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My insurance (Blue Cross PPO) is like what Rebecca discussed, except it is not an HMO, like Kaiser. I don't have to get referrals for anything, no limits of on things like PT, and reasonable co-pays (20.00-50.00) for various services and drugs. The cost to us has gone up over the years, but, still quite reasonable compared to what i hear from others. Employees at my work have a choice of the same plan (we get it through DH's work), but pay a lot more money for their premiums.
I would never buy one of the high deductible plans. I know they are cheaper premiums, but good health care is pretty important to me. I've had enough things, that while not life threatening, could have been costly if I hadn't had this insurance. My insurance paid for one of my kid's experimental surgery to cure his Raynaud's, 12 years ago, 2 cardiac caths for DH, and a few MRIs/CT scans for me, all for 20.00 co-pays. No complaining here.

Glad it's worked well for you Crankin. My employer is in the process of phasing out the traditional HMO, and new employees do not have that option. They have raised the premiums, deductibles, and co-pays so much for the HMO that there is no difference in the out of pocket limit for either plan and, indeed, it's slightly higher for HMO plans. We USED to have an HMO like you describe, but that ended in 2008 or so. Even under the HMO the employee is responsible for a sizeable percentage of tests, scans, and surgeries. I try not to remember what our insurance USED to be like, that doesn't do me any good.

I guess it is really up to employers (yes, I know this sucks) to decide how important wellness and keeping employees healthy is, without breaking the bank. There is no deductible on my plan, or any of the others offered by DH's or my employer. The difference is, that at my work employees do have a choice of a plan where you have to use certain doctors and you can't go to any of the big name hospitals in Boston. While I don't run down there, like some of my friends do, I want to have the choice, and it is worth it to me, to pay for this. When I was sick a few years ago, I went to Brigham and Woman's for a second and third opinion from 2 rheumatologists and a neurologist. While it probably wasn't necessary to that extent, the advice they gave me stopped me from any more rounds of searching. I have recommended one of the doctors to several people, including my own patients.
Of course, like California, Massachusetts has several things that are mandated to be paid for, which I am supremely thankful for.

When we moved to FL we had to switch insurance from our usual State of Illinois HMO to an Open Access plan they offer for people living/working out of state. We went from fantastic coverage with livable deductions to bizarre coverage (drive an hour to Orlando,to see the covered ortho instead of the one who's highly rated and a block from our house), and super high co-pays.

I wish a lot of Canadians who ***** and complain about our system, would read in detail what some of you experience in the U.S.

Just to give a taste of CAnadian health care system for someone like myself who also has employee health care benefits since this situation was my most intensive use of the health care system for me so far..

My concussion accident a year ago after cyclist crashed into me ..
Since I was injured in another province, my ambulance ride was $500.00CAN. It was covered by my employee health care benefit. Yes, I would normally have to pay all that. A British Columbia resident would be paying under $100.00.

Kept overnight in emergency services in bed where I was seen by neurologist and interns every few hrs. I did have some meals. Then I was discharged. I made sure I asked for my discharge patient record. I was in a large rm. along with 10 patients. Quite fine for overnight. I knew I would need it once return to Alberta for my rehabilitation.

I found out later I didn't have to pay for any costs in emergency services because British Columbia authorities check again Alberta's public hospital care rates, etc. So no difference in rates. Otherwise I would have to pay for any differences.

Then I had to see my family doctor in Alberta every 2 wks. during lst 5 months of my rehabilitation. No charge, just call my doctor. There were some charges for her to fill in employer disability forms for medical assessments each time. This is more for the employer but still it is a charge. The doctor kindly charged me at a reimbursable rate where I got covered off by benefit plan. I did have some drugs which were 80% coverage for cost but if I didn't have employee benefit, I would have had to pay in full.

Had 8 sessions of physiotherapy which were covered by employee benefit. However without benefit, I would have had been limited to 6 sessions through only certain physio clinics. I had never used physiotherapy before.

I did see a sleep doctor specialist twice..there were no out of pocket expenses. It was part of the public health care system. If I had an overnight sleep assessment that would have been $800.00. But I didn't need that. We already knew what my problems were. (which are common for concussion patients).

I would have had to have far more serious after effects for a full neurological assessment which was another 4 month wait. But I didn't need that. I was already working full-time.

Because I work for govn't, I do have a better employer health care benefits which include disability insurance because I couldn't work for first few months at all.

