How does the American healthcare system work?
Health care in the United States is organized into a complex bureaucracy. While health care facilities in the rest of the world are mostly owned by governments or private companies, a large percentage of hospitals and clinics in the United States are owned by private nonprofit organizations.
However, the United States is the country with the highest health expenditure in the world. While these expenses are largely covered by public agencies such as federal agencies or state and local governments, they may also be covered by private insurance and individual payments.
At the same time, unlike most developed countries, the US healthcare system does not provide health care to all of its residents. Since there is no single national health insurance system, the United States relies primarily on employers who voluntarily provide health insurance to their employees and dependents.
In addition, the government has programs that tend to cover the health expenses of vulnerable groups in society, such as the elderly, the disabled and the poor. These programs are different from each other and they all have a certain type of person they are targeting.
Obtaining health insurance in the United States is not easy. You might think that once you have the money, everything is easy, but in reality, things are a bit more complicated. You have to be very careful and take care to choose the right insurance.
Health insurance in the United States for non-citizens
The United States government does not provide health insurance to all of its residents, and health insurance is not mandatory for those living in the United States. It is optional but strongly recommended and necessary because health services are very expensive, more than in any other country in the world.
There are two types of health insurance in the United States, private and public. Most people use a combination of the two. The American public health insurances are: Medicare, Medicaid and the Children’s Health Insurance Program.
The United States has the most expensive health care in the world. Therefore, it is highly recommended to have appropriate health insurance.
Medicare is a national health insurance program dating back to 1966. It provides health insurance to US citizens over the age of 65, but also to younger people with end-stage kidney disease, amyotrophic lateral sclerosis, and certain other disabilities.
Data shows that in 2018, Medicare provided health care to nearly 60 million people in the United States, of whom more than 51 million were over the age of 65.
Medicare is divided into four parts:
- Part A – which includes hospitals, skilled nursing and aged care services.
- Part B: Covers outpatient services, including certain provider services during a hospital stay, and outpatient hospital charges
- Part C – An alternative called Managed Medicare that allows patients to choose health plans that have at least the same service coverage as Parts A and B, often with Part D benefits, and annual out-of-pocket limits for deficiencies A and B. To connect to this section, you must first connect to sections A and section B.
- Part D – covers most prescription drugs you give yourself.
Medicaid is a federal and state program that helps people with limited income and resources cover the cost of health care, and it covers benefits that are not normally covered by Medicare, such as nursing and housekeeping services. personal care.
It is the largest source of funding for medical and health services for low-income people in the United States. Data shows that the United States provided health insurance to 71 million low-income or disabled people, or 23% of the total US population.
Children’s Health Insurance Program
Formerly known as the Children’s Health Insurance Program (SCHIP), this program provides health insurance coverage to children from low-income families who are not low enough to qualify for Medicaid.
The Affordable Care Act – Obama care
The Patient Protection and Affordable Care Act is a federal law signed by President Obama that makes it mandatory for every citizen to have health insurance or face penalties. The law supports low-income families by taxing health care providers and high-income families because it is designed to reduce health care costs while providing better health care for Americans.
The Affordable Care Act allowed parents to add children up to age 26 to their policies in a bid to entice younger, healthy people to pay the premiums. It also enabled the poor to receive treatment for chronic illnesses instead of emergency rooms.
Private health insurance in the United States
There are about a thousand private health insurance providers in the United States, each offering different plans at different rates based largely on a person’s medical history. However, while there are individual plans that only cover one person, there are also group plans that cater specifically to families.
There are generally three types of health insurance in the United States:
- In the United States, traditional fee-for-service health insurance plans, which tend to be the most expensive, are difficult for those with below-average incomes to purchase. However, these are the best plans because they give you the most flexibility.
- Health Maintenance Organizations (HMOs), which offer limited choices to health care providers, but also offer lower discounts and cover the cost of more preventative care. It is evaluated and approved by the National Quality Assurance Committee.
- Preferred Provider Organizations (PPOs), which, like HMOs, offer lower discounts but give you more flexibility in choosing a provider by giving you a list of providers to choose from.
How to Choose a Good US Health Insurance Plan?
When looking for a good health insurance plan, be sure to ask questions such as:
- Does this plan give you the right to visit a doctor, hospital, clinic or pharmacy of your choice?
- Does it include specialists such as ophthalmologists and dentists?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physiotherapy?
- Does the plan include home care or palliative care and medications that a doctor can prescribe?
- What are the discounts? Are there any discounts?
- What is the maximum amount you have to pay for your expenses?
Also, be sure to understand how your provider will handle a billing or service dispute, as some plans may require a third party to resolve the issue. For foreigners in the United States, we recommend the GeoBlue Xplorer plan.
Health Insurance Requirements for Foreign Visitors to the United States
Although U.S. authorities have not made health insurance mandatory for short-term travelers to the country, as B-1/B-2 visa holders, we strongly recommend that every traveler purchase insurance before traveling to the country.
The main reason you should buy insurance is that health care in the United States is very expensive, and even a mild headache will cost you hundreds of dollars, while a broken limb will cost you thousands.
Medical events are never predictable, so it’s best to prepare for them and get insurance so you can save if needed.
Health Insurance Options for Legal Immigrants
Immigrants who are legally in the United States are eligible for private health insurance in the United States. Additionally, legal immigrants may also qualify for lower monthly premiums and disbursements based on your income, as follows:
- Individuals with an annual income of 400% or less of the FPL are eligible for premium tax credits and other Marketplace insurance savings.
- While those whose annual household income is less than 100% of the federal poverty level and who are not eligible for Medicaid are eligible for tax credits and other Marketplace insurance savings because they meet all other eligibility requirements.
Most of the time, “qualified citizens” are eligible for Medicaid and Children’s Health Insurance (CHIP) coverage because they meet the income and residency rules of their state of residence.
Eligible non-citizens include:
- Permanent residence permit
- Asylum seekers, refugees, foreigners, abused spouses, children, parents or victims of human trafficking and their spouses, children, siblings, parents or persons with a pending visa application for a victim of trafficking human being
- Cuban/Haitian participants,
- Persons released in the United States for at least one year
- Conditional registration was granted before 1980
- Persons with a suspension of removal who are members of a federally recognized Indian tribe or an Indian born in Canada.
However, most will have to wait 5 years in the US to get US Medicaid and CHIP coverage after qualifying. Refugees and asylum seekers are exempt from the waiting period.
Additionally, states have the option to waive the 5-year waiting period for children and pregnant women to be eligible for Medicare and CHIP.
You can get a free US health insurance quote here. Although you can choose the plan that suits you best, we recommend GeoBlue Xplorer.
Health Insurance Options for Illegal Immigrants
Illegal immigrants to the United States can only obtain health insurance from private providers because they are not covered by US government-sponsored health insurance.
Community centers can provide Medicare to undocumented immigrants to the United States, called safety net providers, as long as the Medicare applicant can co-fund the Medicare service.