In this vlog, I’m going to explain about health insurance in USA
In this vlog, I’ll explain about different types of health insurance in USA
In this vlog, I’m going to explain you about how to choose the right insurance for you if you are in USA
If you are not in USA, in this vlog, you’ll understand that how much health insurance costs in USA
The United States has by far the greatest burden of health care bills in the industry
The rise of the insurance industry may have been a catalyst for price inflation
Reduction of health insurance
It was when you get this third-party payer system
where the patient doesn’t have to pay all of the costs
How much a health insurance plan can require people to pay out of pocket
when you go to the doctor or the pharmacy
So, health insurance is basically used to protect us from high medical bills
So, let’s say I have a fever and I go to doctor
and if I don’t have insurance, then I end up paying around $700
and these are the approximate figures
There is a babysitter in our house and she was saying that she is not insured
She had to get a root canal done and she ended up paying around $2,000
And let’s be sure that if anyone has a heart attack, they should get a touchwood
So, they will end up paying around $200,000 if they don’t have insurance
And guys, the darkest truth of insurance is that there are a lot of Desi people
who are my friends as well
They are students who have never taken insurance
They have not taken insurance for around 3-4 years
Not necessarily only about students
There are a lot of other friends too who are working here and they are not insured
If by any chance you meet such a person, feel free to just tell them to take insurance
And I will tell you why
The reason is, if you don’t have health insurance right now
and if you end up in hospital
and if the hospital bills are huge
and if you don’t pay that bill
and after 10-15 years when you apply for a green card
That time such questions, you know, they will ask you
saying that why didn’t you pay the bill
So, to avoid this, we have health insurance plans
And health insurance plans depend on company to company
It varies a lot
It depends on how your company negotiates with that insurance company provided
For example, the company I work for has a very bad insurance
And the company Nupura works for has a very good insurance
So, what we have done is, we have taken insurance from Nupura’s company
And I am her dependent on that insurance
For example, I am in a company and I have a friend in another company
And the insurance provider of both the companies is the same
But it is not necessary that their premium and my premium is the same
Because it is totally up to the company the way they negotiate with the insurance provider
And guys, one more important factor is
The bigger the company, the better the insurance
The babysitter who comes to our house, she used to work with Starbucks
So, the insurance she got from Starbucks included cosmetic surgery and IVF fertilization
So, now let’s talk about different types of insurance that are available
The first one is HMO, Health Maintenance Org
It is budget friendly, low in premium
And third thing is you literally need PCP referral for everything
Now, what is PCP?
PCP is nothing but Primary Care Physician, like a family doctor
Every person in US, whoever is insured, he needs to have a PCP, Primary Care Physician
For example, let’s say you have a big issue
And if you go to a special doctor, the first thing they will ask you is,
Baba, who is your PCP?
When I came to US from India, my first year
A lot of friends asked me to get my PCP done
Choose a doctor who knows you everything in and out
For example, if you have a pre-existing disease
The way you are in terms of health
But I have never done it
Just because I had that strong confidence in me
That what can happen to me
And that’s the reason I never did in my first year
So, I highly recommend if you are new to India
And you have been here for a long time
And you are watching this video
And you don’t have a PCP
Just go and have a PCP
And choose a Desi Doctor
This is what I would suggest
Just because Desi Doctor would know the way we are
And our eating habits
In this plan, you need to have a PCP referral
PCP is General Practitioner
He is a General Doctor
He is not a Specialized Doctor
But I get pimples on my complete face
So, ideally, I should be going to a Dermatologist
But I cannot visit a Dermatologist directly
I need to go to my PCP
PCP will check my face
And probably, he will give me some medicines
And if those medicines don’t work out
That time, he will give me some additional medicines
And he will try some different things on my body
Even that is not working
Then he will give me a letter saying
Go to a Specialized Doctor
And you can get your treatment done from this doctor
And that Special Dermatologist
He should be part of your network
And if that Dermatologist is not part of your network
That means, you will have to bear the entire cost
And insurance will not pay anything
In HMO plan, many doctors
Who are big doctors
They will not participate in HMO plan
Just because it is budget friendly
They don’t get much money in it
And they will have to see the patients as well
That’s the reason they do not participate
And second thing is
There are many companies that do not support HMO
For example, there is no HMO in Nupura’s company
So, all in all, it is based on the company
And the way they negotiate with the insurance provider
And next type of insurance is HDHP plan
Which is High Deductible plan
So, what happens in this is
You will have to pay deductibles
It’s kind of maximum amount you pay
Towards the service
Which has been provided by the hospital
Usually, in this plan
Individual around 1400
And family around 2800
With 10% of the co-insurance
And around 8000 out of pocket expenses
I will explain everything
So, let me talk with an example
With deductible 1400
And out of pocket expenses is 8000
So, in Jan, I go to a doctor with some issue
And doctor send me a bill of 1200$
In March, I go to a doctor
With some other issue
And this time, doctor sends me a bill of 200$
Now, what happens is
In May, I go to this doctor with some issue
Doctor send me a bill of around 600$
Now, deductible hit me
Just because I paid 1400$
Now, co-insurance kicks in
Co-insurance means
% of the fees which we will have to pay
Towards the service that they have provided
Usually, it’s 10%
But in some companies, it’s 20%
So, now the total bill is 600$
So, 10% of 600$ is 60$
So, I pay 60$ and walk off
But now, it will be fun
Let’s say, in Oct, I go to doctor with some other issue
And this time, doctor sends me a bill of
So, I need to pay 10% co-insurance
Of 75000$ which is 7500$
But, wait a minute
In a year, how much did I pay?
