Help - Relocating to the US from the UK

[andy58]

Hi,
I need help understanding the bottom line average costs out of pocket (even just a range would help) for IBD patients in California and what happens when you don't work. I am British and don't understand the US system at all.

Story Background:
An American Citizen by birth, I've now been offered a good job in California but am very scared to make the move. I live in the UK where I am %100 covered by the National Health Service (NHS). I've never lived in the US despite having a passport and SSN.

Medical Background:
I have UC (one false-alarm hospitalisation 14 months ago) and am on 40mg Humira/Adalimumab every two weeks and 15mg Methotrexate once a week (+Folite). In the UK I get my Humira delivered to my home and there is no money exchange whatsoever for the medication. I just get it from a cooled van along with replacement sharps-bins when its full and a travel pack.
For the Methotrexate I pay £8.40 (~$11) per monthly prescription (the UK flat rate for any pharmacy-supplied drug with a script). Also, here I don't pay anything and there is no money exchange for medical appointments or tests.

It doesn't matter if I am employed or not, I guess I can say that I pay a grand total of £8.40 a month for having the disease and treating it (and you can get that for free too if you are unemployed). I obviously don't need to pay any insurance payments other than my regular taxes or any co-pays or deductibles. Also, nobody here argues about approving a medication if a senior doctor suggested it (I was on Infliximab beforehand).

I am seriously considering not taking the attractive low-six-figures job in California, which is offering significantly more money than I make here and what they call "a generous health plan", and staying in the UK just because of this. I can't imagine having to pay thousands of dollars for treatment and being worried about unemployment and medical care or skimping on appointments and tests cause of costs.

How do you all do it? What does it actually cost you out of pocket? What happens if I quit my job/get fired?

THANKS SO MUCH!
Andy

 

[ronroush7]

Hi. I get my Humira from a company that I think is called Abbvie. I only pay five dollars out of pocket.

 

[andy58]

thanks ronroush7. but how much do you pay monthly or yearly for everything (compared to my nothing here)? if you need colonoscopies or other meds and tests. What is the actual bottom line. Also, what happens if you quit/get fired?

thanks again!
Andy

 

[my little penguin]

The issue you face is you need to ask your future employer what your employee contribution is for insurance. They will send you a benefits package.
It should state whether the plan is 80/20 79/30 90/10 or 100% plan
Whether it's an hmo or ppo
And how much you have coming out of your check a month just for premiums to have insurance.
So you would have that amount x taken before taxes out of your pay a year
Then you have your deductible y that is the amount you must pay before the insurance switches over to paying 80% of the bill or 90% of the bill.
Then you have your Maximum out of pocket z
This means once you pay so much a year (z) not including premiums for insurance then everything else for the year is free

Colonoscopy are considered preventative medicine and are covered at most place 100%
Your company will have a book on what is covered and what isn't

Humira would be through your prescription plan
Must require a speciality pharmacy deliver it to your door
You then apply for the my humira card from Abbvie(separate from your company insurance )
They cover your drug copay up to. Certain dollar amount then you pay as low as $5
Until you hit your companies prescription plan out of pocket max
Then all your prescriptions are free for the rest of the year .


Every insurance plan is a little different and varies by company
So no one can tell you what your cost will be except the companies HR dept .
So if you consider the worst case scenario
Your yearly out of pocket =
Monthly premiums out of your pay check (X) times 12 months
Plus deductible (Y)
Plus max out of pocket (Z)
This gets you to 100% free no copays nada
For the medical side
Prescription side is your copay for humira (A) -minus theamount abvie will cover of your copay (B) = your new lower copay (c)
Until your max out of pocket for prescriptions is reached (D)
Note A counts towards D

Also realize the amount you pay for premiums a month/copays /max out of pocket etc
Can change from one year to the next

Most companies consider benefits as a extra part of salary

 

[ronroush7]

Most other drugs and tests aren't as cheap. I am sorry. I can't quote a price. I am sorry. I am retired. I don't know what happens if you get fired.

 

[Lisa]

As mlp said, costs can vary greatly. You need to see what types of insurance plans are available from your employer - there may be multiple options available with different premiums, out of pocket costs etc.

In my case, I work for State Government, and have a whole slew of plans to choose from. The one that I carry for myself and my family breaks down somewhat like this -

Family coverage my cost out of pocket before taxes is @380/month = 4560/year.

My employer also contributes, their share according to my last years taxes is almost $18,000!

Doctor visits cost me $20- each as a co-pay as long as I stay with an in network doctor. Otherwise it may be full price or don to 20%.

Emergency Room visit I think is $70-, x-rays $35-, hospital stays are fully covered.

The biggest plus for me is the prescription coverage - this is where you really want to look at the offered plans - I am on Remicade every 8 weeks. I pay ZERO out of pocket as this is billed under major medical instead of prescription plan as it is administered at an infusion clinic. When I get bloodwork done, it costs me $20 for a co-pay.

 

[lisadc1]

Andy58, My Little penguin described an avenue to your needs so well. Definitely check into the human resources at your new place of employment you will find the answers you are needing. Best wishes!

 

[andy58]

Thank you my little penguin, your reply is incredibly helpful. and Lisa as well!
I truly appreciate the time you took to answer and the thoughtful replies!
What happens when one quits their job? is there a grace period or do you have to cover it all on your own the moment you're out?

 

[my little penguin]

Typically you don't "quit" a job until you already have another one lined up
But if you are fired etc
You can pay out of your pocket for a "cobra" plan
Basically the same health plan as you got before but you pay a lot and it's only good for I think 6-18 months

Most folks get another job and then put a start date at the new company two weeks after they put in their resignation
So no lapse in coverage

You don't typically just quit

 

[Scipio]

When you quit your job you are usually covered under your old plan until the last day of the month in which you quit. So if your last day of employment is say March 1st, your insurance coverage will continue for 30 more days. If your last day is March 30th it will continue for one more day.

Many insurance plans are what is called "portable." Which is to say that you have the option to continue the same insurance coverage indefinitely after you leave provided you pay for the full amount yourself. That's often an expensive option because you no longer have the employer's contribution. It all comes out of your pocket. But that may still be better than starting over with new individual policy bought on the open market, because you can continue with the old group rates that your previous employer had negotiated.

Portablility is usually seen as stop-gap measure to continue coverage until your new coverage from a new employer, or Medicare, or whatever kicks in.

 

[andy58]

Thanks very much all who answered and took time to help! I will speak to the HR Partner and research the healthcare plans they are offering (gibberish acronyms to me for now but google is my friend) and then see how much it will probably cost me per year and compare to my net income in the UK. My guess is that in the US I will still come out ahead even with the Bay Area's cost of living (London ain't cheap either). At least until the company goes bust like tech companies tend to do
THANKS AGAIN!