Health Insurance: Basics of Medical Care in the USA

Finding the right health insurance is the key to saving one's life. Check Colonel Penny's tips to find the best healthcare policy.

Health insurance is a type of insurance that covers the costs of medical and surgical expenses of the person. Depending on the type of coverage, the insured pays out of his own pocket. Then the fees are reimbursed, or the insurer makes payments directly to the provider. The United States of America, in the area of medicine and pharmacology, occupies a leading position in the world. Before you take out insurance here, it is essential to understand the system's features.

Health Insurance

What is Health Insurance?

In the US, there are several types of insurance. Insurances are divided into Business one (corporate) - issued for employees of the employing company and individual (with different conditions for persons 65+ and everyone else). Medicare is a public health insurance program in the United States for people aged 65 and over. This program is made for residents under 65 who have a disability or a severe illness, such as kidney failure. It does not cover all medical care but helps pay for a lot of services.

Medicaid is a federal program. It helps pay for health care for low-income US citizens. This program provides benefits not usually covered by Medicare, including home care services. Health insurance is usually included in employer benefit packages in countries without universal health care, such as the United States.

Why is Health Insurance Important?

The health care system in the US is an insurance system. Of course, you can get to a doctor or a hospital (hospital) in the absence of insurance. It's just a matter of the price of the issue. Having health insurance is essential to not go broke on medical bills. Pros and cons of health insurance:

Pros Cons
Security. Very expensive).

Savings on treatment costs, especially in serious cases (for example, hospitalization and surgery can result in 30-50 thousand dollars).

The coverage is not complete, you will always have to pay extra for most procedures.

There are tax incentives.

The terms and costs of health insurance vary significantly from state to state. In addition, in some states, health insurance is mandatory, and you can be fined if you don't have it.

 costs of health insurance

What are the Types of Health Insurance?

Among the main types of insurance:

  • HMO — health maintenance organizations. The cost of health insurance in the United States of this type is the lowest. It is due to the few doctors and medical institutions you can visit. You will have a primary physician who will make referrals to other specialists. Coverage does not include out-of-network services, except for emergency medical care.
  • PPO - preferred provider organizations. The network of institutions is still present, but it is much broader. You can be treated both in the network's institutions and outside it (but the conditions on the web will be much more favorable). Also, you do not need to make a referral to specialists. They will accept you with and without insurance. Buying this type of health insurance in the United States will cost much more than others.

There are also other, less popular types of insurance. Point-of-service (POS) means that you will pay less by using the services of doctors and hospitals from the network. An Exclusive Provider Organization (EPO) is the same as an HMO, only without the primary doctor and mandatory referrals to specialists.


What Payments are Covered?

In particular, the following payments are covered by the basic health insurance coverage of the state health insurance funds:

  • Outpatient medical care.
  • Basic dental care.
  • Basic health screening.
  • Stay and treatment in the hospital.
  • Necessary medical measures for rehabilitation.
  • Assistance in connection with pregnancy and childbirth.

These are the primary benefits you can expect, but they vary from state to state. To learn more about insurance in the US, check out the video from Ensemble Health Insurance A specialist can tell you how insurance works and the main types in detail.

How to Get Health Insurance?

Here are the primary ways to get health insurance:

  • The underprivileged segments of the population, the disabled, and the unemployed are fully or partially paid for by the state.
  • If the family income is low and the employer does not pay for insurance, you need to make it yourself. Suppose the family falls under the requirements of the state health insurance program. In that case, part of the insurance premiums will be compensated by the state.
  • When applying for a job, the person needs to determine if the employer will pay for the person's health insurance, in part or whole. It is a widespread practice in the US. Through the employer, a person can get profitable insurance not only for himself but also for his family.
  • Entrepreneurs and those for 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. The dental insurance and vision insurance are issued and paid separately.

 dental insurance

How Much Does Health Insurance Cost in the US?

The cost of healthcare in the US varies from $200 with the most minimal package of services. The average price of employer-sponsored insurance is $500. It is possible to purchase a policy independently, but not all applicants can afford it. A candidate goes through very tough insurance underwriting. Even a long-forgotten, cured ailment revealed during the examination process can increase the cost of an insurance policy. In short, the level of medicine in the United States is as high as the cost of providing medical services.