Totally, I paid 1200$
Plus 200$ plus 60$ plus 7500$
Now, I have paid
So, it is 8960$
But, my out of pocket expense is 8000$
So, I will get a discount of 960$
Meaning, in my 7500 bill, I will have to pay
7500 minus 960 is equal to
Just because my out of pocket expense is 8000$
It shouldn’t be like this, but it’s an example
So, let’s say, it’s December
There is a lot of winter and cold
I end up going to hospital
And then, doctor sends me a bill of
That time, I don’t have to pay anything just because
I have met my deductibles
And also, I have met my out of pocket expenses
So, insurance provider will take care of entire expense
So, let’s talk about third type of plan
That is POS plan or PPO plan
POS means point of service plan
PPO means preferred provider organization plan
In this, it’s totally high in premium
Second, low deductibles
Around 600
Meaning, doctors can be
within the network or they can be
outside network too
PPO is towards the higher side when you compare
to POS and it is more flexible
I will explain you how
If I have POS and I get a lot of
So, if I decide to go for
a dermatologist who is not
within my network, but he is a good doctor
I have to visit him
So, I will have to go to my PCP
and I will have to request him
And once I have that referral
to the doctor, then only I can go and visit
the doctor. If I don’t have that referral
that means I end up paying the entire cost
Co-insurance as usual, it is a part
of POS and PPO as well
But there are many companies
which don’t have co-insurance
for POS and PPO plan especially
Meaning, once you hit the deductibles
After that, you complete out of pocket
After that, you don’t have to pay anything
Everything is being taken care by the insurance provider
But there is a catch in this
There is something called as co-pay which is part of POS and PPO
I will explain you what co-pay is
Co-pay is nothing but
minimal charges which provider ask you
to pay for the service that they have provided
Let me explain how
Let me explain with an example
Deductible has $600
I am sick in January. I go to a doctor
and they ask me to pay a bill of $1000
I pay $600 and I walk off because of the deductibles
I am sick again in February
I go to doctor. I pay co-pay of $20
and I walk off
As I said, co-payments are fixed fees
your provider charges for the services
Now in March, I am sick again. I go to doctor
with some different problem
I pay co-pay of $20 and walk off
Now in April, I am sick again
and I go to doctor
with some problem
and this time the doctor thinks that
I have some problem which needs diagnosis
like x-ray or CT scan or something like that
Now what happens is
you first pay your co-pay
and after that
the fees of x-ray or CT scan
can be around $800 to $900
This time
this part
your co-insurance
it starts kicking in
but if POS or PPO
if co-insurance covers the company
then you end up paying nothing
you just pay $20
and you walk off
Guys, this is the basic explanation that I have provided
and it varies from company to company
and also the way company has negotiated
with the insurance provider
So guys, let’s talk about the premium
that every individual ends up paying
The premium is calculating
depending on the factors like
where you live, in which state
second is depending on your age
third thing is the type of the insurance that you have selected
fourth is your family size
and fifth is company
the way they have negotiated with the insurance provider
According to MoneyGeek website
a typical 40 year old
he ends up paying around $712
and if he is in Maryland
then he will end up paying around $338
Nebraska is showing around $527
but I do not pay $527
I pay around
$400 to $500
I won’t say the number
So guys, let’s talk about how to select health insurance plan
in USA
So guys, basically I will tell you 4 events
of my life and after that
I will give a summary
that will help you to choose health insurance
No.1 event
I came to USA from India in 2014
and that time I was a bachelor
I was 28 so I was super confident
so that’s why I went for a low deductible plan
whenever I used to have fever
I used to take a crocin and I used to sleep off
Second, in 2015
I got married
so after marriage I got little
matured when compared to
what I was in 2014
I was a little scared because
Nupura was about to come from India to USA
and that time it was winter
and I did not want to take any risk
because my friends told me
not to take any risk and take some good plan
so that’s why I took POS plan
but next year I saw that
Nupura got adjusted to this weather
so again I changed the plan
and again I put it on low deductible plan
No.2, in 2022
we were planning for a baby
and that’s the reason we changed our plan
to POS plan
No.4, now we have a baby
so that’s why
we moved back to the original plan
that is high deductible plan
so this indicates three things
No.1, you know your body better than me
so if you do not visit hospital at all
then best plan for you is
high deductible
but if you visit hospital
or visit your plus one
then it is good to have a POS plan
No.2, always review your previous year’s
medical bills
and if medical bills are increasing
then you can change from high deductible
to POS
or if medical bills are not increasing
and if you are on POS plan
then you can easily switch back to the high deductible plan
No.3, spend two days of time
and whatever documents
insurance provider gives
just read that documents
I don’t do this myself
but I am just telling you a tip
just because I don’t have time to read it
and second, I don’t understand anything
so one of the tip
that I do is
I go to their website
like our insurance provider is Aetna
I go to their Aetna website
they have chat option
I ask every single thing
to them
single thing to them
and they will answer that
I can also call them
but you know what happens in call
suddenly questions don’t come
when you chat, it’s like you can work
and then you can chat
you can think and you can ask them question
and you can get everything answered
if you don’t even know the details of the plan
you can just ask any basic thing to them
because they don’t see you
they don’t know
you can basically ask any stupid questions
so guys I hope
you found this video informative
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