Health insurance in the United States is an integral part of the life of every American. At the same time, the American healthcare system is very complicated. For an outside observer, it may seem unnecessarily complex in its structure. The essence of the insurance system is that every American pays a monthly amount to the insurance company. In health problems, the insurance company would bear the costs and pay medical bills. It is better to pay relatively small amounts each month to the insurance company so that you do not get big money if you need surgery or other complex medical interventions one day.
How to Get Health Insurance in the USA
Getting health insurance can take place in several ways. It directly depends on your wealth and the availability of an employer. The state will pay insurance for people in poverty, as well as for the disabled. People with low incomes, for whom the employer does not pay insurance, must purchase it independently. In this case, the state will bear the costs only partially. For these categories of people, the Affordable Care Act was developed.
If the employer does not pay for your insurance and your income is considered medium or high, you are required to buy an insurance policy on your own without the participation of the state. If the employer pays, then you do not incur any personal expenses. People over 65 receive Medicare, which is paid for by the state. There is a wonderful video for those who want to dive deeper into the system's intricacies. Check this out to find out an easy explanation of the insurance system: https://youtu.be/DublqkOSBBA.
Types of Insurance
The Basic Medical Insurance reimburses the costs associated with visits to the general practitioner and medical specialists, surgical interventions, anesthesia, and all kinds of consultations — and covers three-quarters of what a person who is not too sick spends on doctors and medical care.
Those who do not rule out being hospitalized someday should take out Basic Medical Hospital Insurance. It covers two months of continuous hospital stay and 80 percent of all hospital bills.
The third type of insurance is Major Medical Insurance. You can get sick for a long time and expect, without a doubt, that all the treatment costs will be compensated for you. Here, however, there are also options. By paying more, you can make a contract so that general health insurance will cover up to 100 percent of your expenses. Moreover, it is worth knowing that dental insurance and eye insurance are sold separately and are not included in the primary insurance.
Medicaid is the government's insurance coverage for individuals and families with limited incomes and other material benefits. Each state independently sets the threshold for this insurance and the procedure for calculating income, money in bank accounts, and real estate. Eligibility for Medicaid may depend on pregnancy, disability, and residence status in the United States.
Differences in Insurance Plans
Consider the main differences between insurance plans and decipher the terms that you need to know when buying:
- Type of insurance. As a rule, HMOs and PPOs are the most popular.
- Insurance network. A group of medical hospitals, pharmacies, and private doctors has a contract with an insurance company. You may come to the hospital, and they do not accept your policy because the clinic is not a part of a network.
- Premium. It means the amount of the insurance premium that you will pay to the insurance company every month.
- Non-recoverable and non-reimbursable expenses are one of the most critical points. These are expenses that are not covered by the insurance plan and that you will have to pay for yourself.
- Co-payment is a fixed amount that you pay for a visit to a doctor or any other medical service. The rest of the cost is covered by your insurance company.
- A deductible is an amount you must pay for health screening before insurance coverage takes effect.
- The out-of-pocket maximum is the maximum amount you can spend on medical services by paying for them out of your pocket. The insurance company will cover 100% of your medical expenses when this amount is reached.
Coverage for services and drugs is part of a plan too. Each insurance has an extensive list of services and drugs that it covers. The Summary of Benefits is a complete list of all the covered services you get when you purchase an insurance policy. Naturally, this information is available until the moment of purchase on the insurance company's website.
Choosing Between PPO and HMO Types
If you live stably in one city and move around the country a little, if you don't mind that, you will need to be treated where the insurance company indicates if you have your family therapist. If you don't watch that, the company provides it to you, and it is better to go for the HMO variant. In this case, you will have low Deductible and Premium, and you can save a lot. It is worth remembering that you cannot just appear without an appointment in this case. You will have to sign up for all services and doctor visits in advance.
If you often move around the country, want to choose your doctors (for example, according to reviews on the Internet), the ability to come to any hospital without an appointment, choose PPO. At the same time, Deductible and Premium will be significantly higher than in the first case.