The U.S. health care system has long been commercialized. It is important to understand that there is almost no free help here. Health insurance in the United States is very expensive. Benefits are left only to pensioners and the poor.

How does the insurance system work in the United States?

Insurance is an important part of American life. Citizens are accustomed to insuring everything: health, property, houses, cars, life. Medicine is no exception. It is necessary to understand how much health insurance costs in the United States from the basics of the system.

Medical services in America cost a lot of money. If you get into an accident or become seriously ill, the amount of treatment will be more than $100,000.

In order not to go bankpt, it is easier to buy a policy. According to it, the insurance company receives monthly premiums. In return, in the event of an insured event, she undertakes to pay the bills.

Formally, everyone has equal rights to receive medical care. Only those who come to the hospital without health insurance are waiting in line. They also most often refuse important procedures. This is one of the reasons that causes tension in society. The problem was especially evident in 2020 against the backdrop of the pandemic.

What is Health Insurance?

The system is that the insurance company collects the fund. From it, in the event of an insured event, payments are made to the client. Coverage is carried out under the terms of the contract. If any medical manipulation is not included in the list, then it is paid from the patient's pocket.

Coverage of costs is also agreed with the contract. If the policy is concluded in the amount of $15,000, and $20,000 is spent, then the difference is paid by the sick person.

U.S. Health Insurance Options

The service market is clearly divided. The price of health insurance in the United States per year depends on the package chosen. Rates vary by state. The main parameters can be distinguished:

• EPO is an exclusive appeal to only one network of medical institutions.
• HMO – the patient can apply to any clinic connected to this program.
• PPO – it is possible to use the services of doctors outside the network without a referral.
• POS is a point system. To get a consultation with a specialist, you need a referral from a therapist. There are discounts for on-net service. But the patient has the option to go elsewhere.

Most offers from insurance companies fall into one of these types.

The law prohibits insurers from changing the price during the year. So, for example, the purchase for 2020 was possible only from November 01, 2019 to February 15, 2020.

Exceptions: relocation, loss of policy, changes in family composition (death, birth of a child, divorce, etc.). In addition, special situations (e.g., obtaining a green card, being released from prison, etc.)

Terms and Features of Insurance in the USA

There is no compulsory health insurance in America and there are no plans to do so. The American pays for his own treatment. The policy includes only a certain list of services.

According to open sources, half of the bankruptcies of individuals are related to the payment of medical treatment.

The main features of the American health care system are:

• Most medications are available only by prescription. It is impossible to self-medicate here. A pharmacy will not sell even the most ordinary ointment without a doctor's prescription. The insurance policy usually covers the cost of the drugs.
• Insurance companies are not interested in concluding a contract with seriously ill people.
• More than half of the contracts are for companies that cooperate with specific employers. Therefore, the competitiveness of the market is often questioned.
• Self-referral is expensive. For example, an ambulance will cost about $800, and a doctor's visit will cost $15 or more, depending on your qualifications.
• The high cost of health insurance in the U.S. forces Americans to get treatment in cheaper countries. For example, they go to Mexico, Canada or England.
     

Do I need insurance in the USA?

You can live without insurance if you don't end up in the hospital. In addition, it is not even included in the mandatory package of documents for obtaining a visa. The problem will only arise if the person gets sick. The services are paid for independently, and the doctor will treat only as long as the patient has money.

Of course, no one will refuse emergency assistance. The patient will be brought out of clinical death, diagnosed, stabilized, and then discharged.

Charity is developed in America. But you should not constantly count on the help of the community or the church. It is easier to buy a policy.

The Affordable Care Act, passed by Barack Obama in 2010, called for all citizens to have insurance. Absences are subject to a fine. Trump tried to overturn it, but the Senate rejected the proposal. The reform is being curtailed gradually.

Who needs health insurance?

Even children are insured. They may also be diagnosed with a disease that will require expensive treatment. Most often, a package is bought for the whole family at once. The price of health insurance in the US depends on many factors. For example, age, health status, whether the person smokes, etc.

How do I get health insurance?

The receipt depends on the place of work and the level of earnings. The disabled, pensioners and the poor are entitled to public assistance. The working-age population is left to its own devices.

The Affordable Care Act states that people with low incomes can count on compensation from the budget

Types of Health Insurance for U.S. Citizens

Health insurance in the United States has different classifications. Moreover, it primarily depends on age.

Insurance for children under 18 years of age

There are usually benefits for minors. Some states provide free programs for children. The cost depends on the composition of the family, the number of members, and the total income. If the general family rate does not include a dentist, then there is a chance that a visit to him can be obtained through the children's program.

Family Insurance

Reviews of health insurance in the United States agree on one thing. The average payout per person per month is between $150 and $500. Even at least 1 family of 4 people will spend $1,000 a month just to pay insurers.

There are special family rates. With them, you can get more services for less money. If even in this case it turns out to be expensive, then the employer comes to the rescue.

Employer Insurance

Most U.S. organizations work with major insurers. They are provided with special group rates. Employees receive favorable health insurance, and the employer receives tax deductions. Some companies are ready to insure not only employees, but also their family members.

