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Ask HN: Should I be worried about healthcare in the US as a SWE

Hello everyone I'm a software engineer and I'm in the last stages of interviews with few companies based in the US. Now everything looks great in terms of job prospects, income (100-160K ranges) but one thing that worries me is that my partner has a chronic disease and we are worried that in the US it could potentially make us bankrupt and we're better off staying in the UK. We read horrific stories about healthcare in the US, but I'm wondering if having an income and the privileges that come with a SWE job, would it put us in a more comfortable place? Can anyone help shed some light on healthcare situations but for SWE/people with equivalent financial situation. Does it make a difference? What things to look for? Thanks a lot!

topkai22 5y ago
I am not a HR professional or lawyer, so please verify everything I say. The US healthcare system is a pain in the rear to navigate, is incredibly awful if you are uninsured, and (as a system) is insanely expensive. That all being said, if you and your partner are insured it should be fine. It’s perfectly normal to ask for details of insurance coverage and other benefits during the hiring process. Basically, you’ll want to ask 4 things - Will my partner be coverage under my insurance (if you are legally married the answer is almost certainly yes, if not the company should help you navigate an answer). If you partner won’t be covered on your insurance that’s a big potentially move stopping issue. - What is my monthly payment (this comes out of your salary) - What is the deductible for you and your partner/family (this is the amount of money you must pay every year before insurance starts paying out. With a chronic condition just expect to pay it every year). Expect this to $5000-10000. - What is the out of pocket maximum? (Even after you pay the deductible you may be on the hook for something like 10% of a bill until your total payout reaches the out of pocket maximum. This should be something like $17k for a family at most. What does all that mean? Basically if you are a really expensive patient the most you and your partner(together) can expect to pay health providers is around $17k. Realistically, it’s probably less. The one really big wildcard here is that not all doctors or hospitals are covered by any given insurance (called in-network versus out-of-network). This generally isn’t a big deal- you just pick from the list provided in by your insurance and doesn’t apply to emergency care- but people sometimes still make the mistake and it can be expensive. One distinction you might encounter are HMO (health management organization) plans versus PPO (preferred provider organization) plans. HMO plans are more restrictive but are cheaper. I’d take a PPO plan until you are settled in the US for a bit. In general, healthcare in the us on a $100k+ salary is going to be fine. I have a friend who had a very pre mature child. Kid is doing great, but his care cost $2 million in the first year and ~$15k there after. They paid nothing the first year and about $6k/year afterward. I hope that helps. Please verify with an HR professional at any company you receive an offer from- explaining benefits is a major part of their job and there might be things I’m forgetting. And (presumptively) welcome to America. I was born here, but still think it’s a pretty great place after living elsewhere. I hope you are able to find as much joy and fulfillment in this country as I do.
- healthinsurance 5y ago
  Thanks for the detailed response! Although it's a chronic disease, it doesn't require monthly treatment or anything of that nature. So the $17k is in addition to what I'd pay per year out of my salary, is that correct? The story of your friend's kid is a good reminder that cost doesn't always equal price. Thanks for the kind words. We do hope to find as much joy and fulfillment in the next adventure!
  - topkai22 5y ago
    Yes to the $17k potentially being post paycheck. However, the actual number will vary quite a bit by insurance plan. I picked the max legal limit for plans you can buy for yourself, also known as “marketplace” or “Obamacare” plans that you can buy as an individual. Almost any tech company provided insurance will be better. Mine limits my deductible to ~$3500 and my out of pocket max to ~6500 for a family of 5. Again, please talk to your HR pros to really understand an individual company’s offerings. Also take the time to talk to your HR people/relocation specialists/ coworkers about how to set up other benefits. Beyond just health insurance there are various programs that might benefit you. There might matching funds or tax benefits (flexible spending accounts, retirement savings plans, extra insurance offerings, etc.) Sorry if that’s a lot, but don’t worry too much about it. It should feel more like icing on the cake when you get the point where HR is telling you how to get even more money by taking advantage of these programs, and every company I’ve worked for (admittedly not many) spends a substantial amount of effort making sure you can understand this stuff.
wreath 5y ago
This depends on the coverage your company provides. Afaik, the larger the company the more likelihood that they have good coverage for you and your partner. As topkai22 mentioned, it's normal to ask for these sorts of things. Good luck with your move!

