishSea 17,819]

3 hours ago, Pat2021 said:

Hi everyone,

 

As a new immigrant to California, especially from Europe with standardized "free" healthcare, the US system is very daunting to me.

• Is it reasonable to compare it to private health-insurance here in the UK where I can claim some treatments (like dentist / optician) back via receipt?
• I was wondering if there are any guides out there that explain how it works in detail and what to take into account?

 

So far from what I've researched, I have a few questions.

I've seen "Covered California" as an option in California.

• Am I eligible for it? I read something about "Public Charge" not being allowed to take any benefits, but I'm coming on an IR1 Visa so not sure if it applies?
• For the calculator - what counts as "Household size"? We will be living with my wife's parents - do we include them / their income?
• Is it a generally good health care plan before I find a job?
• Can I switch off it once I find a job or is there some cooling-off period?
• I've seen something about enrollment being open now - does that mean I need to join right now?
  • We're arriving in the US in second week of January, so should I wait until then or join now for coverage start 1 of January? Can I join if I'm not physically in the US yet?

 

My wife / sponsor is moving back at the same time as me and her job allowed her to transfer over to the US branch. As such, she will get a healthcare packet.

• Does it make sense for her to enroll both of us as a family plan, or is it better for her to do single healthcare and I go with "Covered California"?
• Her job's branch is in NY, so her healthcare is NY centric - meaning that it mostly covers NY service providers. Is this relevant / important? It's "UnitedHealthcare", however, they also offer "Kaiser Permanente" for CA residents.
  • Is this plan sensible for someone in California or will we have issues finding covered treatments? I've heard Kaiser is not great.
• As she will be moving it counts as "life change" and she can enroll me onto the plan - however will there be an issue in me leaving the plan if for example I'll find a job and get a better plan? Would we have to wait to the next "enrollment period"?

 

I know it's quite a few questions, we still have a few weeks to decide. Thank you in advance

If you have the option of being added to your wife’s employer-based plan, that is preferable.   I would think it is also required, as for Medi-Cal, I believe you’d have to attest to not having the option of another type of plan, since it’s publicly funded.

 

The location of the employer in a different state won’t matter- covered participants will be able to seek care by providers (who accept the plan) where they live.

 

If you get a job that offers coverage, you will generally be required to accept that as your primary plan.   The requirement would come from your wife’s employer/insurance provider.

 

Sometimes you can keep the spouse’s plan as a secondary insurance, which is what we have done.   Depending on coverage and monthly premiums, this may not make sense.

 

good luck!

[Mike E 11,739]

Sounds like you  aren’t in the USA yet and your wife will have a job that offers United healthcare PPO.  My advice is that you enroll in that when you get your I-551.  I’m in a United health care PPO through my pergola employer and will be switching to another PPO due to retirement. 
 

Kaiser is an HMO.  Perfectly fine for most stuff.  Not so good imho if you have stage 4 cancer and need to / want to go out of state for treatment, though I know people who have had Kaiser and stage 4 and survived just fine. 
 

You can change to Kaiser after a year on the PPO during the employer’s annual open enrollment.  

Health   care isn’t a problem for most Americans and the stories you read about it being a problem are mostly hype.  Pay attention to open enrollment rules from your employer, spouse’s employer, and if neither employer your state (such as Covered California) or if your state doesn’t participate, Healthcare.gov

 

If you are young and healthy, and your employer or spouse’s employer offers a health plan with an HSA, suffice to say you should go all in on that.   The operating costs to you are lower and the tax benefits are incredible. Some  people  retire with hundreds of thousands  of dollars in their HSA and you can use an HSA for healthcare costs or for retirement. 

[Jamie and Richard 26]

Hi! Welcome to California! Been living in California all my life and also had Covered CA before while I was between jobs. Also helped and volunteered getting immigrants in Los Angeles signed up for Covered CA.

 

4 hours ago, Pat2021 said:

• Is it reasonable to compare it to private health-insurance here in the UK where I can claim some treatments (like dentist / optician) back via receipt?

