The US Healthcare System: A Comprehensive Guide to US Health Insurance
Healthcare in the United States can be overwhelming to someone who has never needed medical attention in this country before. Just the thought of health insurance, doctor visits, and prescription drugs is enough to make you want to stay as healthy as possible. Here’s what you need to know about the US healthcare system and US health insurance plans so that you can navigate the US healthcare system like a pro, without breaking your budget or feeling like you aren’t getting the care you need when you need it most.
The US Healthcare System can be confusing, especially if you’re new to the country and don’t have any friends or family members who can show you around the system. Luckily, you don’t have to feel confused anymore! Our guide to the US healthcare system will help you figure out which health insurance providers are best for your situation, which are most likely to help you avoid costly medical bills, and what to do in case of an emergency when it comes to healthcare in the US. Ready? Let’s get started!
Healthcare in the United States is organized in a complex bureaucracy. While in the rest of the world, healthcare facilities are owned chiefly by governments or private sector businesses, in the US, a large share of hospitals and clinics are owned by private non-profit organizations.
What is health insurance?
Health insurance is a policy that helps cover the cost of health care and medical expenses. Policies can be purchased individually or through an employer, which will typically offer benefits as part of their employment package. Self-employed must buy coverage on their own, although in some cases, the individual may qualify for subsidized rates. When purchasing individual coverage, premiums may vary based on age, income level, state of residence, and tobacco use. You must provide proof of your citizenship status before enrolling if you apply for public assistance programs like Medicaid or Medicare Part D prescription drug coverage.
Is health insurance mandatory in the US?
Health insurance is not mandatory in the United States but is essential. The Affordable Care Act made health insurance available for low-income families and individuals, covering millions of people who had been uninsured before. The best way to find out what plans are offered in your area is by going online and seeing what is available. If you cannot afford or don't want coverage, you can pay a fee when you file your taxes. It's important to understand that some things will not be covered under this plan, so it's a good idea to understand the basics before enrolling. For example, if you go outside of the country, treatments related to pregnancy will not be covered under this plan either. Another thing that might affect your coverage is pre-existing conditions such as cancer, diabetes, or depression. Before enrolling, ensure you understand these and how they might affect your plan.
How much does health insurance cost in the US?
How do I know if I need health insurance?
How long will my coverage last?
To figure out how long your coverage will last, you need to understand what kind of health insurance policy you have. The two types of policies are high-deductible policies and comprehensive policies. High-deductible policies tend to be less expensive than comprehensive policies but will only cover the costs up to a certain amount before you pay the rest. On the other hand, comprehensive policies will cover all expenses until the deductible is met. If you have a high-deductible policy, then it's essential to make sure that there's enough money in your savings account so that when you complete your deductible, there's enough money in the budget for any follow-up care that may be needed.
What types of benefits do I get with my health insurance plan?
The benefits vary by employer and health plan if you have employer-sponsored insurance. These plans will typically include coverage for hospitalization, doctor's visits, lab services, prescriptions, mental health care, and more. The plans also have a deductible amount you'll need to pay before your insurance kicks in. As of 2023, most people choose a high-deductible health plan paired with a tax-advantaged health savings account (HSA). With this setup, you'll get lower monthly premiums and a higher deductible than what's offered on other types of plans. An HSA allows people to save money tax-free for future medical expenses or use it as an investment vehicle (the money grows tax-free).
Medicare is a national health insurance program that dates back to 1966. It provides health insurance for US nationals older than 65 and younger people with end-stage renal disease, ALS, and other disabilities.
Data shows that in 2018, Medicare provided almost 60 million individuals with healthcare in the US, over 51 million of which were older than 65.
The Medicare program is divided into four parts:
- Part A covers hospitals, skilled nursing, and hospice services.
- Part B – covers outpatient services, including some providers’ services while inpatient at a hospital, outpatient hospital charges
- Part C – is an alternative called Managed Medicare, which permits patients to select health plans with at least the same service coverage as Part A and B, often the benefits of Part D and an annual out-of-pocket spend limit which A and B lack. One must sign in parts A and B first to sign in this part.
- Part D – covers self-administered, primarily prescription drugs.
Medicaid is a federal and state program that helps people with limited income and resources to cover medical costs while covering benefits typically not covered by Medicare, such as nursing home care and personal care services.
It is the largest source of funding for medical and health-related services for low-income people in the United States. Data shows that the US provides health insurance to 71 million people with low income or disabilities, 23% of the US population.
Children’s Health Insurance Program
Formerly known as the State Children’s Health Insurance Program (SCHIP), this program covers health insurance for children of families with a modest income that is not low enough to qualify for Medicaid.
