Does anyone have a US healthcare plan?

Hello. I am thinking about taking out a US healthcare plan. Not travel insurance, an actual healthcare plan. Has anyone else done this while living in the UK?

We haven’t had a great experience with the NHS or private plans here. Yes, I know the NHS is under an incredible amount of pressure and they have my utmost respect. However, even with private we’re paying around £1600 per month for my husband’s medication. If we’re going to pay that much I am thinking it may be better and probably cheaper to just fly back to the US for medical appointments.

Has anyone else been in this situation?

I have US healthcare*.  It won't cover treatment here, but if I'm in the US, my care would be covered.  My plan was to fly back annually for checkups and to see my specialists.  But I've been here since February of 2013, and I have made zero trips back (not even to see family).

But if you can afford a plan and you will be flying back, anyway, and you feel you're not getting what you need here, I can see how it would make sense.

Another member recently went to the US to get some health matters sorted out because she knew she wasn't getting the care she needed under NHS.  I think she paid out of pocket for everything when she was in the US.

Here's a thought that occurred to me in my own case: I wanted to keep up with my old US specialists because I knew them and they knew me, and I trusted that they knew what was new and different for me, so they wouldn't under- or over-treat me if I had a medical crisis.  But then I realized if I had a medical crisis, with my condition I wouldn't be able to fly home, so I'd be stuck here having to become acquainted with local doctors in the middle of a medical emergency, and that's not the best time for me to spring ME on them.  So I got established here, and now I have the best respiratory consultant I could have hoped for and I'm comfortable with the fact that I can't make the flight.

From a practical point of view, pay attention to the terms of the policy.  Probably, if you give them your money and go to an approved network provider, it'll be fine, but make sure there's no residency issues that invalidate the policy.

*Government coverage, not private.

Hi.

I had a US Blue Cross plan provided to me for free as an early retirement perk by my former employer. It had coverage anywhere in the world. There actually were private doctors that would accept it there, but the list was by no means extensive. The plan was considered "catastrophic coverage" as there was a really hefty out-of-pocket deductible that had to be paid before the normal 80/20% split in costs would kick in. Once that was taken care of, it covered pretty much anything medically necessary as it was governed by the US ACA regulations, regardless of my place of residence.  It also would have paid for medication. If my medication charges were what you are currently paying, I'd have met the deductible in  three months.  (If I had to go out of the BC network, it would reimburse a percentage of my costs, after that deductible. I think it was about half, sorry, I just don't remember.)

In looking at an old "pay" stub, it looks like the company was paying about $225 a month for my coverage, but reminders that it was a group plan for a very large employer. I have no idea if it would be possible to get a similar plan while living overseas, but it might be worth looking into. I am thinking (and I could be wrong) that if you are not of retirement age, there would not necessarily be underwriting involved because of the ACA. But I'm not sure about the international aspects of that. I know that if I had wanted to change from the plan I was on to another offered to me, but that had a much lower initial deductible and higher monthly premium costs, I could have done so with no medical underwriting involved. But, again, that was a plan through a US employer. I'm not sure if it can be done as an individual or not. Definitely worth checking into, though.

Good Hunting!

PS - I found medical costs there are considerably lower than in the USA, so you might want to figure that into your equation. If you could direct pay to a private doctor there, it would possibly still be cheaper than if you had to do the same in the USA, or pay for the insurance premiums, if you don't use a lot of highly specialized care?

Is there a reason his care can't be transferred to the NHS? Often you have to go private in order to see the specialist in a timely fashion, but then they are happy to transfer you to their NHS service if you live in the catchment or have had the formal referral via GP or local specialist.

I don't think a US insurance plan would be worth it unless the cost of the plan plus medication is less than the cost here, but then you also add on stress of travel in specific time frames to get it refilled.

Something else to consider, are there any options that would be cheaper in Europe?

£1,600/month for prescriptions sounds awful. Are you getting the best deals? Can you live in Scotland or Wales and get it free, probably not if you are working?

https://www.moneysavingexpert.com/family/cheap-prescriptions/

Our US health insurance was costing us $900/m before we left in 2016 and then we had copays, deductibles etc on top. It cost that much because we needed a PPO plan so we could have coverage out of State as we traveled a lot.

Part of your problem will be finding an insurance carrier in the USA that will write a policy for you if your residence address is not in the USA. They tend to base the premiums on where you live. If you still are using a US address you might be able to get one in that area. I would want to check it all out carefully, though, because if you run up a big insurance bill and they decide you are doing them fraud by using a non-residence address you could be stuck with both the full bill and whatever state penalties there might be for so doing.

