Toolkit

Health insurance and understanding the US system

Guidance-oriented planning notes for Canadians moving to the U.S. (not legal, tax, or insurance advice).

Health insurance in the U.S.

What’s different from Canada, what to ask, and how to avoid expensive surprises.

The two concepts that matter most

  • Network: “in-network” care is usually far cheaper than “out-of-network.”
  • Cost sharing: deductibles, copays, coinsurance, and out-of-pocket maximums.
Translation

In many U.S. plans you may pay the first chunk (deductible), then a percentage (coinsurance), until you hit an annual cap (out-of-pocket max). That’s why a “cheap premium” can still be costly.

Real questions people ask about U.S. health insurance

  • “Is U.S. healthcare ‘free’ like Canada?” No — costs and coverage depend on your plan. Expect premiums, deductibles, and copays.
  • “What if I move before a job starts?” Plan for a coverage gap. People often use short-term coverage or travel-style bridge options (eligibility varies).
  • “What’s a deductible vs out-of-pocket max?” Deductible is what you pay before the plan pays more; out-of-pocket max caps covered costs in-network (rules vary).
  • “What’s the biggest mistake?” Assuming a cheap monthly premium means cheap care — check deductible, network, and urgent-care/ER rules.

Most common coverage paths for Canadians

  • Employer plan: often the best value if offered (ask about start date + waiting period).
  • ACA marketplace plan: depends on eligibility and timing (state-specific rules).
  • Short-term plans: can fill gaps but may exclude pre-existing conditions and key benefits.
  • Travel/visitor coverage: sometimes used briefly, but read exclusions carefully.

What to ask HR (copy/paste checklist)

  • When does coverage start? Is there a waiting period?
  • What are the deductible and out-of-pocket maximum?
  • Is there a family deductible? Is it “embedded” or “aggregate”?
  • Which local hospital systems and clinics are in-network?
  • Are prescriptions covered? What’s the formulary?

If you’re moving to GA/FL/TX, ask HR to confirm that the plan’s network is strong in your specific county/city.

“Surprises” Canadians commonly run into

  • Going to an in-network hospital but being treated by an out-of-network specialist.
  • Confusing “copay” (flat fee) with “coinsurance” (percentage).
  • Not realizing some services require pre-authorization.
  • Not budgeting for dental/vision (often separate).

Simple guidance for your first 90 days

  1. Pick one primary clinic that’s in-network and near you.
  2. Learn your plan portal (ID cards, claims, finding providers).
  3. Build a small “medical buffer” in your budget (even $25–$50/week helps).
  4. Confirm urgent care vs ER rules and likely costs.
Emergency vs urgent

ER visits can be expensive. For non-life-threatening issues, urgent care is often a better first stop—if it’s in-network.

Helpful official starting points

Rules can change by state and year—use official sites for the most current info.

If you want, I can add an “Insurance Q&A” tool

We can add a simple form in the admin dashboard so visitors can submit questions, and you can post answers as a blog-style FAQ.

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