The Affordable Care Act – Obamacare
The Patient Protection and Affordable Care Act is a federal statute signed into law by President Obama. It made it mandatory for every citizen to have health insurance or be penalized. The Act subsidizes low-income families by taxing healthcare providers and high-income families, as it was designed to lower healthcare costs while providing better healthcare for Americans.
The Affordable Care Act allowed parents to ad their children up to 26 to their policies to have younger healthy people paying premiums. It also allowed poorer people to get treatment for chronic illnesses instead of using the emergency room.
US Private Health Insurance
There are about a thousand private health insurance providers in the US, each offering different plans at different prices, mainly depending on a person’s medical history. However, while individual plans cover only one person, there are also group plans targeting families in particular.
Usually, there are three types of health insurance in the United States:
- Traditional fee-for-service health insurance plans are usually the most expensive, that those with an income lower than the average income in the US have difficulties purchasing. However, these are the best plans as they offer you the most flexibility.
- Health Maintenance Organizations (HMOs) offer a limited choice of healthcare providers, yet it also provides lower co-payments and covers the costs of more preventative care. They are evaluated and accredited by the National Committee for Quality Assurance.
- Preferred Provider Organizations (PPOs), like HMOs, offer lower co-payments. Still, they give you more flexibility when selecting a provider, as they give you a list of providers you can choose.
How to Choose a Good US Health Insurance Plan?
When looking up a good health insurance plan, make sure you ask questions like:
- Does that planning grant you the right to go to any doctor, hospital, clinic, or pharmacy you choose?
- Are specialists such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care, and physical therapy?
- Does the plan cover home or nursing home care and medications a physician might prescribe?
- What are the deductibles? Are there any co-payments?
- What is the most you will have to pay out of your pocket to cover expenses?
Make sure you also understand how a dispute about a bill or service is handled by your provider, as in some plans, you may be required to have a third party decide how to settle the problem. We recommend the GeoBlue Xplorer plan for foreigners in the United States.
Health Insurance Requirements for Foreign Visitors in the US
Though the United States Authorities have not made health insurance mandatory for short-term travelers, as B-1/B-2 visa holders, it is highly recommended that every traveler get insurance before their trip to the country.
The main reason you should get insurance is that healthcare in the US is costly, and even a check-up for a simple headache will cost you hundreds of dollars, while a broken limb will cost you thousands.
Health incidents are never foreseen; therefore, it is best to be prepared for them and get insurance, so in case of need, you save yourself money.
Health Insurance Options for Legal Immigrants
Immigrants that are lawfully present in the United States are eligible to get private health insurance in the US. In addition, lawful immigrants may also be suitable for lower costs on monthly premiums and lower out-of-pocket costs based on their income, as follows:
- Those with an annual income of 400% of the federal poverty level or below may be eligible for premium tax credits and other savings on Marketplace insurance.
- Whereas those with annual household income below 100% federal poverty level that is not otherwise eligible for Medicaid are eligible for premium tax credits and other savings on Marketplace insurance, given that they meet all other eligibility requirements.
Most of the time, “qualified non-citizens” are eligible for coverage through Medicaid and Children’s Health Insurance Program (CHIP), given that they meet the income and residency rules of the state where they are based.
“Qualified non-citizens” are considered the following:
- Lawful permanent residents
- Asylees, refugees, battered non-citizens & spouses, children, or parents, victims of trafficking and or their spouse, child, sibling, or parent, or individuals with a pending application for a victim of trafficking visa
- Cuban/Haitian entrants,
- Those paroled into the US for at least one year
- Conditional entrant granted before 1980
- those granted withholding of deportation and members of a federally recognized Indian Tribe or American Indian born in Canada.
However, most of them will need to wait for five years in the US to get Medicaid and CHIP coverage in the US after they qualify. Refugees and asylees are exempt from the waiting period.
In addition, states have the option to abolish the 5-year waiting period for children and pregnant women so Medicare and CHIP can cover them.
Health Insurance Options for Illegal Immigrants
Illegal Immigrants in the US can get health coverage only from private providers, as the US government-funded health insurance does not cover them.
Community centers can provide medical help to undocumented immigrants in the US, termed Safety Net Provider,s if the healthcare seeker can participate in fee-for-service medical assistance.
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- USA Immigration - https://bit.ly/usa-immigrations
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- World Immigration - https://bit.ly/world-immigrations
- Employment Opportunities - https://bit.ly/abroad-employments
- Education Opportunities - https://bit.ly/abroad-scholarship-programs
- Homepage explore - https://bit.ly/immigration-center