A Swede's guide to US health insurance

When I moved from Sweden to the US the scariest unknown was how health insurance worked. And I must say that it is mind boggling at times. In my six years in the US I have experienced three different approaches. The short version is that if you consider moving to the US, make sure you understand how your health insurance works!

First of all I started out lucky. The old Microsoft insurance was awesome. Go to any doctor and pay nothing. naturally I got the feeling that doctors wanted to run tests event for the most unlikely things just to make sure but if you are OK with a lot of tests it is fine. Downside was that they freaked us out when my daughter was born with a large birth mark on her spine.

Then Microsoft changed the policy. In the new system you get a few thousand dollars in a special health savings account that is yours whatever happens. Downside is that you pay 100% of health care costs essentially until you've used all that "free" money you got. Once you max out (spending a few thousand of your own money) you pay nothing. This system is great when you are not sick. And sucks if you for example break a leg.

When I moved outside Microsoft I got a different kind of insurance. Now I pay $20-$25 per visit for most things. But for larger things (like a broken leg) I pay a percentage of the total bill. Again up to a limit per year.

Since my son broke his arm in the end of last year and it was a nasty injury that took three hours of surgery and a day in the hospital I got to experience a more complicated case... As somebody not working in the healthcare business the bill you get is insane. For example; the hospital bills about $44K to fix my son's arm. Insurance however has a special rate so they pay only $27K. I have to pay about $1K... Of those dollars the vast majority is for the hospital bed and food (if I understand the bill correctly). The rest is for various drugs given during and after surgery. For example we paid seven cents for some morphine...

The explanation is that insurance companies have negotiated special rates for anybody with insurance. But that does not mean that people without insurance pay the full price either. typically hospitals give people without insurance about 20-30% discount I've been told. I've also been told that what you pay highly depends on how things are billed.

For example my current insurance covers a yearly checkup for free. When we needed some forms signed by a doctor for my son's new school that office charged it as a yearly checkup. When we later did the yearly checkup it was not covered. If one of them would have billed as a regular office visit both would have been covered. A difference of about $350...

I also recently needed an MRI done. Since it was labeled diagnostic MRI it was free for me. I learned however that if the MRI is done as part of surgery. That is if the MRI is done to prepare for planned surgery I would pay a percentage of the cost...

So my experience is that unless you have really good insurance that covers everything it feels totally random how much you pay if you do anything more complicated than office visits. If you are a foreigner moving to the US; what has been your experience?

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