With the passing into law of the controversial US government-run US medical insurance in March 2010, president Obama has provided a very important benefit to Canadians wishing to move to the US. This benefit was not specifically intended for Canadians but Canadians who legally immigrate to the US will be able to get access to "affordable" health insurance regardless of any pre-existing conditions or age. This new legislation is going to take years to implement so it will be difficult to predict when exactly this coverage will be available for Canadians coming to the US. We do expect this to happen some time in 2011 so keep in touch through The Border Guide Forum for updates, at www.TheBorderGuide.com.
Canadians and Americans like to constantly debate which country's medical system is the best. My nearly 30 years' experience in this area has taught me that you can never answer this question unless you can determine when, where, and what medical assistance you will need in advance. Of course, this is the million-dollar question, because if you knew when, where, and what illness you were going to have, you could shop the medical purveyors in either country to get the best care. However, this is equivalent to trying to plan your spending in retirement so that the last cheque you write on the day you die bounces. By combining the best benefits from both countries and planning so you can easily access both countries' medical systems, you can obtain the best protection with maximum flexibility. (See the next section, "Have Your Cake and Eat It Too!")
Canadians over 65 who have resided in the United States legally for at least five years, or who are US citizens, are eligible for complete US Medicare regardless of any pre-existing conditions. The cost is approximately $700 USD per month each, or $100 USD per month each if you or your spouse has contributed at least the minimum amount to US Social Security programs on US employment earnings. (See Chapter 13 for more information about qualifying for US Social Security.) There are also numerous private insurance carriers that provide Medicare supplements to fill any gaps in US Medicare coverage. If you do not qualify or are waiting to qualify for US Medicare and are over 65, there is limited but quite adequate choice of coverage available to you from private insurance carriers, most of whom originate outside the United States. Be sure to secure this coverage before becoming a US resident so that it is effective when you leave Canada and there are no gaps in coverage.
Those under 65 have a wide variety of health insurance options. Health insurance works much like car insurance in the United States. If you want zero deductible, with your auto insurance company paying for the slightest scratch, you will pay a substantially higher premium than someone with a $1,000 deductible. With health insurance in the United States, you can choose your coverage and your deductible. For example, a healthy person aged 60 can get a health policy with a $2,500 deductible and a $2-million coverage limit from an AM Best A-rated company for less than $350 per month.
A good health insurance broker knowledgable about both US and Canadian health issues can be of great assistance to those who are considering living in the US. In addition, those who are tired of having only travel insurance and want full medical coverage and complete year-round access to the US medical system should talk to a health insurance broker. The cost of this insurance, particularly if you use a high-deductible plan, can be very reasonable when compared to your standard travel insurance policy. Unlike travel insurance, these policies will cover you for non-emergency medical assistance in the US, as well as for emergency help 12 months a year regardless of where you travel. With this year-round access, if you needed what your provincial plan classified as non-emergency heart surgery and you were in a waiting queue in Canada, you could get almost immediate surgery in the US for only the cost of your deductible. You should also note that if you have one of these year-round, full-coverage policies and develop a serious medical condition, you cannot be dropped from your plan; whereas if you have travel insurance only, when your current six-month policy expires, you might never be able to get coverage again and would be limited to travel within Canada for the rest of your life, unless you were prepared to risk travel without insurance.