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Diabetic Healthcare Cover in the USA

achwookie

achwookie

Newbie
Messages
2
Location
Leigh, Lancashire
Type of diabetes
Type 2
Treatment type
Other
Hi,

New to the Forum but had diabetes for about 10m years now.

I am looking to find Health Care Cover for my diabetes in the USA, as I am moving over there next year to start a business.
Looked at the online quotes and generic healthcare cover websites and found them to useless as each quote never includes Diabetes as the main cover - and needs to be individually assessed - then they never bother to come back to me.

Ideally I'd like the same cover as provided by the NHS - Check-ups, eye/feet and medications
So, does anyone know of a US based Health Insurance cover that would cover my medications etc whilst over there ??
I'm lucky that this can be partially covered by the company, but I'd Ideally not want to be ripped off as well.
 
DavidGrahamJones said:
Would you not have problems as the diabetes is a pre-existing condition?
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No, that changed in recent years (Affordable Care Act) and health insurance companies are no longer able to deny you based upon pre-existing conditions.

My knowledge on Ex-Pats and non-US citizens is very limited as I don't have much personal experience with how those people are protected by our laws.

@achwookie, there are two things you mentioned: that you were starting a business here, but also that it would be "Partially covered by the company." Those statements can both be true, but it's very important to be clear about if you are the owner of this business or if you're simply helping to open the business. Basically, who is paying for this employer-sponsored plan?

In terms of selecting an individual insurance plan, there are two basic options: high-deductible plans and low deductible plans. The general rule of thumb is that high-deductible plans are best for people who don't have a lot of medical costs while low-deductible plans are best for people who do.

Side note: My general rule of thumb is to avoid the Emergency Room (ER) unless my life is at risk. As soon as you step foot onto an Ambulance or check into the ER, you're going to get assessed a $2000+ bill. If the emergency is minor, there are locations called "Urgent Care" facilities that can provide assistance for minor emergencies, but at a much more reasonable cost.

I would dare to say that most Americans don't know how all of this works and I'd be wasting our time trying to explain everything because it's very complicated. However, if you have specific questions feel free to ask them and I/we will do our best.
 
My experience with diabetic healthcare coverage under the affordable care act has been great overall. Premiums can be high for diabetics but citizens have tax credits which can be applied to the monthly premiums. I have used the affordable healthcare act coverage in two different states now and have found that most of my needs have been covered. My monthly out of pocket costs after my tax credit are $27.54 per month.
I had a suspicion that this was a fishing post to rail against the healthcare system in the USA.
 
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TorqPenderloin said:
No, that changed in recent years (Affordable Care Act) and health insurance companies are no longer able to deny you based upon pre-existing conditions.
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Does that depend on your type of residency?

As a separate issue, back in June I was admitted to a hospital in Maui, Hawaii, as the result of a faulty blood reading. Two further tests in the hospital plus lab work to make sure, all confirming that I wasn't having a heart attack (I didn't think so either, having dug a hole 16ft X 10 ft X 1ft and moving 2.5 tons or 100 X 25kg bags of pea stones from the DIY store to my house and then to the end of my garden) just before the trip. This didn't stop them from doing more heart tests than I realised existed and it was only when they said I needed a triple bypass my suspicion was really raised. I just said that I didn't think my insurance covered that and I was discharged within 2 hours.

I had hoped that my travel insurance would cover the total bill and at the moment they are in dispute because of the grand total of . . . . . . . . . . $US 16,000. My GP here in the UK has told me that I don't need a triple bypass which is nice but means I have more questions than answers. I was told by an American couple at the departure lounge in LAX that there have been several cases of MDs referring people for surgery that wasn't required. I had wondered why the MD had reacted so favorably when I said I had insurance, but was discharged so quickly when I said it didn't cover triple bypass surgery.

I should add that I didn't go to the MD with a problem, just to get some prescribed tablets I'd not got with me.
 
If I interpreted your story correctly, that's a much different situation than what we consider being denied based on a pre-existing condition.

As I mentioned previously, our emergency room hospitals are much different here in the USA and it would be wise to only use them if you have a life-threatening emergency. Once you're there, an ER (Emergency Room) doctor's job is to get your condition stable (I.e.-keep you from dying) and then discharge you.

Here in the US, ERs aren't allowed to turn anyone away even if they don't have insurance. However, that doesn't mean you're going to necessarily get the absolute best end-to-end treatment.