One of the difficult things probably in Canada which would be the same for parts of the U.S., is it's only the big cities that have specialists and the lack of family doctors in some rural areas. In Alberta, unlike Ontario, it is far more rural. Strong network of family doctor care and specialists are only concentrated in 2 cities for the entire province...Edmonton (350 km. north of Calgary. Edmonton is about 200 km. or more south of Fort McMurrary, the infamous Canadian oil tar sands area) and Calgary. This is very different than southern Ontario which has several top hospitals and other facilities because of several university medical schools in several major cities in that province plus programs for all other allied health care specialties.

I can't complain about our medical system in Quebec either. Sure, you go to ER or see a doctor and it is all "free". But we do pay through our taxes. The wait in QC can be quite long in a ER room, unless a true true emergency. It is not because you are through the door by ambulance that it goes faster. They have codes and go by this.

I do have work group insurance also. It covers for $1000 physio, same for psychologist, etc... no doctor reference required. If I did not have this, I would have to go through public system...with often a delay of a year, even two to get an ultra sound or an MRI.

I have knee injections (synvisc), which came up to more than $1000 per knee, all 100% covered by my insurance
I had MRI, scans, etc...fully covered by my work insurance.

If I had to go through our public system, forget it.... I would have to cough out the money (for most things until you reached a max of expenses), and claim when doing my tax report the following year and only get a tiny return on the expense, if I do get one as you have to reach x% of your net income before being allowed returns.

We also have insurance coverage through our SAAQ (Quebec automobile insurance).

Overall, we have insurance wall-to-wall but it does not mean you get it right away. I'm one of the few luckiest to have a family doctor (some have been waiting for years here in QC - don't know for other provinces). I can see her pretty rapidly if needed. She can prescribed some pills over the phone and they are sent straight to the pharmacist of my choice.

But it all does not come free. I am taxed by the province for a universal system. And I also pay taxes (taxed benefits) for my private work plan. For work, the benefit is +/- $3000 added to my salary. For the provincial one, I have no clue how much we end up paying through taxes but I know my total taxes I end up paying at the end of the year is nearing 50% of my gross income. That is a lot off a paycheque and we are "just" higher middle class. QC is the highest taxed province in Canada.

But at least we know if something happens while in QC, I am covered. And I can opt for any therapist I want or where I want.
If something happens elsewhere in Canada, I am covered partially from QC and I need to have a personal insurance to cover the difference (some provinces have agreements between them). But we have to get the E-care and we are brought back asap in QC.
And if we travel out of Canada, we better brace ourselves with a personal insurance (work is good enough) to cover for any emergency visits as Quebec will only reimburse us for what they would normally pay for the same service in QC, which is a lot less than in some other countries. Same here...they stabilize you and take you right back into your province asap.

We do have excellent specialists if needed too because I live near Montreal. So that is not an issue for me, but those living more remote of big centres, it is a major issue.

Ah. And dental is never covered, nor glasses, etc...unless you were involved in an accident (work or car), or on welfare (and not everything is covered). So those are expenses out of your pocket, unless your work insurance has coverage for those. Many don't. Mine does, but not my husband's. Dental is so expensive that a lot of private insurance have a premium so high that companies prefer to decline it here.

Oh ohhh. Talk about health care/insurance and I get more than earful. Let's just say that its another reason for me to emigrate out of US. I pay through the bloody nose for no-health care. Deductible is sky high, premium is sky high. I'm getting fleeced just to avoid the penalty from IRS. And for what?

Some may complain of excessively long wait in ER. but most self respecting ER operate on a strict rule of who is in dire need. If you have a simple fracture and not a compound fracture you may wait while a gunshot victim is rolled in taken care of first. This happens here in US as well as in any other civilized country. Well they may not have a gun shot victim but you get the idea.

So I paid how much last year for nothing.

[QUOTE=smilingcat;709229]Some may complain of excessively long wait in ER. but most self respecting ER operate on a strict rule of who is in dire need. If you have a simple fracture and not a compound fracture you may wait while a gunshot victim is rolled in taken care of first. This happens here in US as well as in any other civilized country. Well they may not have a gun shot victim but you get the idea.[QUOTE]

That's correct smilingcat, serious emergencies are handled immediately. My sister is an emergency medicine doctor.
I was and actually had a CT scan. (No I wasn't charged.) I was unconscious and wasn't even aware I had this done to me. I was put on a spinal board because they weren't sure what happened to me. So I woke up a few hrs. later on a spinal board in the hospital bed.