Also, something to consider:  when you're in the USA you're protected by the ACA (until you are Medicare-eligible, when things get complicated) so you can't be denied cover for pre-existing conditions.  Overseas, no ACA protection, so there might be underwriting involved - and if you're running up that kind of expense on medications I would assume there's a pre-existing condition. It almost assuredly would not be covered so you'll still be out the medication costs for it.

Maybe this will help you?  https://money.usnews.com/money/blogs/on-retirement/articles/2018-07-17/how-to-choose-health-insurance-for-retirement-overseas

Part of your problem will be finding an insurance carrier in the USA that will write a policy for you if your residence address is not in the USA. They tend to base the premiums on where you live. If you still are using a US address you might be able to get one in that area. I would want to check it all out carefully, though, because if you run up a big insurance bill and they decide you are doing them fraud by using a non-residence address you could be stuck with both the full bill and whatever state penalties there might be for so doing.

Also, something to consider:  when you're in the USA you're protected by the ACA (until you are Medicare-eligible, when things get complicated) so you can't be denied cover for pre-existing conditions.  Overseas, no ACA protection, so there might be underwriting involved - and if you're running up that kind of expense on medications I would assume there's a pre-existing condition. It almost assuredly would not be covered so you'll still be out the medication costs for it.

Maybe this will help you?  https://money.usnews.com/money/blogs/on-retirement/articles/2018-07-17/how-to-choose-health-insurance-for-retirement-overseas

Good points.

Also if he is 60 or over then all prescriptions are free in England.

Thanks everyone for your responses.

My husband is on a biologic, which by their nature are difficult to produce so are therefore more expensive than other meds. The approach the NHS takes is to exhaust all the least expensive options first before using a biological, but unfortunately the other meds are not very effective. He has had an amazing response to the biologic so keen to keep him on it.

When we first arrived in the UK we still had US health insurance and he flew back to get meds every 3 months while he waited on the NHS list to see a specialist. He’s in with the NHS now, but they only want to use cheap ineffective meds. We have private UK insurance now through my company but unfortunately they do not cover chronic conditions, which is why we are paying list price. On top of that we pay the private dr a consultation fee of around £275 every 3 months. So, if I do the math right I will save £ if I can find a plan in the US that is <1691 per month.

As for an address in the US, I guess I could use a family member’s address. That might have tax implications though so will need to do some research there.

Thanks everyone for your responses.

My husband is on a biologic, which by their nature are difficult to produce so are therefore more expensive than other meds. The approach the NHS takes is to exhaust all the least expensive options first before using a biological, but unfortunately the other meds are not very effective. He has had an amazing response to the biologic so keen to keep him on it.

When we first arrived in the UK we still had US health insurance and he flew back to get meds every 3 months while he waited on the NHS list to see a specialist. He’s in with the NHS now, but they only want to use cheap ineffective meds. We have private UK insurance now through my company but unfortunately they do not cover chronic conditions, which is why we are paying list price. On top of that we pay the private dr a consultation fee of around £275 every 3 months. So, if I do the math right I will save £ if I can find a plan in the US that is <1691 per month.

As for an address in the US, I guess I could use a family member’s address. That might have tax implications though so will need to do some research there.

Welcome to the hell everyone has to go through on the NHS. But you should be able to petition the trust for this if he has already failed those medications in the US and you have the documentation for it. Nothing is easy with the NHS, but eventually you usually get what you need medication wise. I had to re-fail nearly everything except those that caused really severe side effects.  I'm sorry it's been difficult, but if you plan to live here long term I do encourage learning how to navigate the NHS. Your local healthwatch may have a help desk who can provide advice, or your local citizens advice.

I have to agree with margo and jfkimberly.  It's a frustrating process in the beginning, but if you're thinking you will be in the UK for a while, it's worth it to get used to the NHS sooner rather than later.  jfkimberly said it well - should an emergency strike (especially for those with chronic/complex conditions), it's worth it to have relationships with doctors and specialists already established within the NHS which will make managing the emergency easier. 

They do love the red tape and gated step-wise approach to treatments, but if the treatment is covered, you can eventually get it if you go through the motions.  It's not great, but might be something that's worth going through during the short-term for long-term access?  Disease-specific charities might help with faster access, and that might be another avenue to look into to get this sorted. 

Sorry to hear of your challenges; I hope you can get a solution that works for you (whichever path(s) you go down).