OT- American medical system?Insurance?I'm confused!

[Guest guest]

Ok, let me start and others can jump in where I fail. LOL

In reference to your comment:

1) Medicare. Paid and supported by the Government. This is FREEhospital and a lot of medical care. Such as Doctor's visits, tests etcand they pay 75% of any bill that is over the scheduled fee.

We also have this, actually paid for by the working people, and it's for

those age 65 and older and will pay 80% of the medicare approved

amount which is set by the government. If a doctor accepts this then

he can charge only the approved amount. This leaves this group(all

over 65) to pay 20% of the approved amount. This person can also

carry a private insurance which will pay the rest. This is known as

medigap insurance.

I said above that it's paid for by the working people. While we work we

pay into a fund for this and then the government disburses it to cover

medical cost.

We also have Medicaid (called by different names in some states)

but this covers those people who have incomes below a certain level.

It works on the same order that Medicare does. When this group of

people also are over 65, they can be covered by both, so almost all

of their medical expenses are paid for.

That is where the simplicity ends. During our working years and

when we are above the income level for medicaid we can buy our

own individual policies. There is almost no limit to what kinds of

policies we can buy. Many of these policies are offered through

our employers. Of course this is where so many people get in trouble. As they select their "type of coverage", they often

take the cheapest policy, especially if they are young and in good

health. We have a saying here "you get what you pay for." That

is why you hear so many stories about insurance problems.

By the time we need to use our policy, we find that maybe what

we need it for is not covered.

This can get even more difficult in that sometimes smaller companies

are not check by the government to see that employees insurance,

the cost of which is deducted from the employees wages, is actually

paid into the insurance company. This is the first thing that came to

mind when Michele said she worked for a small company and her

insurance had lapsed. I sincerely hope this is not the case, but it's

a possibility.

I know this is about as clear as mud....but it's the best I can do in

a first lesson. It's question time and if I can't answer them, I'm sure

someone here can.

Maggie

Alabama

Start the year off right. Easy ways to stay in shape in the new year.

[Guest guest]

Just when I 'think' I finally understand how the American medical

system works and 'what' insurance is 'supposed' to do. I read a post

and get confused again! Someone please explain it to me in PLAIN

UNDERSTANDABLE language.

Here's how it is in Australia.

Debbie has probably already told you, but we have ONLY TWO types of

medical care. (Easy hey?)

1) Medicare. Paid and supported by the Government. This is FREE

hospital and a lot of medical care. Such as Doctor's visits, tests etc

and they pay 75% of any bill that is over the scheduled fee. That's

like if a Gastro visit is supposed to cost $110 (there are basic

charges the Government say's they have to charge. BUT Doctor's can

charge OVER that) then Medicare will cover 75% of the cost of the

appointment.

I have found ANY Doctor you ask NOT to charge OVER the scheduled fee

so you are not out of pocket WILL charge you just the Government rate.

So ALL covered usually. NO COST TO ME. But so many people don't know

you can ask this! And just pay up and over.

About 75% of our hospitals are PUBLIC (Medicare). They are NOT low

grade hospitals you would find in the Third World, but quiet nice.

Some are very nice.

Medicare also has PBS (Pharmacatical Benefits Scheme). So ANYONE with

a Governement card NOT Mediacre card as everyone has to have that but

Centrelink, Aged Pension etc (78% of the population)then we get

charged only $4.20 per prescription. Once we reach $360 in a year on

prescriptions, they become free. I make this earlier and earlier every

year.

2) THIS IS NOT COMPULSARY. Private health insurance.

We find the best deal for us and our family if we want them covered.

NO WORK PLACE OFFERS AUTOMATIC insurance, although as Nurse's we do

have our own insurance coverage but we don't have to join.

Our Private hospitals are like 4 star hotels with yummy food and grog.

On MY insurance for an example:

It's $103.75 per month.

I get 100% hospital coverage. That's EVERYTHING. Theatre, Doctor's,

pharmacy, tests, x-rays etc. AND a private room. Nice!

I pay $200 ONCE A YEAR excess when I go into hospital. AND THAT'S IT.

I can buy sports shoes and get $100 back. Same with doing a 1st aide

course.

They also pay back $45 on NON PBS prescriptions.

I can see a chiropractor, natropath, dentist, optomotrist etc which is

also covered.

I UNDERSTAND in America if you have NO insurance you can attend an ER

BUT they charge you?

NO INSURANCE then no Doctor's or tests? Can you PAY for the visit in

cash? Probably expensive. But how much would a 'normal' Doctor's visit

cost?

Then you have deductbles. What is this?????

I am so confused!!!!!

I find this a fascinating topic so ANY info is most gratefully

appreciated.

Australia