I did have an ultrasound for soft tissue damage while in emergency care. No, I was not charged for that.
Helene, for non-urgent ultrasounds it has been just a month or so wait in Calgary for me. No charge if ordered by doctor.
I was lucky to find a family doctor who I like, not far from home and work when I moved to Calgary. At the time of my accident, it was critical, that I had already established a relationship with a family doctor after moving from Vancovuer.

Alberta has its own problems for available family doctors and part of it, is due to rapid population growth. 35,000 people moved to live in Calgary area. It was the fastest growing city in Canada before the oil bust. Economic recession has caused some oil workers to return back to Maritime provinces, etc., but we still have a bigger population.

Same for regular lab tests for physical checkups ordered by doctor. No charge. It is part of the health care system.

YEs, Helene is right, dental care is not covered at all by the Canadian public health care system. Nor is counselling. For the latter, there might be some access (free or discounted) for low-income and IF there is a non-profit organization with counselling services but sometimes that is more group oriented which really doesn't fit initially a lot of needs. I just happen to have some access because of an employer benefit.

Dental care is very expensive in Alberta. More than British Columbia and Ontario where I've lived for several years. There was an news article a few months ago that compared the different provinces.

Germany I have heard has a good public health care system..but their personal tax rates are higher.
I was a bit shocked that Alberta govn't was dumb enough to nix the personal monthly payment rates. B.C. is now $75.00 monthly payment for individuals to B.C. Mionistry of Health, if you are in highest income bracket: http://www2.gov.bc.ca/gov/content/he...dents/premiums Regardless of whether or not, you use any health care services. I see that payment as simply necessary for maintaining the health care system.

I can't find a fee for Ontario residents. But anyway, here are some general conditions, etc.: http://www.health.gov.on.ca/en/publi.../services.aspx
My father had prostate cancer and had excellent top specialist care in Toronto for ..5 years. But then 1 of Canada's major cancer research hospitals is in Toronto. He saw doctors every few months. I have not heard from siblings about costs and would have by now, if there was any or if it was exhorbiant or unreasonable. My father was low-income senior.

He was also admitted to palliative care at a hospital for remaining 2 months of his life. He could not get out of bed nor walk. Again if it was unreasonable costs..I would have heard by now (and probably asked to share costs with siblings for care).

As long as CAnadians can get medical care for needs via their family doctor and then seeing specialists when they need to, then it's not worth getting pissed off about paying higher taxes. I think the waste may be on the administrative side, (million dollar computer technology contracts that get screwed up for health care. THat's a problem of govn't not placing strong contractual controls on consultants.)

I'm biased : I have several siblings who work in the health care system in different facilities and different jobs in Metro Toronto. I honestly don't know why people think they can get more services for less taxation, yet not contribute out of their own wallet.

My husband is on wait to have an inguinal hernia surgery. The surgeon said the wait is between 3 to 6 months (3 months if all goes well, 6 months if he gets many calls for cancer surgeries). Nothing to pay either. We saw our generalist who referred to 3 different surgeons, doing surgeries in various hospitals. It was up to us to decide which one he wanted to get the surgery done.

We saw our generalist mid-October, saw surgeon mid-November, pre-op tests were done at hospital on Dec 15 and are good for 6 months. Now we wait for the call. All this is "free" through our province plan. Surgeon said that if husband has any pain until surgery day to get to the ER.

If he wants to get the surgery done faster, we can go through a private clinic. The actual surgeon does not do private, unless the companies pay for it (probably need to be a COO or something). A private surgery costs around $2000 for this. My BIL had it a few years ago. Since he is in no pain/discomfort, we will wait. When he gets the call, it will be 48hrs (sometimes it can be 24hrs if cancellation) and he can refuse twice before being put back at the end of waiting list.

I told him he could go private but prefers to wait.

If I can pay $2000 for my dog's hip surgery (done 2 weeks ago), pay for his physio, etc... I can't complain if I have to pay something for us humans.

If people in Canada truly knew the price of medical care, those who complain about it, would probably be very surprised if they'd see the details of a visit or surgery.

