Health insurance and coverage in the US for T1D

I’m considering moving to the US next year. I’ve never lived or worked in the US before and I hear so many different stories from people with T1D about their insurance coverage.
When I move to the US I’ll probably apply for a job like this one: https://www.governmentjobs.com/careers/nashville/jobs/1849107/epidemiologist-1
Can anybody explain to me what my insurance policy would look like, how much I would have to pay for insurance costs and what coverage I could expect? And also: are insurance companies (still) allowed to have a one year waiting period for insurance benefits to kick in because of a pre-existing condition like T1D?

That sort of government-job will very likely come with health insurance partially paid by the agency you work for. You’ll pay a portion of the monthly payments (usually a couple hundred dollars), and you may have a large deductible (the amount you pay out of pocket in addition to your monthly premium) before your insurance kicks in. You may have access to a pre-tax Health Savings Account as well.

However, with what the Senate is doing right now, it’s hard to say what pre-existing condition coverage is going to be like next year. It might be the same as now (insurance companies can’t deny you or charge you more if you have T1), or it might be radically different (companies can deny service, raise rates, or refuse to pay for medical services).

If it makes any difference, I’m very seriously considering leaving the US to work in Europe or Canada over the next few years. Insurance here is too complicated, too expensive, and too dehumanizing to put up with when their are alternatives out there where people are treated like human beings.

Just as a rough guideline, I pay more than 1 out of every 5 pretax dollars I make on healthcare (insurance premiums, deductibles, or copay).


By the way @anon92548039, you can usually find what kind of medical plans are offered from human resources. For the Nashville city job you listed, the medical plans in their confusing entirety are described at the following website: http://www.nashville.gov/Human-Resources/Benefits/Employee-Benefits/Medical-Benefits.aspx

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I’m not sure if you’re paying attention to what is going on here but a second vote on repeal of the aca may take place next Wednesday. That would mean people with pre-existing conditions and anyone who needs any type of expensive care will be charged much higher costs which they can’t afford. The costs are already exorbitant. Many things such as hospitalizations emergency room visits and maternity etc may not be covered at all. People are going to die if this goes down. Type one is very expensive even if you have good insurance. To give an example I was in hospital for 24hrs last spring and the bill was $12,000 if paid for out of pocket. You can never predict with this disease what will happen or when an emergency will take you to the hospital. I don’t think this is a great time to be coming here.

I’m definitely paying attention to the horrorstory that’s going on with the repeal and replace ACA in the US! Like many of you, I have sleepless nights about it as well. I can’t wait for it to be October first, when this repeal and replace monster hopefully will be slain forever.
It was only after the ACA was made into law by the Obama-adminstration that moving to the US seemed like a realistic option for me.
And nowadays, I think it’s time for me to take a risk in my life in stead of always doing the sensible thing! And keep in mind: It’ll take at least another year before I would move to the US (I’ll have to finish my master in epidemiology first!).
Dutch families on an average income spend about one fifth of their income on health care benefits. Not all of those expenses are directly traceable because they are included in taxes. Don’t forget that a lot of European countries have considerably higher taxes on wages (In the Netherlands about 40% of your wages go straight to the tax authority). I pay about 145 dollars a month on the healthcare plan you are required by law to have. Then there is the 460 dollars out of pocket expences each year I can’t escape because of my T1D. And the Freestyle Libre isn’t covered so that adds another 145 dollars a month.

@anon92548039 - If you will be going on employer provided group health insurance then what ever is going on an DC with health bills will have a far lower impact on you. If you wait for the government to come up with the perfect health plan for you then you may be waiting a long time.

In your first post, you indicated a job opportunity. In which case the ACA would have had at best minimal impact for you.

On the other hand if you are planning to move the the US without any actual job in hand then you may want to follow all the political news closely.

In terms of your question on whether it is “allowed” to have a waiting period? For employer provided group health plans involving sought after positions - this is not really relevant. The job position you posted had quite a list of specific skills. During an interview if you have skills the employer wants then everything is negotiable. If an employer wants you then you can tell them you NEED to have insurance start on day 1. You can tell them the starting 2 weeks vacation is not adequate and you need to start with 3 weeks. If you are in a strong position then you can negotiate anything.

I can assure you it will be a lot more expensive here even with good private insurance. And everyone will be affected by this not just people on aca. What they are trying to do is destabilize the whole system and make it crash and burn even if this doesn’t pass by defunding Medicaid. Next comes Medicare and social security. The current gov has been planning this for many years. It’s all about money for them- so the rich can get even richer with a huge tax cut. They don’t care about people one bit. As far as they’re concerned if you’re old, sick, chronically ill, poor etc. too bad- it’s your fault. If you can’t afford insurance and or pay the exhorbitant costs you can just die.

