Overview of Health Plans in the Unites States
How health insurance works in the United States is one of the most exciting questions for those planning a move or long-term residence in the United States.
It is believed that health services in the United States are among the most expensive in the world. Even for a simple test or an elementary procedure, the patient can be charged a bill of several thousand dollars. In order to protect residents of the country from such expenses, the health insurance system is created.
According to the Kaiser Family Foundation’s Center for the Study of American Health:
- 49% of Americans have employer insurance;
- 20% – Medicaid, the state insurance program for the poor;
- 14% – Medicare, the state program for retirees;
- 6% – policies established by the Obama reform in 2010;
- 1% – Pentagon policies;
- 9% of Americans do not have health insurance.
We analyze what types of insurance exist in the USA and whether it is possible to get insurance for free.
How does the insurance system work in general?
It is assumed that legal residents of the United States pay a certain amount (usually $ 250-400) monthly to the insurance company, which in turn covers part of its costs in case of illness. True, some insurance plans have a certain limit – the maximum amount that a patient will have to pay for medical bills within one year. This limit is usually between $ 1,000 and $ 5,000.
For example, you underwent an urgent operation worth $10,000. You you pay $ 2,000, and the rest is covered by the insurance company. In fact, US health insurance only covers up to 80% of your medical expenses.
Types of health insurance
- HMO (health maintenance organizations). This option is considered one of the most economical. After all, it offers a certain number of doctors and clinics that a patient can visit. It is clear that the insurance company will not cover your expenses at clinics not included in its list, unless it is related to emergency care.
- PPO (preferred provider organizations). Here you will also receive a list of certain clinics, but it will already be much broader. But you can get your covered treatment at other clinics, but your costs will go up. In addition, you can make an appointment with any specialist yourself, bypassing the therapist. But the cost of this insurance type can be 1.5-2 times higher than that of an HMO.
- POS (Point-of-Service) Similar to an HMO, but less popular, but a doctor can send you for treatment to a clinic not mentioned in the contract if necessary. And then your personal expenses for the services of specialists can increase.
- EPO (Exclusive Provider Organization). Another double of the HMO, however, without a primary therapist and without a mandatory referral to other specialists.
Important! Remember that each type of insurance has its own tariff plan: platinum, gold, silver, bronze and minimum coverage. The range of services that insurance can cover its cost also depends on the tariff plan. By the way, you need to have a separate insurance to go to the dentist or ophthalmologist.
How and where to buy health insurance in the USA?
Insurance in the United States is purchased during a certain period of the year – from November 15 to February 15. An exception is a change in the family composition, relocation, and similar reasons. In this case, you can buy health insurance outside this period.
Insurances are purchased on the dedicated Health Insurance MarketPlace. It is collected all the proposals of the companies, taking into account the income of each client. After all, the cost and package of services for people with low and high incomes will differ.
By the way, part of the US states denied the federal website Health Insurance MarketPlace. Because of this, they were allowed to create their own platforms for placing offers of insurance companies. You can find a website for buying insurance in the desired state on the ObamaCare portal. Information is updated monthly.
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