It is similar. Once you sign up, you can choose which plan and price is feasible for you. I chose Blue Cross for $89/ month. The plan I chose was an HMO so I had to stay within the network. If you would like to choose doctors outside of the network, just like in any other state, please select a PPO. Obviously, you need to expect a higher monthly premium. 

4 hours ago, Pat2021 said:

• I was wondering if there are any guides out there that explain how it works in detail and what to take into account?

once you have selected a package, they will give you a breakdown of how your benefits work. Call their customer service if you need more information on how this works. They are pretty helpful and now many people who migrate to the states need people to walk them through the process.

 

4 hours ago, Pat2021 said:

 

So far from what I've researched, I have a few questions.

I've seen "Covered California" as an option in California.

• Am I eligible for it? I read something about "Public Charge" not being allowed to take any benefits, but I'm coming on an IR1 Visa so not sure if it applies?

Yes, lawfully present immigrants are eligible for Covered CA. This isn’t Medi-Cal so this is not the same. 

4 hours ago, Pat2021 said:

• For the calculator - what counts as "Household size"? We will be living with my wife's parents - do we include them / their income?

Their customer service can give you a better breakdown of this, but I have been told the income is based on who will be claimed on the persons income taxes. I would assume the income will be based on just you and your wife’s income. Please check with customer service

4 hours ago, Pat2021 said:

• Is it a generally good health care plan before I find a job?

It’s in your best interest to have any kind of medical insurance until you get one through an employer or your wife’s employer.

4 hours ago, Pat2021 said:

• Can I switch off it once I find a job or is there some cooling-off period?

Yes, just be sure to contact them before your next monthly premium payment is due right before your new insurance with your employer begins. Most employers have a 90 day probation, however there are plenty of employers in LA who have ditched the probationary rule. 

 

4 hours ago, Pat2021 said:

• I've seen something about enrollment being open now - does that mean I need to join right now?
  • We're arriving in the US in second week of January, so should I wait until then or join now for coverage start 1 of January? Can I join if I'm not physically in the US yet?

Open enrollment is open now until January 31st. As long as you have a physical address in CA, get enrolled now so you can make any necessary changes later!

4 hours ago, Pat2021 said:

 

My wife / sponsor is moving back at the same time as me and her job allowed her to transfer over to the US branch. As such, she will get a healthcare packet.

• Does it make sense for her to enroll both of us as a family plan, or is it better for her to do single healthcare and I go with "Covered California"?

If her income is feasible enough for her to survive paying for the both of you on her premium, her best bet is to add you to her insurance 

4 hours ago, Pat2021 said:

• Her job's branch is in NY, so her healthcare is NY centric - meaning that it mostly covers NY service providers. Is this relevant / important? It's "UnitedHealthcare", however, they also offer "Kaiser Permanente" for CA residents.
  • Is this plan sensible for someone in California or will we have issues finding covered treatments? I've heard Kaiser is not great.

I would strongly advise her to stay from Kaiser, but if she wants to enroll with them, you should be able to visit any Kaiser location in CA. I used to have United and it was great! As long as it is a PPO there shouldn’t be any issues. If it is HMO check with the insurer to see if there will be any issues.

4 hours ago, Pat2021 said:

• As she will be moving it counts as "life change" and she can enroll me onto the plan - however will there be an issue in me leaving the plan if for example I'll find a job and get a better plan? Would we have to wait to the next "enrollment period"?

Pretty sure you can remove someone from your plan at any time. My mom removed my dad from her health insurance when his business was able to start offering insurance to employees and it wasn’t during open enrollment time. 

 

 

I hope this was of some use to you! 

 

 

[top_secret 2,417]

6 hours ago, Pat2021 said:

Hi everyone,

 

As a new immigrant to California, especially from Europe with standardized "free" healthcare, the US system is very daunting to me.

• Is it reasonable to compare it to private health-insurance here in the UK where I can claim some treatments (like dentist / optician) back via receipt?
• I was wondering if there are any guides out there that explain how it works in detail and what to take into account?

