Hello. I'm a US Citizen, and I support and advocate for universal healthcare. I have learned about how many of the Social Democracies operate their universal healthcare system. But while I understand some of the economics behind it, I don't know what it's like to actually experience your healthcare on a day to day basis. I have asked Australians and British citizens about their healthcare, and now I'd like to ask Canadians about theirs.
I figured I would share the basis of how my healthcare plan works, and you could tell me what you think of it and how it compares to yours. The general overview of my healthcare plan is as follows:
- I have to stay in-network to receive insurance benefits, meaning I must go to a healthcare provider that accepts my insurance. If I don't, I have to pay completely out of pocket. This doesn't apply to emergency rooms.
- My health insurance is tied to the company I work for. A portion of my check goes to my insurance.
- After I meet my deductible, my insurance pays 70% of my covered in-network healthcare costs, and I pay the other 30%. However, I have an out-of-pocket maximum, so I only have to keep paying my 30% share until I reach that out-of-pocket limit. After I reach my out-of-pocket maximum, my insurance pays 100% of my covered in-network care for the rest of the plan year.
- Healthcare procedures in the US often cost a lot of money, even with insurance. But the out-of-pocket maximum helps with this a bit.
- My plan is a PPO, meaning I can see a wide range of doctors and specialists without needing a referral. I also have a primary care doctor.
- All insurance companies, including mine, are liable to deny claims. This is one of my biggest fears when using medical services. Estimates show that insurance companies in the US deny ~20% of medical claims. Medical procedures can cost tens to hundreds of thousands of dollars without insurance, so it's very bad to have medical claims denied.
- This is of course not the only type of healthcare plan that Americans have, this is simply my healthcare plan, but it is a quite common plan to have in the US, at least to my understanding.
Thanks and I look forward to your replies.