US Health Insurance – Guide to the US Healthcare System
How Does the US Health System Work?
Healthcare in the United States is organized into a complex bureaucracy. While healthcare facilities in the rest of the world are mostly owned by governments or private sector businesses, a large proportion of hospitals and clinics in the US are owned by private non-profit organizations.
However, the United States has one of the highest healthcare costs in the world. While these costs are covered in large part by public payers such as federal agencies or state and local governments, they are also covered by private insurance and individual payments.
At the same time, unlike most developed countries, the US health system does not provide health care to its entire population. With no single nationwide system of health insurance, the United States relies primarily on employers who voluntarily provide health insurance coverage to their employees and dependents.
In addition, the government has programs that cover healthcare costs for vulnerable sections of society such as the elderly, the disabled and the poor. These programs differ from one another, and all have specific types of people who are subject to them.
Getting health insurance in the US is not an easy task. One might think that once you have money everything is easy, but in reality things are a bit more complicated. One should be very careful and take care to choose the right insurance.
Health insurance for non-citizens in the United States
The United States government does not provide health insurance for all its people, and health insurance is not mandatory for people living in the US. It is optional, but highly recommended and necessary because health services are very expensive, more so than in any country around the world.
There are two types of health insurance in the US, private and public. Most people use a combination of both. US public health insurance is: Medicare, Medicaid, and the Children’s Health Insurance Program
Medicare is a national health insurance program that dates back to 1966. It provides health insurance for US citizens over age 65, but also for younger people with end-stage renal disease, ALS and some other disabilities.
The data shows that in 2018, Medicare provided healthcare to nearly 60 million people in the US, more than 51 million of whom were over the age of 65.
The Medicare program is divided into four parts:
- Part A – Which covers hospitals, skilled nursing and hospice services.
- Part B – Covers outpatient services, including services from certain providers while inpatient, outpatient hospital charges
- Part C – There is an option known as managed Medicare, which allows patients to choose health plans with at least the same service coverage as Parts A and B, often with Part D benefits and annual spending limits that A and B lack. . . To sign in this part, one must sign in part A and B in fist.
- Part D – Covers most self-administered prescription drugs.
Affordable Care Act – Obamacare
The Patient Protection and Affordable Care Act is a federal statute signed into law by President Obama, which mandates that every citizen have health insurance or face penalties. The law provides subsidies for low-income families by taxing healthcare providers and high-income families, as it was designed to reduce health care costs while providing better health care for Americans.
The Affordable Care Act allowed parents to add children up to the age of 26 to their policies, allowing younger healthy people to pay premiums. It also allowed poor people to seek treatment for chronic illnesses instead of using emergency rooms.
US private health insurance
There are about a thousand private health insurance providers in the US, each offering different plans with different prices, which largely depend on a person’s medical history. However, while there are individual plans, which cover only one person, there are also group plans specifically targeting families.
Generally, there are three types of health insurance in the United States:
Traditional fee-for-service health insurance plans, which are typically the most expensive, are difficult to afford for those with lower-than-median incomes in the US. However, these are the best plans as they give you the most flexibility.
Health maintenance organizations (HMOs), which offer a limited choice of healthcare providers, also offer lower co-payments and cover more preventive care costs. They are evaluated and accredited by the National Committee for Quality Assurance.
Preferred Provider Organizations (PPOs) offer the same low co-payments as HMOs, but they give you more flexibility when choosing a provider, because they give you a list of providers from which you can choose.
How to choose a good US health insurance plan?
When looking for a good health insurance plan, make sure you ask the following questions:
Does the plan give you the right to visit any doctor, hospital, clinic or pharmacy you choose?
Are specialists like 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 care or nursing home care and prescription drugs?
What is the most I will have to pay out of pocket to cover the cost?
Make sure you also understand how your provider handles a dispute about a bill or service, as with some plans, you may need a third party to decide how to resolve the issue. We recommend the GeoBlue Xplorer plan for foreigners in the United States
Health insurance requirements for foreign visitors to the US
Although United States authorities have not mandated health insurance for short-term travelers to the country, as B-1/B-2 visa holders, it is highly recommended that every traveler obtain insurance prior to travel to the country.
The main reason why you should get insurance is that healthcare in the US is extremely expensive and a check-up for even a simple headache will cost you hundreds of dollars, while a broken limb will cost you thousands.
Health related events are never seen, so it is best to be prepared for them and get insurance, so you save your money in case of need.
Health insurance options for legal immigrants
Immigrants legally present in the United States are eligible to obtain private health insurance in the US. In addition, legal immigrants may also be eligible for lower monthly premiums and lower out-of-pocket expenses based on your income, as follows:
People with annual incomes at or below 400% of the federal poverty level may be eligible for premium tax credits and other savings on Marketplace insurance.
People with annual household incomes below 100% of the federal poverty level who are not otherwise eligible for Medicaid are eligible for premium tax credits and other savings on Marketplace insurance, provided they meet all other eligibility requirements.
For the most part, “eligible noncitizens” are eligible for coverage through Medicaid and the Children’s Health Insurance Program (CHIP), provided they meet the income and residency requirements of the state where they are based.
“Qualified non-citizens” are defined as:
Legal permanent residents
Asylees, refugees, victimized non-citizens and spouses, children or parents, victims of trafficking and persons with pending applications for visas for his or her spouse, child, sibling or parent or victim of trafficking
Those who were paroled in the US for at least one year
Conditional entry allowed before 1980
Allowed to withhold deportation and to members of federally recognized Indian tribes or American Indians born in Canada.
However, most of them have to wait 5 years in the US to get Medicaid and CHIP coverage in the US after they qualify. Refugees and asylum seekers are exempt from the waiting period.
Additionally, states have the option to eliminate the 5-year waiting period for children and pregnant women to be covered by Medicare and CHIP.
You can get a free US health insurance quote here. While you are free to choose the best plan for you, we recommend GeoBlue Xplorer.
Health insurance options for illegal immigrants
Illegal immigrants in the US can only obtain health coverage from private providers, as US government-funded health insurance does not cover them.
Community centers can provide medical care to undocumented immigrants in the US, known as safety net providers, if the healthcare seeker can share the fee for the medical care.