Unlike other countries, the US does not have universal health care that provides basic coverage to all its citizens. Instead, it has a combination of private-and public-sector provision. Outside of the government’s two public health insurance programs—Medicare (for 65+ or under 65 with an eligible disability) and Medicaid (for low income)—it’s a private industry. And it’s expensive. It’s imperative to have health insurance to help protect you from the high cost of care and medical services, including hospitalization and surgery.
The majority of people receive coverage through their employer’s health insurance plan. As you are relocating for work, you will be eligible for employer-sponsored health insurance too. However, health care insurance plans can be confusing. Like other employment benefits, the insurance coverage provided and the costs to employees can differ significantly between employers. Even with health insurance, you can expect to incur expenses because it’s a cost-sharing system.
Such a concept will be new to many of you, so we’re going to examine when you can expect to incur expenses and what insurance coverage terms you need to know.
Costs You Share
A health insurance premium is a total cost paid for coverage of the plan. Typically, the employer shares a percentage of this cost with you. And you pay your share of the contribution as a payroll deduction. However, many insurance companies require the employer to pay at least fifty percent of the premium cost for its employees. But once they meet that requirement, the employer can use discretion on the total percentage they pay.
You can expect your employer to offer a few health insurance plans to choose from. You can also expect them to extend health insurance coverage to your dependents (spouse or children). Although an employer is not required to pay family premium costs, some do. If you elect to include your family in your policy, the cost involved will be deducted from your payroll.
The idea of this cost might be concerning, but it’s worth noting that employers participate in group health insurance plans. With a group plan, the employer establishes and maintains coverage for all plan participants, which spreads the insurance risk across the group of policyholders and reduces the price for each individual. So, with large employers, the discount offered can be substantial, and will most likely be more affordable than the alternative option of buying separate individual coverage for your family.
Cost of Care
You can also expect to share the cost of certain services with the insurance company. However, there will be a portion of your bill that the insurance wouldn’t cover, and you will be responsible for it. These costs apply through a combination of cost-sharing features to include copays, deductibles, coinsurance, out-of-pocket maximums, and in-network and out-of-network providers. I know, that’s a lot of terminology! All the ins and outs can be hard to make sense of initially. So, let’s go through them one by one.
- Copay: This is a flat fee that you pay for a doctor’s visit or to fill a prescription. Certain services such as an annual checkup and some preventative care provisions are exempt from copays and provided at no cost because they contribute to keeping you healthy.
- Deductible: This is the amount you pay each year for health care (services and medication) before your health plan begins to cover your costs. Again, certain preventative services are exempt from the deductible amount and provided at no charge.
- Coinsurance: This is the share of the cost you pay after you meet your deductible. Your share is calculated as a percent of the amount that the insurance plan allows for the service provided, and your insurance carrier pays the remaining balance. Again, certain preventative services are exempt from coinsurance.
- Out-of-Pocket Maximum: This is the maximum amount you pay for covered health care expenses within your benefits plan year. This maximum includes money you’ve paid towards copays, deductibles, and coinsurance. Once your out-of-pocket maximum is reached, then your health plan will cover all other eligible medical and prescription costs for the remainder of the benefits plan year.
- In-network Provider: This is a list of healthcare providers who have a contractual agreement with the insurance carrier to provide services at an agreed-upon and discounted rate. You can take advantage of these savings by staying within the network of approved providers. I would advise you to stay within the network whenever possible.
- Out-of-network Providers: Any healthcare provider that does not have a contract with your insurance carrier is considered out-of-network, and they can charge whatever rate they like. Therefore, you will pay extra for their services, so be sure to check your in-network providers before selecting an out-of-network option.
Know Your Numbers
Comprehensive health insurance is a critical component of your employee compensation package. Employers share the cost of health insurance coverage with their employees, but the contribution ratio can differ significantly. As you do your research, you will notice that some employers pay a lot toward the cost, while others pay less. Therefore, it’s essential to understand the benefit coverage provided and the percentage share you’ll assume should you need medical care.
Ask recruiters for a summary of their health plan and when you become eligible to enroll—is it on day one, or is there a waiting period? The summary will outline the benefits (medical, dental, and vision), the coverage offered, and the services covered before the deductible applies. It will also outline the out-of-pocket costs for employee contributions (individual, partner, and family coverage), copay, deductibles, coinsurance by category and procedure, voluntary benefits, and wellness programs. It’s a comprehensive summary, but it’s worth taking the time to go over it.
Once you’ve reviewed the benefits information, you can make an informed decision on whether the insurance plan meets your needs and the needs of any family members traveling with you. As a nurse, you know that no one plans to get sick, but you must prepare to protect yourself from financial loss due to illness in the US. So, take the time to educate yourself about your employer’s health insurance plan, regardless of how tedious it may seem. Trust me; it will help minimize financial stress and avoid surprises once you start working. And I hope it gives you peace of mind as you prepare for your new life in the US.