Letter from America – health insurance in the United States

In the first of a new series of insights into other countries’ systems, John from across the pond gives us an appreciation of the complexities of health insurance in the United States.

Greetings from across the pond. My name is John and I am a retired high school teacher from Pennsylvania. I am writing to provide you all with some information about the American healthcare system. Let me say from the start that these are personal anecdotes, which reflect my experiences and understanding of how the system works… or sometimes doesn’t work!

Just a bit more about myself. I am currently 69 years old and was able to retire from teaching in 2006, after 33 years in a rather well-to-do American public high school. I think public school means something different where you are? My school was in no way private, and was totally supported by taxpayer dollars. I really should have worked another two years to gain full retirement, which for teachers in Pennsylvania is 35 years, but I could no longer work with the school principal, so I took a 6% hit on my retirement.

I was very lucky that my school district would continue to carry me on their insurance plan until I turned 65 and was eligible for Medicare – the national system for senior citizens. Now you have to understand that there are 500+ school districts in Pennsylvania and they all have different forms of medical insurance, costs, coverage, etc. And I must tell you that working in a district that would allow me to pay the same insurance premiums as current employees, for 10 years post-retirement, is incredibly rare. I was most fortunate in this.

On my 65th birthday, my school district dropped me like a hot rock and I was instead automatically enrolled in Medicare. I won’t go into incredible detail in this first instalment except to tell you that Medicare will only cover 80% of what they think your medical care should cost, and only then if the hospital and/or physicians where you are being treated participate in Medicare. They are not obliged to, so you have to be very careful because there are many cases where a hospital participates but some of the doctors on the staff there may not. I know people who have gotten a very nasty surprise.

So your next task is to find a supplemental insurance that will cover some of the rest of your costs. I went with the supplemental program which is offered to educators and school employees in Pennsylvania, but there are other plans to choose from… Sort of. Which of these other plans are available to you depends on which county you live in. Since Pennsylvania has 67 counties, you can imagine the joys of assessing and choosing from all of the information you get from private insurance companies, trying to get you to spend your healthcare dollars with them. The vocabulary alone is baffling: coverage, open enrolment, pre-existing conditions, deductible, donut hole, co-pay, tiers, medigap policies.

Confused yet? Well, I will leave it at that for this instalment. I have been told that you are in danger of losing your national healthcare system and having it replaced with something similar to ours. I have little understanding of how your NHS works, but hopefully you will see what you might be in for if you aren’t watchful, but allow the system you already have to be eroded until it resembles the American one.

 So on that note, I will leave you to ponder this little bit of rudimentary information. Next time I will hopefully tell you more about Medicare, my supplement and some of the fun and games we get to deal with.  Let the lunacy begin.

Meanwhile best wishes from over here.

John from across the pond