Thanks for the 411 on the US medical system. Lots of questions, if you'll indulge someone who truly does not know how this whole system works, but am very interested. I hope you are recovering well. ❤
Thank you ... here are some very very brief answers to some of your really thoughtful questions ...
Is there any substantive difference between PPO and HMO? Yes with HMO you must stay within the medical group that you select. In a PPO plan you have a wider selection of where you can go, these facilities are considered in network. If you go for care out of network the copays are much higher. This is just a very brief explanation.
Do you also have to make monthly payments for your plan,(yes the premium is deducted from each paycheck twice a month. Around $200 each month) as well as pay a deductible for service plus pay the balance that's not covered? Hmmm.. for example my MRI cost around $5600, the insurance pays a set amount to the hospital, then my share of the bill was $784 which is applied against the $5000 annual deductible. Does your employer have access to/knowledge of your medical information and care, or is it separate and private still? Still protected
So, you can have health care for an issue cease simply because you just don't want to pay further or can't afford to continue pursuing care for a health problem? One option (if income is low) would be to apply for charity care. Also if low income the patient might qualify for public aid.
Possibly right when your health is getting worse and you need important care the most, as your illness drags on? If very ill might qualify for disability payments ... Do you ever get annoyed if a doctor doesn't figure something out on the first go, if you have to keep returning and paying more deductible or for more tests? This did happen to me years ago but not recently ...
If so, doesn't this impact your very relationship when money enters into their care of you?
What if you become so ill that you can no longer do your job, do you lose your insurance plan too when you need it most? Yes.. if permanently unable to work I would be able to apply for disability and Medicare coverage. Continuity of coverage for minor children if you lose/change employment? Or if you change jobs, do you lose access to the "network" of doctors or healthcare facilities and you must go elsewhere and have to start all over again?
How do doctors decide which system they'll work for and can they work for more than one? Nowadays docs usually work for one healthcare system. Do these plans advertise for medical professionals? Are there medical facilities that house healthcare from a lot of different providers/plans under the same roof, eg, two doctors in the same office available to patients under different HMO or PPO plans? Actually yes ... true example.. XYZ hospital built a new hospital and on that campus ABC hospital is leasing space for a medical oncology practice and yet another hospital system is leasing space for a rehab facility.
Can providers take public healthcare patients too or is your system completely divided? Can you lose out on the best doctors because you're not in their "network" (not sure if I'm saying that correctly)? YES!!
It seems like a vicious cycle, you can have the best plan but only if you're healthy enough to afford it (and therefore not need most of it). If you become unhealthy and can't work, you lose out unless you're wealthy to pay the entire amount out of pocket. I could be wrong how it works? ... Many patients in my area are on Medicaid (public aid, subsidized by the government/tax payers.)
Everyone must feel extremely nervous whenever any kind of possible serious illness is being investigated or you're considering change in employment. That can't be good for wellbeing and worry and strsss levels? What happens after retirement? At age 65 workers qualify for Medicare. I have a coworker who took early retirement at age 63 and can continue her same insurance for 18 months under the COBRA program. But its costing her $800 per month .. but she can afford it.