American healthcare may be one of the most confusing things you’ll have to navigate when you move here. If you’re being relocated for work by your employer and will be on an employer-sponsored visa, then typically your employer will provide some sort of healthcare plan for you and your family. If you’re moving for a different reason and will not be covered, then by law you’ll need to obtain healthcare on your own.
Many physicians will not provide their services if you do not have healthcare. Note that in the event of an emergency hospitals must provide treatment even if you don’t have insurance. However, you can expect to receive a bill for the treatment and even simple procedures can cost thousands of dollars.
PREMIUMS, DEDUCTIBLES, COPAYS, AND COINSURANCE
When you’re evaluating healthcare plans you’ll see the terms premium, deductible, coinsurance, and copay. These are important terms to understand since they’ll impact the cost of the healthcare plan to you.
A premium is the payment you make, typically monthly, to your health insurer to keep your health insurance plan active. If you have health insurance provided by your employer then they may pay for some or all of the premium.
This is the amount of money that you will personally have to pay for healthcare services each year before your health insurance starts to provide coverage.
For example, if your plan has a deductible of $2,000 then your health insurance won’t cover any costs until they are higher than $2,000. So if you have a procedure that costs $5,000 you would pay $2,000 and your insurance would pay $3,000. If you’re a healthy person who doesn’t require any major treatment during the year then it’s likely you’ll never spend more than your deductible.
Some health insurance plans do provide coverage for basic services like an annual check-up before you’ve met your deductible.
Plans with a high deductible typically have cheaper monthly premium payments, but you’ll pay more out of pocket before insurance kicks in. And some plans with very high monthly premiums do not have a deductible at all.
Think of coinsurance as sharing the cost of healthcare services with your health insurer. This is a fixed percentage amount that you pay for healthcare services and applies after you’ve met your deductible
For example, let’s say you have physical therapy treatment that is covered by insurance and your health insurance plan dictates that each time you visit a physical therapist you have a 25% copay. If the physical therapy treatment costs $100 then you must pay $25 and your health insurance will pay $75.
Plans with a lower monthly premium payment tend to have a higher coinsurance amount.
Some health insurance plans have something called a “copay” when you obtain medical services or prescription drugs. This is a fixed amount that you pay for healthare services and, once again, only applies after you’ve met your deductible.
For example, you may have a prescription for medicine that is covered by your health insurance, but each time you go to the pharmacy to refill the prescription you have a copay of $20 – basically, you have to pay $20 to get your medicine and your health insurance covers the rest.
If your situtation or your family’s situtation requires frequent trips to the doctor or you are frequently refilling prescriptions, you’ll want to find a plan that has a low copay amount.
Some health insurance plans may have both copays and coinsurance.
HEALTHCARE INSURANCE OPTIONS
There are a number of healthcare options available to residents of Los Angeles. Your age and income level with help determine which is best for you. Here are a few great resources to check out.
Find health insurance under the Patient Protection and Affordable Care Act (Obamacare), including finding out if you qualify for federal premium subsidies and/or Medi-Cal programs.
Health Insurance Counseling & Advocacy Program (HICAP)
Non-profit focused on Medicare advocacy and education in California. Find information on Medicare, long-term care and healthcare-related consumer rights and protections.
Health Resources and Services Administration
U.S. agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.
California Department of Health Care Services resource page for people eligible for Medi-Cal and their families and caregivers with information on coverage, enrollment, benefits and related programs.
Medicare (Centers for Medicare and Medicaid Services)
Medicare offers health coverage to people age 65 and older, people with permanent disabilities, and people with specific illnesses.
Official U.S. site for Medicare for people with Medicare and their families and caregivers with the latest information on enrollment, benefits and other helpful tools.
Other options include My Health LA. It is a no-cost healthcare program for Los Angeles County residents, many of whom do not qualify for Medi-Cal, such as undocumented immigrants.
HELPFUL HEALTHCARE RESOURCES
Cost – Amino helps you find a doctor in your area to treat specific conditions. Their cost tool lets you see average costs for the same procedure in your metro area and can be useful to make sure you’re not overpaying.
GetInsured – This simple-to-use site makes it easy for you to shop for insurance if you’re not covered by an employer. You can filter by different criteria such as deductible amount, plan type, and health insurer.
ZocDoc – ZocDoc is an easy way to find a doctor in your neighborhood who accepts your insurance.