Who it’s for and what people take away
Adults who are new to the country, have just lost or changed their cover, or have never had the system explained, and the people who help them.
By the end, people can:
- describe the main ways care is paid for where they live: a public system, public programs, insurance, or paying themselves.
- explain common coverage words such as premium, deductible or excess, co-payment and out-of-pocket cost.
- name the questions to ask before care: is it covered, where can I go, what will I pay, and does it need approval first.
- find the official place to check what applies to them, using the country handout.
Before the session
- Read this whole kit and the country block for where you are teaching, and open each official link once so you know what the pages look like.
- Print one handout (with the right country block) and one worksheet per person, plus a few spares.
- Check the room has a projector or large screen, and test the slides on it before people arrive.
- Write the country’s emergency number and its free health advice line, from the handout, on a flip chart or board before people arrive.
- Ask the host whether anyone needs large print, an interpreter or extra time, and plan for it.
- Decide how you will answer “which plan should I choose?”: you can’t recommend one, and the country handout lists the official places that can help people compare.
You will need
- Projector or large screen with the slides
- Printed handouts with the country block for where you are teaching
- Printed worksheets
- Pens
- Flip chart or whiteboard and markers
Run sheet
60 minutes. Slide numbers refer to the deck.
Session timings| Starts | Length | What happens |
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| 0:00 | 5 min | Welcome and ground rulesSlides 1–2Introduce yourself and Moraph for Good. Explain that the session is general information about how the system works, not medical advice and not advice on choosing a plan, and that nobody will be asked about their own health or money.Say: “Today is about how care gets paid for where we live. I won’t tell anyone which plan to pick or what treatment they need, but I will show you where the official answers are.” |
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| 0:05 | 8 min | Four ways care gets paid forSlides 3–4Walk through the four routes: a public system paid for by taxes, public programs for particular groups, insurance, and paying yourself. Ask the room which of these they have come across, here or in another country.Say: “Most countries use a mix. What is free in one country can cost a lot in another, so it’s worth checking rather than assuming.” |
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| 0:13 | 8 min | The words on the paperworkSlides 5–6Explain premium, deductible or excess, co-payment and coinsurance, out-of-pocket cost and network, using the round made-up example on slide 6. Write the words on the board as you go.Say: “These words sound technical, but they all answer one question: who pays which part of the bill.” |
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| 0:21 | 7 min | Here, in this countrySlides 7–8Hand out the handout. Go through the country block for where you are teaching: what is free at the point of care, the main public programs, and how people sign up. Keep to what the handout says.Say: “This part is different in every country, so everything I say now comes from the official sources printed at the bottom of your handout.” |
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| 0:28 | 15 min | Activity: what would this cost?Slides 9–10Run the activity in pairs or small groups. Walk around and help. Then take one answer per group for each card.Say: “These are made-up situations, so there is no need to use your own. The goal is to practice asking the right questions.” |
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| 0:43 | 7 min | Before you get careSlides 11–12Go through the questions to ask before care and the rule that emergencies come first. Point to the free advice line on the board.Say: “If it might be an emergency, get help first and sort out the cost afterwards. For everything else, a phone call before the appointment can save a lot of money.” |
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| 0:50 | 10 min | Questions and closeSlides 13–14Take questions, using the common questions in this kit. Point people to the official sources on the handout for anything about their own situation.Say: “If I can’t answer something, the official sources on your handout can, and I would rather point you there than guess.” |
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What would this cost?
15 minutes, using the worksheet.
- Put people in pairs or small groups and give each group the worksheet.
- Read out the three made-up situations on the worksheet: a visit to a family doctor, a prescription, and a planned hospital test.
- For each one, groups use the country handout to answer: is this usually covered here, who might pay part of it, and what would you ask before you go?
- Groups write their answers in the table on the worksheet. Encourage them to write questions, not guesses, where the handout doesn’t say.
- Bring the room back together and take one answer per group for each situation. Correct anything that doesn’t match the handout, gently.
Questions for the room afterwards
- Which situation had the most “it depends” answers, and what did it depend on?
- What was the most useful question you wrote down?
- Where would you go to check if you weren’t sure?
Take care
General information, never advice about one person’s situation, and nothing to sell.
- Never ask anyone about their health, their immigration status, their income or what cover they have, and don’t read worksheets unless invited.
- Never recommend, name or compare an insurer, a plan or a broker. Point to the official places on the handout that help people compare.
- Never say whether someone qualifies for a program. Say what the program is and where to apply or check.
- Never give medical advice or say whether something is an emergency. If someone is unsure, point to the emergency number or the free advice line.
- Don’t quote prices or limits from memory. They change, and the handout gives the official place to check.
Questions people ask
Which plan or insurer should I choose?
We can’t recommend one. The country handout lists the official places that explain your options and, where they exist, free trained helpers who can go through them with you.
I’m new to the country. Am I covered?
