If you’re living with a chronic illness, such as depression, asthma, diabetes or arthritis, you’ll know that your health requires careful and consistent management. The good news is that by moving to New York, you’ll have access to some of the best healthcare in the world: first class hospitals, a wide range of specialists and pharmacies on every corner. However, in order to access this great care – and avoid hefty fees! – you’ll need to consider health insurance.
Healthcare in the United States is provided by a mixture of public and private hospitals and clinics. US citizens are expected to have medical insurance, which is often provided by their employer. Whilst it isn’t compulsory for all expats to have health insurance, the cost of medical care in the US is notoriously high. If you’re managing a chronic illness without health insurance, you could be forced to pay thousands of dollars in consultations, tests or prescription drugs. Not to mention the risk of ending up in hospital and having to pay a small fortune.
A travel insurance policy will cover accidents or illness while on holiday, but won’t do the job when it comes to managing chronic illness. The Chief Executive of IMG Europe reminds us that “a travel insurance policy, even a long-stay plan, will only tend to patch you up and seek to bring you back home to your own domestic health system or insurance.” It is not designed to provide the comprehensive, long-term healthcare an expat with a chronic illness will require.
Your employer in New York may provide coverage under the company healthcare plan as part of the fringe benefits of your job package. However, this plan will likely provide only basic coverage and in most cases won’t cover your pre-existing conditions, such as any chronic illnesses. This might mean that you have to pay for many of your medical costs out of your own pocket.
Your employer may provide the option for a more comprehensive plan, in which case you may be required to contribute a small amount, which is likely to be deducted from your salary each month.
Regardless of the plan, it can take up to 90 days from the start of your employment for you to receive your insurance card. However, for many people managing chronic illness, 90 days is simply too long.
Some expats (such as H1 and L1 visa holders) may be eligible for the public healthcare made available through the Affordable Care Act (aka Obamacare). This act ensures you can’t be refused coverage based on any pre-existing conditions. Enrolment is only open over a specific period every year, so depending on the timing of your move, you may have missed your opportunity. You can check your eligibility here or get more info through the government’s Health Insurance Marketplace.
Another, more common, option is that of purchasing international health insurance. International health insurance is designed for those who are planning to spend an extended period of time living or working outside of their home country. It covers both routine and emergency healthcare. There are a range of resources online to help you understand how international health insurance works and how it can be tailored to meet your needs.
International health cover is expensive enough, but you’ll notice that international insurers will charge you more if you’re based in the US. This is because the US is one of the most expensive countries in the world for medical care. Per capita, the US spends more on healthcare than any other OECD country.
Health insurance providers consider you a greater risk to insure if you have a chronic illness. They try to reduce this risk by ‘underwriting’ your policy, using medical information you provide in your application. This may mean that your coverage could be approved with limitations or exclusions, or that you are required to pay a surcharge to offset the additional risk – and cost.
Some insurance providers may refuse to cover your pre-existing condition. Others may offer a waiting period of up to 24 months.
If you still have active coverage before departing for New York, you might be able to use this as ‘prior creditable coverage’, meaning you may be granted a shorter waiting period on your international insurance. This varies for each insurer, so ask questions about this when considering your options.
Start by doing some calculations. Estimate how much you spend on prescribed medication and how regularly you visit the doctor. Then compare different insurance policies to see what exclusions or limitations apply to pre-existing conditions. Depending on the level of treatment required to manage your chronic illness, it might cost you less to pay for this treatment out of pocket than pay the higher premium of your more comprehensive insurance policy.
Other factors to consider when comparing plans are co-payments, coinsurance and deductibles (learn more about these here), as well as waiting periods for coverage of pre-existing conditions.
When selecting a healthcare plan, the range of options can seem frankly overwhelming. Each insurer has different conditions, limitations and costs. However, it doesn’t have to be so difficult. There are plenty of websites to help you compare options, or you may want to seek advice from an international insurance broker. Either way, it pays to do your research to ensure you select the most suitable and affordable health care plan that helps you manage your chronic illness while living it up in NYC.
Are you an expat suffering from chronic illness? What is your experience when taking out health insurance? Share your thoughts in the comments below!