An employee can be connected to a collective tariff. Its price depends on each employee. This is how the organization develops a dislike for the disabled and the elderly. Due to their illnesses, the amount to be paid increases for healthy colleagues.

Dental & Vision Insurance

The main contract most often does not include the treatment of an ophthalmologist and a dentist. Such services are paid separately. Insurers have additional packages for reimbursement of expenses. This is an expensive treatment.

It is often the case that migrants return to their homeland for a short time to have their teeth treated or their vision corrected.

Recently, it has become more and more common to include visits to the dentist and ophthalmologist in the basic rate. But it looks like an option. You'll still have to pay more.

Life insurance

The policy provides for payments to relatives in the event of the death of the insured person. The contract prescribes the conditions of death. Payment can be given in case of detection of a fatal disease. Contributions are accepted regularly or one-time.

Cost of Health Insurance

Given how health insurance works in the United States, it is necessary to analyze the pricing in detail. There is a concept of non-reimbursable expenses. Americans have to pay insurers, and then compensate for part of the medical services themselves.

CO-PAY

Co-Pay is a surcharge. For the doctor's visit and medical services, the patient pays a fixed amount, and the balance is covered by the insurer.

DEDUCTIBLE

Deductible is a franchise. This item is not available for all programs. Deductible does not apply to prophylaxis and routine doctor visits. It means payment for services until the start of the insurance indemnity.

CO-INSURANCE

Co-insurance is also not available in all programs. This means that the client pays 20% of the invoice issued by the clinic. Everything else is covered by the insurer.

OUT-OF-POCKET MAXIMUM    

Out-of-pocket maximum – limit from the pocket. It is implied that the client has a certain amount above which he can no longer cover the costs of treatment. The patient pays up to the limit. Then the insurer gets involved and completely closes the balance.

Cost of medical services in the United States

Typical services of American doctors:

• Ultrasound from $300 to $500;
• consultation with a narrow specialist from $200 to $600;
• operation from $1000 and more;
• The cost of a blood test goes up to $6000 depending on the complexity.

The information is taken from open sources. From it, you can immediately conclude that it is expensive to be treated in America. An insurance policy will allow you to save a lot on treatment. Anyone can get sick at the most inopportune moment.

Who is eligible for health insurance benefits?

In America, there is government assistance for pensioners and low-income categories of the population.

Free Medicare Retiree Insurance

To get under the program, you need to meet certain conditions. There are few of them:

• 65 years of age or older;
• Less than 65 years old, but diagnosed with a certain serious illness.

People with terminal incurable kidney disease are entitled to state assistance. But no one is entitled to regular maintenance. According to the program, payment for a specific disease is carried out. Long-term stay in the clinic is self-paid.

Free Medicaid Insurance for the Poor

The state is ready to provide financial assistance to people with low incomes. Conditions vary by state. The procedure for recognizing the right to receive insurance coverage depends on this. Medicaid depends on the status of stay in America, pregnancy, disability.

If the birth took place under the Medicaid program, then up to 1 year of age, the child automatically receives free health insurance. Adoptive parents of children can also count on help.

Cost of health insurance to enter the United States

Inexperienced tourists often refuse to buy a policy before departure. Health insurance in the United States is not included in the list of mandatory documents. Therefore, the question arises whether it is worth buying an insurance policy at all.

Unlike American insurances, travel packages are cheaper. Their cost is calculated by the number of options included. The price is affected by the duration of America's premises.

For forgetful tourists, there is an opportunity to buy a policy on the spot after arrival. Then, when ordering, you need to indicate that the client is already on the road.

Insurance in the USA for 1-3 months

The cost depends on the insurer and the options chosen. One of the best reviews is medical insurance for traveling to the United States from Tripinsurance, ERV, Allianz and ERGO.

The daily price ranges from 1.40 to 2.20 dollars. If the visit lasts more than a month, then you can choose a program within 131 dollars and more.

Insurance in the USA for 3-6 months

The longer the stay, the more likely you are to end up in the hospital. Even a walk in the park can end in a tick bite. Programs for people who go to the United States for up to six months cost about 328 to 656 dollars.

Insurance in the USA for a year

You can choose a program for 365 days at once. This is beneficial for those who travel more than 2 times a year. There are fares costing 40,000 with disabilities and extended offers from 80,000 and up.

The limit is chosen by the client. It should be remembered that in America, the treatment of even a mild case costs from $10,000.

What should I do if the insured event occurred in the USA?

The regulations are usually indicated in the memo. They must be attached to the contract. The step-by-step instructions look pretty much the same:

• Notify the insurer within 24 hours.
• Call 911 and call an ambulance. She will come regardless of nationality, age and availability of a policy.
• After the visit to the doctor, you have 3 days to buy medicines. Otherwise, the cost of buying them will not be compensated.

You can't make an appointment with narrow specialists on your own without approval. There is a risk of paying the costs out of pocket.

Procedure for Payments in the Event of an Insured Event

Medicine in America is at a high level. Therefore, it is also the most expensive in the world. In the event of an emergency, none of the paramedics and doctors will leave the patient to die.

Of course, help will be provided. But further treatment and payment for the services already provided falls on the shoulders of the patient. Insurance is a guarantee that you will not have to sell your property to pay off debts to the clinic.