It depends on the country and often on your residence or immigration status. The country handout says who the public system covers and where to check, and many newcomer services can help you apply.
Is emergency care free?
It varies. In some countries emergency care in a public hospital is free; in others you may get a bill. If it might be an emergency, get help first. The handout says what applies where you live.
Why do I have to pay if the system is public?
Public systems usually leave some things out, such as some medicines, dental care, eye care or ambulances. The handout lists what is commonly not covered where you live.
What if I can’t afford what I owe?
Ask before you pay. Many countries have programs for people on low incomes, and many clinics and hospitals offer help. The sessions “Finding low-cost care” and “Reading a medical bill” cover this in more detail.
Where you are teaching
The rules differ by country. Teach the shared material from the slides, then use the block for the country you are in, and hand out that country’s sheet.
United States
- A mix of programs and insurance. Many people get insurance through work. Medicare covers people 65 or older who meet citizenship or residency rules, and some younger people with a disability. Medicaid and the Children’s Health Insurance Program (CHIP) give free or low-cost coverage to some people on low incomes, families, children, pregnant women, older people and people with disabilities.
- Medicaid differs by state. Medicaid follows federal rules, but who qualifies, what it covers and what it costs differ from state to state. You can apply for Medicaid and CHIP at any time of year, through HealthCare.gov or your state Medicaid agency.
- The Marketplace. HealthCare.gov is the government’s Health Insurance Marketplace for people buying their own plan. A premium tax credit can lower the monthly premium, depending on household income. To use the Marketplace you must live in the US, be a citizen, national or lawfully present, and not be incarcerated.
- When you can sign up. Outside the yearly Open Enrollment Period, you can only enroll in or change a Marketplace plan if you qualify for a Special Enrollment Period, after certain life changes such as losing other coverage, moving, getting married or having a baby, usually within 60 days.
- Free help to apply. Navigators are trained to help people look for coverage and fill in Marketplace forms. They must be unbiased and their help is free. HealthCare.gov has a tool to find local help.
- If a claim is refused. If your health plan refuses to pay a claim or ends your coverage, you have the right to appeal and have the decision reviewed by a third party.
United Kingdom
- GP care is free to everyone. In England, anyone can register with a GP surgery and see a GP free of charge. You don’t need ID, proof of address or proof of immigration status to register.
- Emergency care. A&E services, walk-in centres, minor injuries units and urgent care centres are free to everyone in England, including overseas visitors, though care after being admitted to hospital may be charged for people who are not entitled.
- Hospital care depends on residence. Other hospital care in England is free to people who are “ordinarily resident” in the UK. Overseas visitors may be charged for it, though some groups are exempt, and people who have paid the immigration health surcharge may be exempt from charges for some services.
- Some things have a charge. In England, most working-age adults pay a charge for each prescription item, and patients often pay towards NHS dental care and eye care. NHS prescriptions in Scotland and Wales are free.
- Help with health costs. Some people get free NHS prescriptions automatically, for example if they are under 16 or aged 60 or over, or get certain benefits. People on a low income can apply to the NHS Low Income Scheme for full or partial help.
Canada
- Each province has its own plan. Canada has a universal system funded through taxes. Eligible residents apply to their own province or territory’s health insurance plan, which decides who counts as a resident and what is covered.
- What the public plans cover. All the plans cover medically necessary hospital and doctor services. Once you are registered you get a health card, which you show at hospitals and clinics.
- What they usually don’t. Public plans usually don’t pay for eye care or glasses, dental care, prescription medicines outside hospital, or ambulance services. Provinces and territories give extra help to some groups, such as seniors, children and people on social assistance.
- There may be a wait. For newcomers it can take up to three months for public coverage to start, depending on the province. In Ontario, for example, there is no longer a waiting period for OHIP; in British Columbia, coverage may start about three months after arrival.
- Refugees and claimants. The Interim Federal Health Program gives limited, temporary coverage to some refugees and refugee claimants until they qualify for provincial or territorial coverage.
Australia
- Medicare. Medicare is the government insurance scheme that gives Australian citizens, permanent residents and other eligible people free or lower-cost health care. Visitors from countries with a reciprocal health care agreement may be covered for some care.
- Public hospitals. Anyone with a Medicare number can get free treatment as a public patient in a public hospital, including the emergency department, though some planned treatments have a waiting list.
- Doctors and bulk billing. If a doctor bulk bills, Medicare pays the full cost and you pay nothing. If not, you pay the doctor and claim part back from Medicare; the rest is called the gap fee. Not all doctors bulk bill, so ask first.
- Medicines. The Pharmaceutical Benefits Scheme (PBS) lowers the price of listed prescription medicines when you show your Medicare card. You usually still pay a co-payment, and medicines not on the PBS cost full price.
- What Medicare usually doesn’t cover. Medicare doesn’t cover ambulances, and covers dental care only in limited cases, such as public dental clinics for eligible people and the Child Dental Benefits Schedule for some children.