 

I had my wife and stepdaughter on "Covered California" for a while after they arrived so I could throw out my experience and opinions.

You will find America has a bewildering array healthcare and health insurance options so it is not an easy subject.  I'm not aware of any guides that summarizes it in an understandable way but maybe someone else could come up with something.

 

Allot of what you do depends on your income level and longer term plans for employment.  I think 'most' Americans still get their insurance provided by their employers.  There again there are a bewildering array of different options and levels of insurance that may be offered by an employer.   This may include free or at various cost levels coverage by a spouses employer.  So first step, if your spouse is already employed, is find out what those options are.  If your spouse has a generous employer, you may be set and she just adds you to her plan.  If their employer sucks (like mine) they may have good insurance provided free for the employee (me), but it costs like a gazillion dollars to add on a spouse and kid.

 

In our case we initially got insurance for my wife and stepdaughter at  "Covered California" however my income level excludes them from any subsidies so we were still paying full price (like $550 a month for minimal coverage.  Still much cheaper than adding them to my employers insurance).  A few months later my wife got a job that offered good insurance for her, so we dropped the insurance we were paying for her.  We are still paying her daughters insurance in full, out of pocket, since that works better than either of our employers options for the child.

 

I 'think' you need a California address to enroll through "Covered California".  We used mine.  I think if your spouse is not in California, someone needs to have an address here to sign up.   You don't need to wait for open enrolment since you have just immigrated and that qualifies as a "life changing event".  Green card is no issue at all.  They initially took her word about immigration status and much much later followed up about social security numbers and proof of status.  

 

My wife and stepdaughter both have Kaiser and we are satisfied with them.  Kaiser's only major downside is that you are limited to their doctors, clinics and hospitals.  you can't just go to any random doctor. But in our part of California their presence is HUGE, and we have had no problems or complaints (so far) getting proper service from them.

 

But really the place to start is looking at what your spouses employer offers.  If it is paid by the employer or reasonably priced, but is a choice of only Kaiser, or something New York centric and you will be living in California?  Then it looks like you are probably getting Kaiser.

 

[Pat2021 43]

Oh wow, thank you everyone for those thorough responses and all the recommendations! 

 

13 hours ago, Jorgedig said:

The location of the employer in a different state won’t matter- covered participants will be able to seek care by providers (who accept the plan) where they live.

Yes that's my worry with United - how's the provider coverage in California? How do I find that out? I know Kaiser is accepted pretty much everywhere, but United, I'm not so sure.

 

13 hours ago, Jorgedig said:

If you get a job that offers coverage, you will generally be required to accept that as your primary plan.   The requirement would come from your wife’s employer/insurance provider.

Huh I did not know that - I imagine that'd be in the fineprint of the booklet? Need to re-read it then.

 

13 hours ago, Mike E said:

If you are young and healthy, and your employer or spouse’s employer offers a health plan with an HSA, suffice to say you should go all in on that.   The operating costs to you are lower and the tax benefits are incredible. Some  people  retire with hundreds of thousands  of dollars in their HSA and you can use an HSA for healthcare costs or for retirement. 

They do offer an HSA - but can you give more info as to why it's that good? From what I've seen it's just another investment account but where you can only use it for healthcare related stuff. Surely we'd get more benefit just investing it in a regular investment account where we can use the money for whatever, including medical emergencies? The company does not contribute to the HSA.

 

12 hours ago, Jamie and Richard said:

I would strongly advise her to stay from Kaiser, but if she wants to enroll with them, you should be able to visit any Kaiser location in CA. I used to have United and it was great! As long as it is a PPO there shouldn’t be any issues. If it is HMO check with the insurer to see if there will be any issues.

Thank you for your post, just wondering why are you advising to stay away from Kaiser?

[Mike E 11,739]

1 hour ago, Pat2021 said:

They do offer an HSA - but can you give more info as to why it's that good?

1. The employee portions of the insurance premiums tend to be lower. 

2. Some employers contribute to your HSA 

 

1 hour ago, Pat2021 said:

From what I've seen it's just another investment account

3. nope, because  returns and growth are tax free while money stays invested.  

