Health Insurance In The USA

Since 2014, health insurance in the United States has been mandatory. The medical sector itself is being gradually reformed when Barack Obama became the president of the USA, who promised people changes and tried hard to implement them.

US medical services are expensive. An ambulance call costs starting from $50. Medical examination — from $ 30 in poor states. It’s just about to be examined. Hospitals do not save on equipment, so it is expensive to get medical assistance. The qualified specialists are more expensive.

Medical expenses are the first cause of bankruptcy of individuals in the United States. The deplorable situation to expensive ruthless medicine results in more than 60% of bankrupts. Moreover, three quarters of these bankrupts were insured. Therefore, insurance, even if it is not the most profitable, is still often better than paying the bills yourself.

Insurance must be released for all family members, including children. Most states have insurance programs for children that are paid for by the state and charitable foundations. In order for a child to receive such insurance, he must be a resident of the United States under the age of 18 and meet the terms of the insurance company.

Children’s insurance usually includes the services of speech therapists, optometrists, dentists.

There are also free insurance programs for the elderly and poor people. These are the famous Medicare and Medicaid. The first one has everything connected to the age. The second one can be issued if your income is very low. Pregnant women, foster children under the age of 26 and large families can count on assistance in paying for insurance.

What is health insurance, who needs it and how to purchase it?

Medical insurance in the USA is a contract with an insurance company under which you pay a certain amount to the insurance company monthly, and it, in turn, takes over part of the medical expenses in case of your disease.

Medicine in America is very expensive, so you can not neglect insurance, it allows you to save a lot in case of disease. Also, most insurance includes scheduled visits to the doctor.

Insurance is mandatory for citizens and holders of US green cards. Its absence imposes a fine in the rate of $400-$700 or 2.5% of annual income.

There are various insurance plans:

  1. Premium – a monthly contribution, transferred by the insured person to the insurer’s account.
  2. Co-payment – a fixed amount that the insured person pays independently for medical procedures or for the purchase of medicines. To clarify which Co-pay you will have to pay for a specific service, you can contact the insurance company in advance. The necessary balance is paid by the insurer.
  3. Deductible – the amount prescribed in the contract that you must spend on medical services out of your pocket under the Co-payment scheme so that the insurance starts working on more favorable terms of Co-insurance.
  4. Co-insurance. The percentage ratio that reflects how much the insurance company pays for treatment and medicines, and how much you yourself. For example, 80/20 means that 80% of the costs are covered by insurance, and you pay 20%.
  5. Out-of-pocket limit. The maximum amount that you can spend on out-of-pocket treatment for a year, you can count on further 100% coverage of your medical expenses by the insurer.

Insurance plans are also divided into groups:

  • Catastrophic and Bronze. They are characterized by relatively low monthly contributions, but at the same time they have a higher deductible and far from the most profitable percentage of co-insurance (no more than 60%). The option is chosen by those who rarely get sick. Although in this case, you need to understand that when contacting a doctor, you will have to pay a decent amount until deductible is reached.
  • Medium/Silver. The most popular plans among Americans. Despite the higher monthly premiums, deductible and out-of-pocket are significantly lower, and payments from the insurer on co-insurance reach 70%.
  • High/Gold and Platinum. If your health is weak or if you plan to undergo a full examination by specialists of different profiles during the year, a plan with the highest monthly contributions, but with the lowest deductible and out-of-pocket and the most favorable percentage on co-insurance (from 80 to 90%) will suit you. Such plans are ideal for people with chronic diseases.

The policy is presented at the reception at each visit to the clinic. All information about insurance conditions is taken from it. After the doctor’s appointment, you are informed whether you need to pay for something or not.

In addition to insurance plans, there are also different types of policies:

  • EPO. The policy makes it possible to be treated exclusively in a specific clinic (network of clinics). When applying for medical care to private practice specialists, the insurance ceases to be valid.
  • HMO. The insurance obliges the insured person to choose a personal therapist who will prescribe all referrals to specialists of different profiles. You will also be limited in choosing a clinic. Usually, such policies have fairly low monthly premiums.
  • PPO. The policy allows you to independently choose which clinic and which doctor to undergo treatment. But it is better to give preference to hospitals and specialists who have signed a cooperation agreement with your insurer (in-network). In this case, the treatment will be inexpensive. Otherwise (out-of-network) insurance does not cover the largest part of the costs. To visit a doctor, you do not need to get a referral from a therapist. The network of clinics for such policies is usually wider than that of EPO and HMO. But the policy itself is more expensive.

Each insurance has an appendix with a list of procedures, services and medicines, the cost of which it covers.

Basic medical insurance rarely covers the services of a dentist and an ophthalmologist. Therefore, these policies are issued separately. Although recently insurance companies are increasingly providing the opportunity to add these options to the basic plan for an extra fee.

How do I get health insurance in the USA?

There are several ways to get health insurance:

  • self-purchase;
  • get it from an employer;
  • issue it using subsidies from the state.

Self-purchase of a medical policy

An online resource has been created in the USA – Health Insurance MarketPlace. Offers from all insurers are collected here. Some states also have their own sites for selling policies.

The States have a specific period for buying insurance. It starts on November 15 and ends on February 15. You can purchase a policy at another time if you have just moved or your family has been replenished with a new member. On the other hand, this has its advantages. During the year, insurers cannot increase the cost of the policy or unilaterally increase the amount of monthly premiums.

Insurance from the employer

Getting insurance from an employer is the best option. This is beneficial not only to the employee, but also to the company. Employers use special group plans and receive tax deductions for providing employees with policies.

Insurance from the employer most often covers the treatment of only the employee himself. But in some organizations, insurance may also apply to family members of the employee.

State insurance

Some categories of citizens with the confirmation they have a low income, can receive a free policy or a subsidy for its purchase. Among the most well–known programs for providing free or affordable insurance are the All Kids program (for children) and Medicare / Medicaid (for pensioners, the disabled and the poor).