What you need to know about health insurance in the United States. Americans do not have the equivalent of Canadian Fare Pharmacare. The vast majority subscribe to private insurance covering the risks related to their health. But how does it work in practice?

Paying for drugs not covered by insurance

If the patient buys a drug paying from their pocket, even in the presence of a medical prescription that certifies the urgency and lack of therapeutic options, the patient cannot request reimbursement of the price paid. This is because it is the FDA, with a specific determination, which inserts a medicine in the list of medicines that can be paid by the insurance services, from which it derives the refund, which, in the case of some drugs, including lifestyle drugs like the immensely popular Viagra, or new drugs on the market, has not yet occurred.

There is not a directive or a specific rule that outlines the situation just reported, but very different times both the courts of merit and the legitimacy have pronounced in this regard, recognizing, by now constant address, the right to the supply where the drugs are necessary, indispensable and irreplaceable as a concrete manifestation of general law.

Therefore, pending approval of the drug by the FDA, the right to reimbursement of the incurred costs exists only if it is demonstrated, before a Judge and in a real judgment, that the drug has the above characteristics, remaining irrelevant failure to register the drug in the US.

But this also creates an opportunity to order a medication from Canadian Pharmacy, which many Americans resort to. When a drug existing in other countries for the treatment of a serious condition is not yet available on the American soil, citizens have full right to import them into the country for the purposes of personal use. The good news is that Canadian Pharmacy prices can save you up to 90% on any drug’s cost.

What is and what is not covered by insurance in the US?

The first thing to know is that the health system in the United States is private, mutual type, which means that everyone contributes to a health insurance plan according to his means of course but also risks he wants to cover.

Thus, there is something for all tastes and all budgets, from very expensive insurance… to the lack of insurance. In the latter case, the MEDICAID system, a free public health insurance, can help the poorest.

Similarly, if you are over 65 years old and you, or your relatives, can not provide for your medical needs, there is the MEDICARE system of national solidarity, financed by taxes on income. Then you should know that there are three kinds of health insurance plan in the United States, PPOs, HMOs and II:

PPOs: Private health insurance:

PPOs (Preferred Providers Organizations) are private health insurance companies that provide employees, through the company that employs them, benefits and reimbursements “comparable” to the Canadian system, provided that the patient refers to practitioners and hospitals of the network defined by the company.

The members of this network are liberal doctors who have entered into a fee agreement negotiated with the insurance company. Know that in this kind of plan, the contribution borne by the employer is collected in a health savings account, completely tax free! PPOs are very widely used in the United States, even by the self-employed who contribute on their own account.

HMOs (Health Maintenance Organizations) bring together under one entity, the health insurance company and the healthcare delivery system. Sometimes the health staff is an employee of the company, sometimes it is paid on a fee-for-service basis and can manage a personal patient.

II (Indemnity Insurances) are true private insurance companies that offer their services, regardless of any wage activity, and operate only at the probability of the damage being realized.

In the United States, all health insurance is not equal. When one learns that medical bills are the first reason for personal bankruptcy in the United States, it is imperative to study beforehand what is covered and what is not, especially since setting up a health insurance can take several weeks. A short lexicon to help you understand:

• Copay: Sum that remains in our case (even if we are insured) and that we pay at each visit to the doctor (about 20 dollars).
• Out of pocket maximum: Maximum ceiling of what we could have out of our pocket.
• Deductible: Franchise, that is, from how much the insurance starts to pay back.
• Coverage and exclusions: Risks covered and not covered by insurance.
• Network: Network of Health Professionals (see PPO).
• Out-of-network: Physicians outside the network (see PPO).
• Out-of-network coverage: Coverage of insurance when visiting an off-network practitioner (PPO case).

Pre-existing condition: If the diagnosis of a disease is prior to the signing of a health insurance contract, insurance is perfectly entitled to refuse health coverage due to this pre-existing illness. But it cannot, however, break an existing insurance contract. In other words, if you want to change health insurance, make sure you are covered continuously during the transition period. It is this problem of pre-existing conditions that the reform of President Obama is trying to resolve.

If you are self-employed, you can choose to subscribe to a PPO or HMO, knowing that you will need to pay a membership fee of about $ 1000 / month for good coverage (based on a family of 4).

Canadian Pharmacy and other options for uninsured patients

If the drug you require is not covered by insurance, or in the event of your reaching the so-called “donut hole” in your insurance plan, or your family does not have any health insurance to begin with, there are still options for affordably buying medications you need.

Canadian Pharmacy pool is the first line choice of these options. The price of prescription drugs in the United States is the highest in the world. Canada is not far off the list, but prices are, on average, three times lower compared to an average pharmacy price tag in the US, which accounts to something. Canada has put in place a system that, although elementary, manages to contain most of the awards, a heresy for many US officials.

In Canada, the Patented Medicine Prices Review Board (PMPRB) sets a ceiling price for each prescription drug. To establish this price, it first assesses whether the product represents a significant therapeutic advance (which is not the case for the majority, according to experts) and then compares its median price in seven countries, including the United States. Buyers, like the provinces, who are acting together now, negotiate with suppliers for potential rebates to control costs.

There is no such system in America. US citizens can come to Canada to buy prescription drugs for their personal needs, but the person must go to a pharmacy and have a prescription from a doctor licensed to practice in Canada. In addition, the doses sold must cover only a period of 90 days.

There are restrictions on prescription drug imports into the United States. Despite this, a dozen states have enacted laws in favor of larger supplies in Canada. They remain for the moment inoperative, but that could change. Having done nothing to resolve, as promised, the problem of the prohibitive price of drugs, the Trump government thinks of the elections and now plans, to save the face, to open the floodgates, according his Secretary for Health, Alex Azar.

You can further increase your savings if you choose in favor of generic drugs. At My Canadian Pharmacy, almost every drug has its generic analogs manufactured by authorized pharmaceutical companies. This brings the prices down by almost 90% without any loss in quality.