1 hour ago, Pat2021 said:

but where you can only use it for healthcare related stuff.

4. . Contributions to an HSA are tax deductible: they reduce your taxable income 

 

5. withdrawals for medical purposes are tax free. 
 

6. once you reach retirement age you can withdraw from an HSA penalty free but you do pay taxes on the withdrawals

1 hour ago, Pat2021 said:

 

Surely we'd get more benefit just investing it in a regular investment account where we can use the money for whatever, including medical emergencies?

7. no you would not for the reasons given above. 
 

1 hour ago, Pat2021 said:

 

The company does not contribute to the HSA.

 

8. Ok.  

[Pat2021 43]

8 minutes ago, Mike E said:

1. The employee portions of the insurance premiums tend to be lower. 

2. Some employers contribute to your HSA 

 

3. nope, because  returns and growth are tax free while money stays invested.  

4. . Contributions to an HSA are tax deductible: they reduce your taxable income 

 

5. withdrawals for medical purposes are tax free. 
 

6. once you reach retirement age you can withdraw from an HSA penalty free but you do pay taxes on the withdrawals

7. no you would not for the reasons given above. 
 

8. Ok.  

Oh, oh wow, I wasn't aware of all that! Thank you. This makes it definitely worth thinking about.

Only issue is, the HSA is tied to the worst plan with the highest deductibles with no copay, while being only marginally cheaper.

[Mike E 11,739]

5 minutes ago, Pat2021 said:

Oh, oh wow, I wasn't aware of all that! Thank you. This makes it definitely worth thinking about.

Only issue is, the HSA is tied to the worst plan with the highest deductibles with no copay, while being only marginally cheaper.

If you are healthy it is financially the better choice depending on your tax bracket.  

[Pat2021 43]

29 minutes ago, Mike E said:

If you are healthy it is financially the better choice depending on your tax bracket.  

Thank you! Definitely something to think about.

[Jamie and Richard 26]

2 hours ago, Pat2021 said:

 

Thank you for your post, just wondering why are you advising to stay away from Kaiser?

If you and your wife are interested in traveling, this is not good if you are traveling to areas outside of their coverage area. 
If one day down the line you are interested in talking to a therapist, expect delays as it goes through a pretty long authorization process. Many other insurers have a nice streamlined process for this, for some reason Kaiser still hasn’t figured this one out, yet. 
There is a lack of flexibility to see any doctor that you’d like. Huge con in my book! Rapport is important and not all doctors are focused on making the best relationships with their patients. I have followed doctors who left a practice and went to another because of our great relationship. Unfortunately, with Kaiser, if a doctor leaves Kaiser as a whole you will not be able to follow that doctor. 
Lastly, their healthcare is standardized instead of individualized. 

[Pat2021 43]

12 minutes ago, Jamie and Richard said:

If you and your wife are interested in traveling, this is not good if you are traveling to areas outside of their coverage area. 
If one day down the line you are interested in talking to a therapist, expect delays as it goes through a pretty long authorization process. Many other insurers have a nice streamlined process for this, for some reason Kaiser still hasn’t figured this one out, yet. 
There is a lack of flexibility to see any doctor that you’d like. Huge con in my book! Rapport is important and not all doctors are focused on making the best relationships with their patients. I have followed doctors who left a practice and went to another because of our great relationship. Unfortunately, with Kaiser, if a doctor leaves Kaiser as a whole you will not be able to follow that doctor. 
Lastly, their healthcare is standardized instead of individualized. 

Thank you again! Lots to think about and there does not really seem to be a right or wrong decision.

 

Is there a way I can find out UHC (United) coverage in LA area? Knowing how many options there are for in-network vs out-of-network would be great.

[powerpuff 6,697]

1 hour ago, Pat2021 said:

Is there a way I can find out UHC (United) coverage in LA area? Knowing how many options there are for in-network vs out-of-network would be great.

https://www.uhc.com/find-a-doctor