# Choices of healthcare



## Thaicat (Dec 21, 2013)

Hi people,

Situation a bit different to my own: My friend George is now living in the USA full time. His english wife will join him soon. Her questions are, while apart and not resident does she qualify for healthcare in the US. 

If not what happens once she recieves her green card.

Kind Regards guys n gals


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## _shel (Mar 2, 2014)

You do realise the USA doesn't have an NHS AKA 100% free healthcare regardless of status or income for citizens.


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## twostep (Apr 3, 2008)

Marriage and immigration are two cups of unrelated tea. Once she has her Green Card status she can enroll in what is called ObamaCare or use an open window of enrollment based on life changing circumstances (marriage) to get on her spouse's insurance.


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## Thaicat (Dec 21, 2013)

I don't know much about it. She is joining George in Texas. He is US citizen but has been in the UK some time.

She will be moving out there to be with him around next Feb I believe.

Certainly here the systems free. Not great, but free.


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## Thaicat (Dec 21, 2013)

Thank you two-step. I think she wanted to join his insurance before moving there.. I was'nt sure she could do that.


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## Bevdeforges (Nov 16, 2007)

To be honest, your friend should ask his employer. In the US, you get what you pay for - the HR department will have the information he's looking for, including how much it will cost and whether or not there is any coverage outside the US.
Cheers,
Bev


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## Thaicat (Dec 21, 2013)

Sure, I think he's working for a family member. So I guess maybe he will need private medical care. I shall get her to do some research.


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## Crawford (Jan 23, 2011)

Thaicat said:


> Thank you two-step. I think she wanted to join his insurance before moving there.. I was'nt sure she could do that.


She can't.


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## Crawford (Jan 23, 2011)

Thaicat said:


> I don't know much about it. She is joining George in Texas. He is US citizen but has been in the UK some time.
> 
> She will be moving out there to be with him around next Feb I believe.
> 
> Certainly here the systems free. Not great, but free.


The NHS is not free ..... it's paid for in part by tax payers.


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## Thaicat (Dec 21, 2013)

Yes.. Thanks for that. It is certainly free for those who have never paid taxes in their lives. I digress..thank you to those who helped. Iv'e passed the info onwards.


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## BBCWatcher (Dec 28, 2012)

Crawford said:


> She can't.


I'd disagree with that. I'm familiar with at least one U.S. medical insurance carrier that has no general objection to adding a non-cohabitating spouse to the same policy. I think this is fairly common, actually. There are a variety of reasons why spouses might not be living together for periods of time.

There's a premium increase when adding a spouse (which may or may not be borne by the employer). Also, U.S. medical insurance may or may not be too useful outside the U.S.


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## twostep (Apr 3, 2008)

BBCWatcher said:


> I'd disagree with that. I'm familiar with at least one U.S. medical insurance carrier that has no general objection to adding a non-cohabitating spouse to the same policy. I think this is fairly common, actually. There are a variety of reasons why spouses might not be living together for periods of time.
> 
> There's a premium increase when adding a spouse (which may or may not be borne by the employer). Also, U.S. medical insurance may or may not be too useful outside the U.S.


The issue will be lack of SS# and services necessary outside the US.


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## BBCWatcher (Dec 28, 2012)

The specific carrier I know about is OK signing up a spouse without an SSN, but they may request proof of marriage in that event. All or virtually all of them ask for an SSN, but in at least one case it's not a firm requirement.

Yes, as I mentioned U.S. medical insurance may or may not be useful outside the U.S. Many policies are, to some extent, but some are not. It's generally in the carrier's financial interest to cover care (at least emergency care) outside the U.S. since it's typically less expensive, but some carriers don't see things that way.


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## Thaicat (Dec 21, 2013)

I spoke to her and her hubby wants her to go to the usa if he can find a policy, should she need care . Again I believe next year once he is settled and has savvings for their home he is arranging for her to move in with him in Texas. Which carrier ? 

By all means feel free to PM me, id like to help them with info if I can. Many peoole have been good helping me.


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## BBCWatcher (Dec 28, 2012)

Her husband should simply check with his carrier to find out what it would cost to add a spouse to his policy. Start with that. Second, he should find out what coverage the policy provides outside the U.S. Third, if the answers to those two questions are reasonable, he should ask about procedures for adding a non co-resident spouse without a Social Security number.

If adding her to his policy is not viable for some reason, she should simply buy travel medical insurance that includes U.S. coverage and repatriation from the U.S. back to her medical system (U.K. NHS I assume). Travel medical insurance shouldn't be too expensive. Some credit cards even include coverage when you charge air tickets.

When/if she moves to the U.S. she'll be a co-resident spouse and get a Social Security number. Then she can join her husband's policy if she doesn't do that now.


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## Thaicat (Dec 21, 2013)

Thank you BBC. As always a diplomatic and friendly fountain of knowledge. Much appreciated.


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## BBCWatcher (Dec 28, 2012)

No problem. For what it's worth I agree with the sentiment upthread that it probably won't make too much sense to add her to her husband's policy until she lives in the U.S., but I did want to push back a bit on the idea that it's impossible.

In my situation it was possible, and it made sense. I added my wife to my policy (with a U.S. carrier) when we married even though she hadn't yet moved house. (That would take another month or so.) Good thing, because she needed to stop by a U.S. hospital 3 days after we married. Nothing serious as it turned out, but I saved her/us money as soon as she married me. And we now have an amusing story to tell future grandchildren, we hope.


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## Thaicat (Dec 21, 2013)

Haha yes Ive heard some amusing stories from family about trips to the hospital..some involving light bulbs, oddly.

