I have been thinking about moving from Germany to the US, specifically California, since there are plenty of tech job opportunities there. I know that tech companies usually offer good health insurance, but I keep hearing horror stories about medical debt and coverage gaps in the US. In Germany, insurance covers almost everything, including hospital visits, ER trips, and even cancer treatment. No one goes into debt over medical bills.
For those living in the US, especially California, if you have good health insurance:
How much does insurance actually cover for serious things like ER visits or major surgeries?
Are there things that even good insurance won’t cover?
Is medical debt really as bad as people online say, or is it overblown?
If you work in tech and get a solid employer-sponsored plan, you won’t have the same problems that people with low-paying jobs or no insurance deal with. Most employer plans fall into one of these two:
High deductible with HSA: You pay the first few thousand out of pocket, but insurance covers almost everything after that. Employers often contribute to an HSA to help with expenses.
Low deductible plan: You might pay small copays—$30 for primary care, $60 for specialists, $100 for ER, $500 for hospitalization.
Preventative care is free, and the most you’ll ever pay per year is a few thousand dollars. The horror stories you hear usually involve people with no insurance or those paying out of pocket for treatments that aren’t covered anywhere. With a good salary, you’ll be fine.
I moved from Europe to California, and it’s not as bad as people make it seem. The numbers you see online are billed amounts, not what people actually pay. Yes, it’s complicated, and dealing with insurance companies can be a headache, but the quality of care is good.
Specialists are much easier to see than in Europe, and if you have decent insurance, the cost-sharing is manageable. If you’re poor, Medicaid covers everything in California. The biggest advantage of the US system is access to specialists and newer treatments, but you do pay more for it compared to what comes out of your paycheck in Europe.
I’ve lived in both systems, and there’s truth to the bad reputation, but context matters. If you have an excellent employer-sponsored plan, it’ll still cost you. Expect $2k–$5k per year in premiums and copays even with a great plan.
Quality of care varies a lot. Some of the best hospitals in the world are in California, but there are also places with standards you’d associate with developing countries. The biggest issue is primary care—getting a regular doctor can take months. If you get sick, you might have to go to urgent care instead of seeing your primary doctor.
That said, for someone in tech with a good salary, medical debt is not likely to be a problem unless something catastrophic happens and you somehow fall through the cracks.
@Brandy
Not sure where you’re getting that info. I’ve never waited more than 48 hours for an appointment with Kaiser, even if it wasn’t my regular doctor.
If you have good insurance, healthcare here is actually pretty great.
I went to the ER last year with stomach pain. I had an ultrasound the same day, an MRI the next, and two specialty procedures within a few days. They even wanted to do surgery right away, but I postponed it for a trip and scheduled it for when I got back with no issue.
Meanwhile, in Canada and Europe, people with the same issue are waiting months for scans and surgeries. The trade-off is the cost, but if your employer pays your premium, your biggest concern will be the deductible and out-of-pocket max, which isn’t as bad as it sounds.
It’s not bad if you know how to work the system. You have to be proactive about your care and understand what your insurance covers.
If you get employer-sponsored insurance, look into HSA or FSA accounts—they help a lot with costs. Your yearly max out-of-pocket depends on the plan, but in tech, it’s usually pretty reasonable. Big companies tend to be self-funded, meaning they design their own insurance plans and just use providers like Blue Cross or Aetna to administer them. These plans are generally better than what’s on the marketplace.
The quality of doctors and access to the latest treatments is great here. If you have good insurance, it’s manageable, but you will pay more out of pocket than in Germany. The higher salaries and lower taxes do help offset that.
California’s healthcare system is a mess in some areas. There’s a doctor shortage, housing is insanely expensive, and access to care depends heavily on where you are and how much you make.
If you have a serious condition, expect to fight insurance companies every step of the way. Doctors are overworked and often don’t have time for thorough exams. Many people end up with big medical bills despite having insurance.
Unless you’re making a very high salary and can afford to pay out of pocket when needed, I’d think twice about moving here for the healthcare alone.
The system here is frustrating. I pay $500 a month and still had to fight to get an appointment with a specialist. If you have a serious issue, you’ll probably need to advocate for yourself a lot.
If you’re poor, you’re screwed. I have a basic state insurance plan, and it takes forever to get specialist referrals. People who can’t afford insulin end up rationing it, which is dangerous.
The problem isn’t just insurance—it’s that everything is slow unless you have money.
Be careful. Insurance plans change all the time, and coverage can be unpredictable. Even if you have a great plan one year, it might not cover the same things next year. People often don’t realize this until they need care.
It really depends on your employer’s plan. Some cover everything, others have high out-of-pocket costs. The Affordable Care Act sets a maximum out-of-pocket limit, but that’s still a lot of money for some people.
If you get a job offer, ask about the insurance details before making a decision. It makes a big difference.