If you’re not in a state that plans to protect its residents in every way they can like NY or CA its going to be terrible. Even then there’s no guarantee of what will happen. This isn’t just about healthcare either obviously it’s about fascism and lunacy. It would be very easy to devise a system that will cover everyone by taxing appropriately and controlling costs. I’d say go to Canada. You won’t have to worry about what is going to happen there or losing coverage and going bankrupt. You don’t have to worry about living in a fascist country being run by a lunatic. Higher taxes are worth that but overall they are not that high relative to what you get.

One thing that might be a nasty surprise is that many Americans actually pay as much or more in taxes as many Europeans. The taxes here are just structured differently, so that they don’t look quite as bad on paper. For example, in addition to federal income tax, I pay a state income tax, a state property tax, a local property tax, sales taxes on everything (including food), extra fuel taxes from the state, payroll taxes to support social programs at the federal level (Medicare and Social Security), and probably some others that I’m missing. When you add all those up together, I suspect that I pay very close to 40% of my earnings in wages on top of the 20% I pay for healthcare.

You also have to consider what you get for the taxes you pay. Even after paying all that tax, the typical American still pays for public university educations, books and uniforms (in some cases) and supplies for school for children, for daycare for children, toll roads around cities, public transportation in large cities, public funding for building public schools and medical facilities (as an “extra” tax after a referendum for a period of years), etc. In my experience in Europe (Belgium and Scotland, primarily), basic food is often more expensive in the US (the staples), and “specialty” products that many Europeans take for granted (like cream, local cheeses, fresh butter, some meat like lamb, etc.) are exorbitantly expensive in the US (by comparison).

Although places like Paris and London have well-earned reputations for being expensive to live in, I think many Europeans would be absolutely shocked by how expensive it is for the average American to pay their bills and eat halfway decently. Throw a kid into that equation, and all the sudden the average American is in serious financial hardship just trying to stay ahead of debt and not declare bankruptcy.

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Well, I do see some parallel rhetoric from former fascist leaders in Europe and the US president who announces: “Wouldn’t you love to see one of these N.F.L. owners, when somebody disrespects our flag, to say, ‘Get that son of a ■■■■■ off the field right now, out, he’s fired,’ ”
Elections are not the hallmark of democracy. Elections are one of the tools to make a country/region/city a democracy. I read a very interesting book on this subject, by a Belgian writer, David van Reybrouck. It’s also translated in English. It’s called: “Against Elections: The Case for Democracy”. I strongly recommend reading it.

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You might be right, but we pay local taxes as well and also taxes on everything we buy ( it’s already in the pricing, so you don’t notice it like you do in the US). And I agree that Europeans probably used to get more back for the taxes we pay, but the last 25 years or so, there have been severe cuttings on just about every wellfare program. Europe isn’t the Wallhala it might seem from the outside (but I’m definitely not saying that the US is all that great either!)
And you are definitely right about the ridicously high food prices in the US! But I hear Lidl is coming to the US, so those problems might be solved some time soon :grin:

When Americans compare our system of health care against the systems in Europe, they don’t consider their health insurance premiums, deductibles, and copays as taxes, but they should!

OH man, I’d LOVE a lidl! My favorite place to shop in Belgium :wink: They always have good local cheeses and chocolates.

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Yes, maybe I should let the location of a Lidl nearby be the most important factor in deciding WHERE in the States I would move to !
https://www.lidl.com/stores

Some health insurance limits choices on insulin and supplies, e.g. cheapest insulin, cheapest test strip, cheapest syringes. Those seem to be older stuff like humalog but not novolog, inaccurate test strips, fat needles, etc. Then you’ll have the choice between paying retail out of pocket or the cheap junk insurance covers. Oh, and some insurance won’t pay for pumps and CGM or just repeatedly disapprove hoping the patient will give up.

This article In the NYT has a good discussion about health care systems in the Western World:

And a follow up, where readers responded:

What I take away from it, and also from your responses, is that you can’t really tell what you’re going to get from your health insurance and at what price in the US. That’s a big difference from health insurance in the Netherlands. I know what I’ll get over here and at what price.

I have probably some of the best employer provided insurance you can get, and it is about $320 per month for me and my family. For just me it would be about $90. Vision and dental are also separate. This particular plan doesn’t have an annual deductible (what you have to pay out of pocket before the insurance will cover anything), but that is fairly uncommon in my experience. On top of that there is a 20, 30, or 45 dollar copay for each prescription depending on if it is generic, name brand (which most modern insulins fall under), or specialty. I know in some countries insulin doesn’t require a prescription, or you can otherwise get as much as you need without much hassle, but here pretty much everything, including pump supplies, requires a prescription for a specific amount. There are also copays for the doctor, so on my plan those are 20 for your regular doctor, and 35 for specialist (like an endocrinologist). My particular plan doesn’t have coinsurance (you pay a percentage, and they pay a percentage) on insulin pump supplies and CGM. BUT, because of that, I have an extremely limited number of places I can order from, that being only 2. They are both absolutely horrible and I have to fight to get my supplies every order I make. For any other medical costs I have to pay 10%. So say I have to have surgery, one night in the hospital, not counting the surgeon cost and anesthesiologist cost, will probably be between 15,000 to 40,000, so that’s 1,500 - 4,000 right there.

