It is believed that physician services in the United States are among the most expensive in the world. Even for a simple test or a simple procedure, a patient can be billed several thousand dollars. The health insurance system works to protect residents and residents from such costs.
According to the Kaiser Family Foundation’s Center for American Health Research:
49% of Americans have employer-sponsored insurance;
20% have Medicaid, the government insurance program for the poor;
14% from Medicare, a government program for retirees;
6% are policies established by Obama’s 2010 reform;
1%, Pentagon policies;
9% of Americans have no health insurance.
Let’s take a look at what types of insurance exist in the U.S. and whether you can get it for free.
How does the insurance system work in general?
It is supposed that legal residents of the U.S. pay a certain amount (usually $250-400) each month to the insurance company, and that in turn covers part of his expenses in case of illness. However, some insurance plans have a certain limit-the maximum amount a patient must pay for medical bills over the course of one year. Such a limit is usually between $1,000 and $5,000.
For example, you have an emergency surgery that costs $10,000. Of that, you
You pay $2,000 of that and the insurance company covers the rest. In fact, health insurance in the U.S. only covers up to 80% of your medical expenses.
Types of health insurance:
HMOs (health maintenance organizations). This option is considered one of the most economical. Because it offers a certain number of doctors and clinics that the patient can visit. It is clear that the insurance company will not cover your expenses in clinics not included in its list, unless it is for emergency care.
PPO (preferred provider organizations). Here, too, you’ll get a list of certain clinics, but it will be much broader. But you can also get covered treatment at other clinics, but your costs will increase. In addition, you will be able to make appointments with any specialists, bypassing the general practitioner. But the cost of this type of insurance may be 1.5-2
times higher than HMOs.
POS (Point-of-service) Similar to HMO, but less popular plan, but the doctor
If necessary, you can be referred to a clinic that is not listed in the contract.
clinic not mentioned in the contract. And then your out-of-pocket costs for specialist services may increase.
EPO (Exclusive Provider Organization). Another HMO, but without a general practitioner and without compulsory referral to other specialists.
Important: Remember that each type of insurance has its own plan: Platinum, Gold, Silver, Bronze, and minimum coverage. The range of services the insurance can cover also depends on the rate plan. By the way, to see a dentist or ophthalmologist, you must have separate insurance.
How and where do I buy health insurance in the U.S.?
Insurance in the U.S. is purchased at certain times of the year – from November 15 to February 15. Exceptions are changes in family composition, relocation, and similar reasons. If that is the case, you can buy health insurance outside this period.
You can buy insurance at a special Health Insurance MarketPlace site. It has collected all the offers of companies, taking into account the income of each client. After all, the cost and package of services for people with low and high income will be different.
By the way, some U.S. states denied the federal Health Insurance MarketPlace site. Because of this, they were allowed to create their own sites to post insurance company offers. You can find out the site for buying insurance in the state you want on the ObamaCare portal. Information on it is updated monthly.
What should you do before choosing insurance?
Read reviews.
In the U.S., the practice of reviews is very developed. Before choosing any product or service, Americans read reviews, this also applies to insurance companies. So research everything online about your future insurance company.
Find out the list of insurance company clinics
It is important to find out if the insurance company contracts with hospitals directly. And which clinics are on its list. It is also better to find out about the clinics themselves through reviews.
Study the insurance plan.
Specifically, what services and drugs are covered. Compare it to your regular annual treatment list. You should not overpay for services that you obviously do not need. Or it’s better to choose a plan with services and drugs that you can use for sure, rather than paying more for them than your premiums. It’s also worth paying special attention to medications, because without an insurance policy, even cough syrup can cost you up to $400.
Important: It is imperative that your insurance must include emergency care and hospitalization.
Calculate Costs
Estimate how much you spend on doctor services each year, add to that the emergencies. Consider the amount you’ll have to spend on your insurance each month and how much it can cover.
Call the insurance company
Specifically, to the customer service department. It is better to do this, of course, before you buy insurance on the website and bind yourself financially for the next year. Ask them all your questions. For example: how to go out of network and how much it will cost, will travel expenses be covered in case of illness, how to resolve disputes over paying for clinic services, etc.
How do I get insurance for free?
The U.S. government funds two types of health insurance plans: Medicare and Medicaid. They are specifically designed for seniors, people with disabilities, people living below the poverty line, and young people. To get it, you need to prove that the person cannot afford to pay for insurance on his or her own. In this case, a number of medical services, including ambulance calls, will cost patients free of charge. I must say that tourists in the U.S. can also take advantage of free medicine, if they indicate that their income is less than $ 1,500 per month.