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University of Chicago Medical Center Emergency Room (Photo via AP)

As you may have gathered from this summer’s furor over the Supreme Court’s healthcare verdict of President Obama’s Affordable Care Act, the subject of what to do if you fall ill in the U.S. – and, more to the point, who pays for it – is a hot topic with many Americans. If they detect the slightest hint of a British accent they are liable to start foaming at the mouth about socialized medicine – the sort of thing that Canada and France does, for goodness’ sake!

While the U.S. ranks only 37th in the World Health Organization’s survey of best countries for healthcare, to some Americans that says more about the WHO’s methodology than any shortcomings at home.

But forget the politics: as a foreigner, on holiday or emigrating, unless you are a billionaire you cannot afford to step onto American soil without some form of health insurance. Here are ten survival tips:

1. If you are planning a U.S. holiday, check that your travel insurance covers you for at least $1 million. Before you even reach a hospital, an air ambulance can cost $50,000. When a normal urban ambulance took me 100 yards in April, that set me back $1,400. Hospitals can charge $20,000 a day, a surgeon might want $100,000 for an operation, and you might need a private plane home. It soon mounts up.

2. But the real minefield is reserved for immigrants. If at all possible, find a large, stable, undemanding employer that will sponsor you and sign you up to its insurance scheme and keep you on for as long as you want to remain in the U.S. Large and stable are possible, but the other qualities are increasingly scarce.

3.  If you can stick around long enough, employer-based healthcare may turn out to be blip. It stemmed from World War II pay controls from which health insurance was exempt. So that is how U.S. companies competed for talent and the practice snowballed. But more companies are dropping health coverage and the sickly economy means that if you lose your job you could be flying home within weeks — no visa, no insurance. So, make healthcare a key part of any job negotiation.

4. The main alternative is to be self-employed, as nearly nine million people already do in the U.S. The type of health insurance you can obtain will depend very much on three factors: your age, your medical history and the state you live in.

5. The Commonwealth Fund, an independent research group, has found that the northern Midwest and the Northeast and West Coasts are the best for healthcare. Worst tends to be the South.

6. If you cannot join an employer scheme, hunt down the best insurance broker in your new locality – someone who is able to navigate the Byzantine range of possible policies. Bring your medical records from the U.K., and keep them handy to answer the many, many questions you will be asked.

7. You will soon hear two sets of initials that lie at the root of health care: HMO and PPO – Health Maintenance Organizations and Preferred Provider Organizations. HMO policies are cheaper but less attractive: your choice of doctors is much more restricted, and, in many areas, amounts to no choice at all. PPO insurers allow for a greater selection of doctors.

8. But if you are self-employed or unemployed you may not be eligible for individual coverage until you have been in the U.S. for five years. Insurers will take you on only if you are part of a group. Then your best option is to form a company, because the minimum size for a group can be as low as two people.

9. Price soon becomes a major topic, not for the critical surgery but for the routine trip to the doctor or pharmacy. A good U.S. general practitioner (GP) is also a financial advisor who keeps a stock of free samples in the bottom drawer. Like Americans, don’t be afraid to ask for a discount or whether your doctor or a supplier “can improve on that price.” Often they can, if you pay cash or offer some other incentive. Europe-trained GPs are often more sympathetic.

10. Currently, if you have a pre-existing condition, such as asthma, high blood pressure or even hay fever, you may be refused any coverage, not just for claims arising from that condition. But this is due to change in 2014 under President Obama’s Affordable Care Act, and some states already have insurance pools for high-risk people — at a price.

For more consumer information: The Foundation for Health Coverage Education

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By Dave Anderson