topkai22 5y ago

I am not a HR professional or lawyer, so please verify everything I say. The US healthcare system is a pain in the rear to navigate, is incredibly awful if you are uninsured, and (as a system) is insanely expensive. That all being said, if you and your partner are insured it should be fine. It’s perfectly normal to ask for details of insurance coverage and other benefits during the hiring process. Basically, you’ll want to ask 4 things - Will my partner be coverage under my insurance (if you are legally married the answer is almost certainly yes, if not the company should help you navigate an answer). If you partner won’t be covered on your insurance that’s a big potentially move stopping issue. - What is my monthly payment (this comes out of your salary) - What is the deductible for you and your partner/family (this is the amount of money you must pay every year before insurance starts paying out. With a chronic condition just expect to pay it every year). Expect this to $5000-10000. - What is the out of pocket maximum? (Even after you pay the deductible you may be on the hook for something like 10% of a bill until your total payout reaches the out of pocket maximum. This should be something like $17k for a family at most. What does all that mean? Basically if you are a really expensive patient the most you and your partner(together) can expect to pay health providers is around $17k. Realistically, it’s probably less. The one really big wildcard here is that not all doctors or hospitals are covered by any given insurance (called in-network versus out-of-network). This generally isn’t a big deal- you just pick from the list provided in by your insurance and doesn’t apply to emergency care- but people sometimes still make the mistake and it can be expensive. One distinction you might encounter are HMO (health management organization) plans versus PPO (preferred provider organization) plans. HMO plans are more restrictive but are cheaper. I’d take a PPO plan until you are settled in the US for a bit. In general, healthcare in the us on a $100k+ salary is going to be fine. I have a friend who had a very pre mature child. Kid is doing great, but his care cost $2 million in the first year and ~$15k there after. They paid nothing the first year and about $6k/year afterward. I hope that helps. Please verify with an HR professional at any company you receive an offer from- explaining benefits is a major part of their job and there might be things I’m forgetting. And (presumptively) welcome to America. I was born here, but still think it’s a pretty great place after living elsewhere. I hope you are able to find as much joy and fulfillment in this country as I do.

healthinsurance 5y ago
Thanks for the detailed response! Although it's a chronic disease, it doesn't require monthly treatment or anything of that nature. So the $17k is in addition to what I'd pay per year out of my salary, is that correct? The story of your friend's kid is a good reminder that cost doesn't always equal price. Thanks for the kind words. We do hope to find as much joy and fulfillment in the next adventure!
- topkai22 5y ago
  Yes to the $17k potentially being post paycheck. However, the actual number will vary quite a bit by insurance plan. I picked the max legal limit for plans you can buy for yourself, also known as “marketplace” or “Obamacare” plans that you can buy as an individual. Almost any tech company provided insurance will be better. Mine limits my deductible to ~$3500 and my out of pocket max to ~6500 for a family of 5. Again, please talk to your HR pros to really understand an individual company’s offerings. Also take the time to talk to your HR people/relocation specialists/ coworkers about how to set up other benefits. Beyond just health insurance there are various programs that might benefit you. There might matching funds or tax benefits (flexible spending accounts, retirement savings plans, extra insurance offerings, etc.) Sorry if that’s a lot, but don’t worry too much about it. It should feel more like icing on the cake when you get the point where HR is telling you how to get even more money by taking advantage of these programs, and every company I’ve worked for (admittedly not many) spends a substantial amount of effort making sure you can understand this stuff.

wreath 5y ago

This depends on the coverage your company provides. Afaik, the larger the company the more likelihood that they have good coverage for you and your partner. As topkai22 mentioned, it's normal to ask for these sorts of things. Good luck with your move!