Someone mentioned to me last week tat in Canada they were talking about showing bills to patients so they were aware of how much a surgery or a visit can cost. I know some blood tests I had to take at some point were over $700 (standard blood/urine panel) if I'd go to private lab. I did not as I did not mind waiting an hour at the CLSC to get it done publicly. My private insurance would probably cover it but I hate "abusing" the system as premiums in the end, end up increasing for the whole people at work. So I try to use it wisely. :)

Wise statements, Helene and Shooting Star. I feel the same way about people who complain about paying for health insurance here. Don't like the 50.00 co-pay? Well, your procedure might actually cost 2,000. Or maybe 10,000.
Taxes are for the common good. That includes health care, roads, police, fire, and schools. Everyone uses these services and it is part of living in a civilized nation that we pay for these things. I don't deny that the US still needs to figure out a way to do this more equitably. It seems like the "red" states have more uninsured people (still) and people who are stuck in those high deductible/co-pay plans because they have opted out of the exchanges as part of the ACA. And then the people blame it on Obama. I thank G-d I live in a state that understands that health care is a right.

Please don't think that I'm bad mouthing ACA aka obamacare its a baby step in the right direction. It's far better than nothing. I just can't get relief from ACA.

Smiling cat, I kind of gave up trying to understand the complexities of ACA as it was being rolled out. So whatever I say is about publicly funded health services is within only what I've experienced...after living in Ontario, British Columbia and Alberta as an adult.

I just found out from my sister that my father's care for cancer chemotherapy and palliative care, did not require costs by him. He was an ideal patient: made very rare use of health services before he had cancer. He had appendix removed....minor surgery. Very healthy. His greatest pain was experienced in final 3 months of life. He was diagnosed with cancer 5 years before.

In all of this, I still believe that it's best I remain as healthy as possible. When there is serious injury/unforeseen major illness, recovery is faster/living is made less painful because there's less/no other pre-existing medical problems. It really is about quality of life. It is not (for me), taking advantage of a public health care system in unwarranted ways.

I don't think you are bad mothing the ACA, Smiling Cat. You are self employed, so it makes it all more difficult. This is kind of what I am talking about; if we funded the national health care plan (through taxes and other appropriations), self-employed people would be able to have the same kind of medical care I have. It should not be employer dependent. But, I am seriously doubting that will happen in my lifetime.

Quote:

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Originally Posted by Crankin

I don't think you are bad mothing the ACA, Smiling Cat. You are self employed, so it makes it all more difficult. This is kind of what I am talking about; if we funded the national health care plan (through taxes and other appropriations), self-employed people would be able to have the same kind of medical care I have. It should not be employer dependent. But, I am seriously doubting that will happen in my lifetime.

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I agree with you on all counts! Personally, I would LOVE to "only" have $50 co-pays, but we have what we have and I'm thankful to have it. Many local employers are moving/have moved strictly toward the CDHP insurance plans as a way of managing cost. As expensive as it is, and while it makes it difficult (or perhaps not possible) to take care of emergency medical costs, I can't complain about the level of preventative care my employer makes available to us at no cost - well - to those who have gone the CDHP direction rather than the HMO. Remember what I said about how they made it so attractive to make the move? I recognize they are doing the very best they can in our current broken system. Hopefully there will come a time when it won't be employer dependant but, like you, I don't see it happening in my working life.

Smiling Cat, you aren't bad-mouthing at all - it is a difficult situation. As frustrated as I get with the current system I know there are those who are worse off than I am. So I focus on trying to stay as mobile as possible, and I think carefully about when it is appropriate to see my doctor...or not. I try to use alternative methods as much as I reasonably can. Thankfully with the rise of non-hospital based imaging centers I was able to schedule my MRI next week at a price 1/3 of what a hospital would charge. Still expensive, but it won't cover 1/2 or more of my 2016 deductible...

DH and I are in the group of Americans who have really benefitted from the ACA. Since we are early retired and too young for Medicare, AND since we have a low income, we qualify for a subsidy and can thus get a very good ACA plan for low cost. We do have co-pays for our doctor visits other than preventive care. So far we have only used it for preventive care and dermatologist visits, plus my asthma inhaler Rx. If we took more out of our retirement funds, increasing our income, we'd pay more for our coverage; potentially a lot more if we didn't qualify for any subsidy. We are legal residents of Florida, which did not establish its own exchange, so we are enrolled through the Federal Exchange and have a Florida Blue PPO "silver" plan. Since we're travelers, we can't chose an HMO plan or we'd be limited to receiving services in Florida.

So, overall, we love the ACA, but we do have to plan our retirement withdrawals carefully to keep our income within the level to receive a subsidy. The monthly costs would be outrageous without this help (~$1100/mo for a typical plan at our ages in Florida). It's actually a form of enforced savings for us since we don't want to withdraw and spend too much of our retirement funds and bump ourselves out of a subsidy. So we can save those funds for later years.