Getting sick in the USA is not a cheap pleasure. The health care system in the United States is the most expensive in the world.
For each inhabitant of the country, the government spends about $15,000 a year, and the annual turnover of the amount to pay for medical programs costs the state $3 trillion.
The state pays health insurance only for poor citizens, the disabled, the elderly, and other needy.
In this material, we will consider the health insurance system in the United States: what is its cost, what are the ways to apply for it.
What Is Health Insurance and Who Needs It?
Health insurance in the United States is a contract with an insurance company, under which you pay a certain amount to the insurance company every month, and it, in turn, takes on part of the medical expenses in case of your illness.
Medicine in America is very expensive, so insurance cannot be neglected. Another strong argument in favor of running away and entering into a contract is that according to the Affordable Care Act, health insurance is mandatory for all legal residents of the country. For its absence, even a fine is provided (on average, $350-400).
For reference: US citizens, green card holders, refugees, persons who have received political or humanitarian asylum, as well as holders of non-immigrant visas (including work and student visas) are considered legal residents.
How to Get Health Insurance?
Depending on your life circumstances and income level, health insurance in the USA you can:
Purchase it independently;
Part of the costs is borne by the state;
The state pays the insurance in full;
The employer pays insurance, fully or partially.
What Are the Types of Health Insurance?
HMO – health maintenance organizations. The cost of health insurance in the United States of this type is the lowest. All because of the very limited number of doctors and medical institutions that you can visit.
You will need to be treated in the same network and 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 wider. You can be treated both in the institutions of the network and outside it (but the conditions in the network will be much more favorable).
In addition, you do not need to take a referral to specialists; they will accept you with and without insurance. Buying health insurance in the US of this type will cost much more than all the others.
There are also other, less popular types of insurance. Point-of-service (POS) means that by using the services of doctors and hospitals from the network, you will pay less. An Exclusive Provider Organization (EPO) is the same as an HMO, only without the primary doctor and mandatory referrals to specialists.
Insurance coverage can be obtained in one of the following ways:
An employer-sponsored health insurance program.
A health insurance program paid for by the spouse’s employer.
A health insurance plan paid for by the parent’s employer, provided the insured is under 26 years of age.
Paid insurance program. Individual health insurance may cover spouse and children. This program is also available through the Affordable Care Marketplace (ACA).
Renewal of COBRA insurance. COBRA is a law that gives people the right to renew coverage under an employer’s insurance program after a job loss, death of a spouse, divorce, or loss of dependency coverage. COBRA lasts up to 18 months.
Public health programs such as Medicaid or Medicare, provided the subject is eligible if they fall into a certain category. Medicaid is a state and federal insurance program for low-income individuals and families. Medicare is a program for people aged 65 and over and for young people with certain disabilities. Moreover, the Children’s Health Insurance Program (CHIP) covers children from low-income families.
Short-term health insurance program. Most Americans now have access to these kinds of programs. They have limited benefits, but a low insurance premium. The duration of such a plan is one year (participants can request an extension twice).
Association health insurance program. Small companies and individual entrepreneurs, when combined, can purchase general health insurance. This program is not expensive and offers some benefits.
From 2016, employers with at least 50 employees must provide medical benefits to 95 percent of their full-time employees (those who work more than 30 hours a week) or pay a fine. Coverage is for employees and their dependents, but not spouses.
What Are Insurance Plans and How Much Does it Cost?
Depending on the percentage of coverage of medical expenses, there are five basic insurance plans:
Platinum – about 90% is paid by the insurance company;
Gold – the insurance company pays about 80%;
Silver – the insurance company pays about 70%;
Bronze – the insurance company pays about 60%;
The minimum insurance – designed for emergencies only and is available only to persons under 30 years of age or to those who can confirm that they are in a difficult financial situation.
It is also worth remembering that insurance plans differ in many important points. There are:
Co-pay (a fixed amount that you pay for each medical service, and the rest is covered by the insurance company);
Deductible (the amount that you need to spend before the insurance coverage);
Co-insurance (you pay a certain percentage of the cost, the rest is the insurance company);
Out-of-pocket maximum (the maximum amount, after spending which during the year you begin to receive 100% coverage from the insurance company).
Dental and eye insurance are traditionally purchased separately. Dental services include only children’s medical insurance in the United States.
The cost of insurance for the most part will depend on your income, region, and chosen insurance plan. For example, Kaiser Permanente HMO insurance in 2016 for a family of one will cost from $160 (minimum insurance plan) to $315 (platinum plan) per month. To calculate the cost directly for you, use the special Shop and Compare Tool calculator on the official Covered California website.