In my case, I ended up in the emergency room last year when I had a blood sugar reading greater than 500mg/dl (28-30mmol/l). I was admitted by my primary care physician (our version of a GP) which meant I was given top priority in being seen by the ER doctor. Even still, they took my blood sugar levels a few times, gave me some insulin and saline through an IV, got my blood sugar down to <15mmol/l, and then sent me on my way with a prescription for (Metformin). That entire 2-3hr experience cost me $1500 out of pocket and it cost my insurance company another $5000.

Long story short, it sounds like your open heart surgery wasn't absolutely necessary (for a number of reasons) so they elected to get your condition stable and discharge you.

The good thing about healthcare here in the USA is that most of the best doctors in the world come here (largely for the money). That means we have access to a ton of specialists and can usually pick and choose who and when we want to see a doctor. While that does seem to come at an added cost, I would personally argue that our taxes here are significantly lower than in the U.K. making the overall costs pretty similar (I'd pay almost $30k/year more in taxes if I lived in the U.K.).
 
DavidGrahamJones said:
Does that depend on your type of residency?

As a separate issue, back in June I was admitted to a hospital in Maui, Hawaii, as the result of a faulty blood reading. Two further tests in the hospital plus lab work to make sure, all confirming that I wasn't having a heart attack (I didn't think so either, having dug a hole 16ft X 10 ft X 1ft and moving 2.5 tons or 100 X 25kg bags of pea stones from the DIY store to my house and then to the end of my garden) just before the trip. This didn't stop them from doing more heart tests than I realised existed and it was only when they said I needed a triple bypass my suspicion was really raised. I just said that I didn't think my insurance covered that and I was discharged within 2 hours.

I had hoped that my travel insurance would cover the total bill and at the moment they are in dispute because of the grand total of . . . . . . . . . . $US 16,000. My GP here in the UK has told me that I don't need a triple bypass which is nice but means I have more questions than answers. I was told by an American couple at the departure lounge in LAX that there have been several cases of MDs referring people for surgery that wasn't required. I had wondered why the MD had reacted so favorably when I said I had insurance, but was discharged so quickly when I said it didn't cover triple bypass surgery.

I should add that I didn't go to the MD with a problem, just to get some prescribed tablets I'd not got with me.
Click to expand...

That is a very small hospital bill for a trip to the Emergency Room involving possible cardiac issues here without insurance. Our healthcare is thorough if expensive at times.
 
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SWUSA_ said:
That is a very small hospital bill for a trip to the Emergency Room involving possible cardiac issues here without insurance.
Click to expand...

Baring in mind I was showing no signs of cardiac distress, I was feeling as fit as a fiddle, my BP was good and it was only an incorrect Troponin reading that got me to the hospital in the first place. They could even get enough blood out of the dozen holes (that's no exaggeration, I counted!) in the back of my hand to fill the phial for the test in the medical centre. They had to squeeze the small amount of blood they had in the tube between the phial and the needle. Two further Troponin tests plus manual lab work to back it up all proved negative yet they insisted on carrying out 4 heart tests and I know that 2 of them cost US$450 each because I was sent the invoice. Whilst I accept medical care is expensive, I wonder why, after three negative troponin tests, a healthy heart echo cardiogram and a healthy MRI scan, did they perform 2 further tests that would take the total to US$16,000.

The first doctor at the medical centre was, as my wife described her, as mad as a box of frogs, especially as her first words to my wife were "your husband is having a heart attack". Confusing to my wife because at the time I was taking the mickey out of the nurses and a trainee doctor, because they could get any blood and we were all laughing our heads off.

I can't ever imagine traveling to the states without proper insurance and if I hadn't had any I wouldn't even have got into the ambulance. It really was a scam. The frog doctor even said I needed a triple bypass but I said I didn't think my insurance covered that and it was bye bye nutty doctor. The hospital faxed all the noted, all 38 pages, to my GP who I saw the day I returned. Her diagnosis was entirely different, I may have some calcification in my arteries, old people do and in fact most of us have some.

The insurers are disputing the amount and I hope to have a breakdown of costs. I'm assuming they're disputing the amount because it doesn't sound right. I will have to wait and see.
 
TorqPenderloin said:
I'd pay almost $30k/year more in taxes if I lived in the U.K.
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That's interesting, I didn't realise how little tax the better off paid. Your 40% (39.6) bracket comes in at US$415,015, and is graduated whereas we have a big jump to 40% at £43K and again to 45% at £150k. That's obviously roughly speaking and for a single person.

There again the US does tax the much lower paid whereas the in the UK, the government doesn't tax you under £11,000. Fascinating, sorry for prattling on.
 
Thanks a lot for you replies - I am heading over to Florida in December and will be looking at the healthcare whilst there. As to the status, I will be owner/partner of the business.
 
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