USA - Canadian Health Systems - The Good - The Bad - The Ugly

USA SYSTEM

A serious accident or illness could put you on the hook for staggering medical bills that will haunt you for years.

Enrollment in federal and state insurance exchanges began Nov. 1 and runs until Jan. 31, but Dec. 15 is the last day to get in if you want coverage starting Ian, 1.

Protecting yourself against an accident's financial consequences "provides a peace of mind that you won't be in tons of medical debt for years and years to come."

If you lack coverage, you're worried about money and you're confused about your choices, here are four questions to consider:

1. What will insurance do for me?

You can count on coverage (or what the government calls essential hearth benefits. All plans sold on the federal marketplaces must offer them.

Preventive services such as shots and screening tests are free. You cant be denied coverage for a preexisting hearth condition. Expect to pay some of the cost for other covered services, such as emergency care or a hospital stay. Beyond the essentials, how much of your health care will be paid by insurance depends on the type of health plan you buy.

But if you're 26 or older, you cant stay on your mom and dad's health plan any longer.

2. Can I afford it?

Are you shouting "No!" here? Sure, many 0* us feel crushed by our bills and dont have extra money to throw around. Half the uninsured Americans who are eligible to buy Obamacare have less than $1,000 in savings. What you will pay for coverage next year depends on what you expect in 2016 income. The government offers tax credits that help people with modest incomes cut their monthly premiums, and for lower-income consumers, there are other subsidies that help reduce the plan's out-of-pocket costs.

You may be eligible for a subsidy if you make between 100 and 400 percent of the federal poverty guideline, or $11.770 to $47,080 for a single person, and live in a state that did not expand Medicaid under the federal health law. If you live in a state that did expand Medicaid and your income is up to 138 percent of the poverty level - $16,243 -you must go on Medicaid and cannot qualify for tax credits.

Monthly premiums vary widely depending on where you live, even for widely held silver-level plans. In 2015, the second-cheapest silver plan for a 27-year-old cost $165 a month in New Mexico but $449 in Alaska, according to the Department of Health and Human Services.

The tax credit can be applied to your monthly cost automatically, or applied to your taxes come April 2017 for plans bought for 2016.

The government sets out-of-pocket maximums for marketplace health plans, limiting your annual expenses for services not reimbursed by insurance. For 2016, the limits are $6,850 for an individual plan and $13,700 for a family plan.

3. What if I don't buy insurance?

That might cost you, too. If you don't buy insurance, the IRS will hit you with a fine at tax time, unless you qualify for an exemption, which can include hardships. Examples of hardship exemptions include eviction in the past six months, medical expenses you couldn't pay in the past 24 months that resulted in substantial debt and ineligibility for Medicaid because you live in a state that didn't expand Medicaid under the federal health law.

The penalty for not having coverage is rising next year to $695 per adult or 2.5 percent of your annual household income above the tax filing threshold of $10,150 for an individual - whichever is higher. The penalty is higher for families.

4. How can I tell what plan is right for me?

Obamacare has five categories of plans: platinum (which pays for 90 percent of your medical costs on average), gold (80 percent), silver (70 percent), bronze (60 percent) and catastrophic (which only pays for very high medical costs).

Sound complicated? The differences are all about how much you will pay for health care services beyond what your plan covers. The platinum plans generally have higher premiums but might save you more in other expenses, such as deductibles and co-payments.

If you go to a doctor twice a year, maybe you don't need a platinum-level plan; bronze or silver plans are for you. But if you have a chronic disease that requires a lot of medicine or treatment, for example, you might come out ahead with a more expensive premium that covers more services.

CANADIAN SYSTEM

Canada's tax-financed health care system covers everybody, gets better results, costs about two-thirds of what USA does and is far more popular than ours with both their public and their politicians. There is no opposition to it in the Canadian Parliament.What's not to like about that?

Oh yes, and the average Canadian is now wealthier than the average American. Their far more efficient and effective tax-based health care system is part of the reason.

Physician Philip Caper of Brooklin is a founding board member of Maine AHCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. 

Note: If you take vacations out of your home province you must have travel insurance. Your Provincial Plan may reimburse you if your travel is limited to Canada, but not USA or Europe.