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Health Insurance in the USA

Health Insurance in the USA

In this article, we will consider the health insurance system in the USA: what is the cost of insurance and what are the ways to get it.

To begin with, it should be noted that the healthcare system in the United States is the most expensive in the world. For each resident of the country, government spending is approximately $15,000 per year, and the annual turnover of the amount for paying for medical programs costs the state $3 trillion. The state pays medical insurance only to poor citizens, people with disabilities, the elderly and others in need.

Major government support programs

Medicare is a US government health insurance program for people 65 years of age or older. Also, this program is designed for residents under 65 years of age who have a disability or especially serious diseases, such as kidney failure. The program does not cover all medical care but helps pay for most medical services.

Medicaid is a federal program that helps pay for low-income US citizens. This program includes benefits that are not usually included in Medicare, including home care services.

Children’s Health Insurance Program (CHIP). This program provides assistance to families with children. The program targets uninsured children in low-income families where incomes are modest but higher than Medicaid requirements.

Key US Health Insurance Questions

Are US residents required to have health insurance?

Yes, every American is required to have health insurance. Otherwise, he or she will have to pay all the costs of treatment, and medical services in the USA are very expensive, although in special cases it may be more profitable to consult a doctor directly.

Also, a person without insurance will have to pay a fine of $1,000 for evading compulsory insurance. Rarely ill people prefer to pay a fine, as it turns out to be more profitable for them than buying insurance.

How can I get health insurance?

Here are the main ways to get health insurance:

  • The needy segments of the population, the disabled and the unemployed are fully or partially covered by the state;
  • If the family income is low and the employer does not pay for insurance, then you need to arrange it yourself. If the family falls under the requirements of the state health insurance program, then part of the insurance premiums will be compensated by the state;
  • When applying for a job, you need to find out if the employer will pay for your health insurance, in part or in full. This is a very common practice in the USA. Through the employer, you can take out beneficial insurance not only for yourself but also for your family;
  • Entrepreneurs and those to whom the employer does not pay insurance are required to arrange it at their own expense;
  • Persons under 26 can take out health insurance through their parents.

Dental medical and vision insurance is issued and paid separately.

Is medical insurance guarantees free treatment?

Unfortunately, it does not. Health insurance in the United States in most cases reimburses only part of the cost, however, given the cost of services in the United States, it will often be more profitable than paying for treatment completely out of pocket. The amount that you have to pay yourself depends on the insurance plan and the service itself. For example, the annual examination of a therapist is 100% covered by insurance.

How does the insurance payment system work?

When contacting the clinic, it is necessary to take an insurance policy with you. Based on the format of your medical insurance, you will need to pay a certain amount for medical services.

What are the conditions of health insurance?

  • Deductible – independent medical expenses, before the insurance coverage starts;
  • Co-pay is a fixed amount that must be paid independently for any medical service, the remaining part of the amount is covered by the insurance company;
  • Co-insurance – a certain percentage is paid independently, the rest of the costs are paid by the insurance company;
  • Out-of-pocket maximum – a certain maximum cost per year, which is fully compensated by the insurance organization.

Where to get insurance?

The sale of insurance policies is strictly controlled by the state. Therefore, at the moment, the only platform for the purchase of a health insurance is www.healthcare.gov. Here you can compare the formats and types of insurance and choose the most profitable option. The law also provides for the period for purchasing medical insurance – from November 15 to February 15. But if a person’s social situation has changed, for example, he/she got a different job / he/she has a wife / husband / children, then insurance is issued at any time of the year.

What are the types and plans of insurance?

Two main types of health insurance policies:

  • Health maintenance organizations (HMO) is a budget insurance option that includes a specific network of medical clinics. This insurance policy does not apply to private doctors;
  • Preferred provider organizations (PPO) is a more expensive insurance option. With it, the choice of a doctor and clinic is freer than with HMO. If an insurance company has a contract with the selected clinic, then you will have to pay a little; if there is no agreement, the amount of the independent part of the payment will be already higher. But the choice of clinics for this type of insurance is much greater than that of HMO.

After choosing the type of insurance policy, you need to choose a plan that defines independent payments and compensation of the insurance company.

Basic insurance plans:

  • Platinum – an insurance company pays 90% of the cost of medical services, respectively, the monthly fees for this policy are quite high;
  • Gold – compensation from an insurance company – 80% of expenses;
  • Silver – 70% of expenses are paid by the insurance company;
  • Bronze – compensation is 60%. This plan is in great demand, as it is relatively inexpensive;
  • Minimal – the most budgetary plan that only compensates for basic medical services. Only persons under 30 years of age and those who for any reason have lost current insurance can apply for it.

How much does health insurance cost?

The cost of insurance depends on the type and tariff plan chosen. The average cost of a health insurance for an adult is $250 – $400 per month. For a family, monthly insurance premiums will range from $1,000.