My plan doesn’t cover anything “out of network”, which means the doctors, pharmacies, suppliers, etc, all have to have special deals with the insurance company for my insurance to accept a claim. So I can’t go anywhere I want (hence why I have such limited options to order supplies). Also, some specific treatments aren’t covered at all, such as the new Minimed 670G. I could get what is called the PPO or “preferred provider organization” plan, which allows me to go out of network, but I lose the 100% coverage for the pump and CGM supplies, and if I go out of network they will only cover 70% of the cost. So if I buy a month worth of CGM and pump supplies from the cheapest, while also reputable, place I can, I would be paying about 300-350 a month on top of the other costs. Also, then I will have a $300 annual deductible for individual, and 600 for family. There are also many complexities between plans, and insurance companies, and it also varies by state. In general, the insurance companies have a lot of power to decide if they will cover something or not, for whatever reason they may choose, even if it should technically be covered.

Those costs are fairly uncommon even for employer provided insurance, and if you need to buy private insurance, the cost will go WAY up. And if they repeal the pre-existing condition protections from the ACA, you can forget private insurance coverage. Or if they did cover you, it would have so high of premiums and so high deductibles that it won’t help that much at all.

@anon92548039 [quote
What I take away from it, and also from your responses, is that you can’t really tell what you’re going to get from your health insurance and at what price in the US.
[/quote]

This is somewhat true. Under the ACA, insurer’s are required to provide a summary of coverage under each plan. Its one of a few provisions meant to make purchasing health insurance easier to understand. In most cases it helps, but health care pricing itself is so muddled it’s almost impossible to calculate your actual expenses, so insurance is only part of the problem.

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Being a type 1 Diabetic in the US is very expensive and incredibly nerve racking. Most insurance companies will only cover the cheapest test strips and solutions to manage your diabetes. Any pumps, CGMs, are generally thousands of dollars per year if you can even get them to cover it. It is an uphill battle, and anytime you change/lose a job you may have to pay out of pocket until your new insurance kicks in or get whatever new plan your job offers which may be terrible. In my experience, every year premiums go up and the coverage gets worse. Don’t forget that the US has a “for profit healthcare system” and they don’t make money paying for all your fancy and expensive life saving diabetic supplies. I wouldn’t take the gamble moving here as a T1. Just my two cents

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Low deductible plans are on their way out. So, a good gov plan estimate might once have been around $250, but are now approaching $450 per month, on the low end, with a $1 - $2,000 yearly deductible. To be on the safe side, I would come with $2,000 in hand to pay down the deductible and have a few months worth of supplies in your luggage when you come. Thats just a rough estimate. Until you meet deductible, a bottle of insulin may run $300. Insurance via gov plan will tend to pay 20% until you meet deductible, and you will pay 80%.

Assume worst case scenario that you are paying out of pocket for everything, maybe $300 per bottle of insulin. Syringes are inexpensive. BG strips and ‘cheap’ insulin can be purchased over the counter, without an Rx at Walmart and are inexpensive ($30/bottle and $10/bottle of strips).

I fear for you. https://www.youtube.com/watch?v=EBj3AAY85Uw

I fear for you. https://www.youtube.com/watch?v=EBj3AAY85Uw

???

Moving to the US would never be because of healthcare, but DESPITE of healthcare!

As a type 1 diabetic, I was a medical refugee from the United States to Canada, where I can get all my healthcare needs met without any user fees. Of course the taxes are higher to pay for that, but as someone who is bound to have disproportionately higher medical costs, but also as someone who is taxed according to the same progressive system as is applied to both healthy and sick people, I profit from getting my healthcare through taxes, where I am not at a disadvantage, rather than user fees, where I am.

What people always forget is that healthcare costs what healthcare costs, and does not get any more ‘expensive’ simply because the government pays for it through taxes. The health bill is determined by the expenses generated by illness in the population, and you can distribute that constant sum in three ways: You can pay for it by the state through taxes; you can pay for it through individuals through user fees; or you can let people go without healthcare, in which case the cost is taken out on the country not in the form of money but in the form of human suffering, poor health, and diminished productivity of curable people left sick.

Of course public healthcare will increase costs because it will cover everyone, rather than leaving some people sick and dying because they can’t afford medical care, but it recoups those costs by greater price controls over the suppliers, since a single negotiator, the state, can bargain more powerfully with doctors and pharmaceutical companies than a divided group of helpless sick people can. Administrative costs also decrease, since the state is the only bureaucracy, rather than countless private insurers and a few public ones. That is why countries with public healthcare pay from 7% to 10% of GDP on healthcare to cover everyone, while the largely private U.S. system spends 17% to cover only 80% of the population. .

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