I shall pass your knowledge on. She has always been a nervous lady and it's her first time away from home. I know she plans to be out there a few times before the move so it could save them money.

Thanks for your approach. I do find some on this board offer opinions or assumptions well before advice. I find that rude and rather child like. Thank you again BBC.


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## misschrissy (Jun 27, 2010)

When I first came here I got a fairly cheap accident cover that would cover medical expenses if I had an accident. I wasn't able to get medical insurance for myself or daughter until we had been here a year.
Unlike the UK where even tourists are covered & can use all the NHS provisions as soon as they set foot in the UK.
Yes the NHS isn't free but it's the major thing I miss living in the USA.


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## BBCWatcher (Dec 28, 2012)

Yes, and that approach doesn't work any more if you want to avoid the tax penalty. This all changed significantly in the U.S. this year (2014). Don't rely on past experiences in this case.


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## misschrissy (Jun 27, 2010)

BBCWatcher said:


> Yes, and that approach doesn't work any more if you want to avoid the tax penalty. This all changed significantly in the U.S. this year (2014). Don't rely on past experiences in this case.


Are you replying to my post ? I don't understand what you mean about 'tax penalty'


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## Bevdeforges (Nov 16, 2007)

I think what BBC is referring to is the fact that, starting in 2014, there is a tax "penalty" (i.e. a sort of fine) if you are resident in the US and aren't enrolled in a health care plan that meets the ACA program standards.

FWIW, the penalty for 2014 is pretty small - something like $95 or so, IIRC. 
Cheers,
Bev


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## BBCWatcher (Dec 28, 2012)

The penalty for tax year 2014 is $95 or 1%, whichever is larger.


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## misschrissy (Jun 27, 2010)

Bevdeforges said:


> I think what BBC is referring to is the fact that, starting in 2014, there is a tax "penalty" (i.e. a sort of fine) if you are resident in the US and aren't enrolled in a health care plan that meets the ACA program standards.
> 
> FWIW, the penalty for 2014 is pretty small - something like $95 or so, IIRC.
> Cheers,
> Bev


Thanks for explaining, I've lived here over 4 years but have medical insurance so haven't been following the ObamaCare initiative.

I have Anthem and my plan was due to end in August but they seemed keen to have me extend it to the end of the year, which I did even though I'll be abroad end of July for 6 months, I was concerned about having a gap in my provision, sounds like I should do some research on this as I am paying quite a bit each month and may now be able to get a more reasonable deal.

My husband doesn't have medical insurance, he's not been to a doctor in nearly 30 years, but he's 66 so would get Medicare if he ever wanted to visit a doctor (he is an alternative medicine practitioner; he's not mentioned having to be part of a scheme but I know he's keen on Universal Heathcare like Canada, UK etc have but not being compelled to be in a scheme.


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## BBCWatcher (Dec 28, 2012)

misschrissy said:


> ....I am paying quite a bit each month and may now be able to get a more reasonable deal.


Yes, quite possibly. It depends on your income, but you could be eligible to receive subsidies to buy medical insurance. If your income is modest enough then that insurance might be free. Healthcare.gov has all the answers, though you may have to wait until November now to sign up for 2015.



> My husband doesn't have medical insurance, he's not been to a doctor in nearly 30 years, but he's 66 so would get Medicare if he ever wanted to visit a doctor (he is an alternative medicine practitioner; he's not mentioned having to be part of a scheme but I know he's keen on Universal Heathcare like Canada, UK etc have but not being compelled to be in a scheme.


He does have universal healthcare (Medicare), but, goodness, why hasn't he signed up? Most countries with universal healthcare -- Italy included, as an example -- require that you sign up for it! Medicare Part A is free, and he should at least sign up for that, immediately. The longer he waits the more expensive his monthly premium will be for the other parts or for Medicare Advantage, so he should be very careful to understand what he's (not) doing.

I hate to say it, but, forgetting his own self interest for a moment, he's really not being considerate of you and his family who would be burdened when he needs medical care. For the sake of his family, at least, he should fix that, now.


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## misschrissy (Jun 27, 2010)

Thanks BBC, I'm only 61 so don't think I can apply till I'm 65. He has very strong feelings about western medicine and won't be advised about anything, I know he never bought medical insurance but he recently took his SS payments so I'll check with him if he signed up for Medicare. Thanks for the advise I will check about this today.


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## BBCWatcher (Dec 28, 2012)

Fair enough, but U.S. Medicare is not exclusively a "Western medicine" program. Medicare Part A covers up to 6 months of hospice care, for example. Medicare imposes no obligations on receiving particular forms of medical care. He can decline anything he wants -- and he can write a living will with medical directives to make sure that his wishes are fully respected. Medicare just helps pay, and there's nothing wrong with that, especially when he already paid for Medicare. (He did. He paid hefty U.S. payroll taxes during his working years.)

Medicare Part B (and Medicare Advantage) pays for canes, to pick another example. I'm pretty sure walking canes were invented before Western medicine.  Didn't Moses use one? Charlton Heston did in the movie -- a staff, anyway.

There's some good home healthcare coverage, also invented before Western medicine. One or a couple specific chiropractic services are covered (not all). Broken bones aren't treated much differently in various medical traditions -- a sling is a sling, for example -- and Medicare Part B pays for the sling.

So, he cherrypicks, and that's perfectly fine.


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## misschrissy (Jun 27, 2010)

That makes absolute sense - circumstances are a bit complicated though and prefer not to elaborate, but I need to sort this out - thank you so much for alerting me, I have been travelling around so much these last 5 years I can see I have overlooked this potential problem, I just assumed he'd automatically be eligable for medicare should he need it urgently.


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