How Does the US Health System Work?
Healthcare in the United States is organized in a complex bureaucracy. While in the rest of the world healthcare facilities are owned mostly by governments or by private sector businesses, in the US a large share of hospitals and clinics are owned by private non-profit organizations.
Yet, the United States is the country that has the highest healthcare expenditures in the world. While these expenditures are covered in a large share by public payers as by Federal institutions, or State and local governments, they can also be covered by private insurance and individual payments.
At the same time, unlike most developed nations, the US health system does not provide health care to its entire population. As there is no single nationwide system of health insurance, the United States primarily relies on employers who voluntarily provide health insurance coverage to their employees and dependents.
In addition, the government has programs that tend to cover healthcare expenses for the fragile parts of the society as the elderly, disabled and the poor. These programs differ from one another, and all have a specific kind of people that are subject to.
Getting health insurance in the US is not an easy thing. Someone may think that once you have money everything is easy peasy, but in fact things are a bit more complicated. One must be very careful and look out to pick the right insurance.
Health Insurance in the United States for non-Citizens
The United States government does not provide health insurance for all its people, and health insurance is not obligatory for those living in the US. It is optional, but highly recommended and necessary since health services are very costly, more than in any other country anywhere across the globe.
There are two types of health insurances in the US, private and public. Most people use a combination of both. The US public health insurances are: Medicare, Medicaid, and Children’s Health Insurance Program.
Medicare is a national health insurance program that dates back to 1966. It provides health insurance for US nationals older than 65 years old, but also for younger people with end stage renal disease, ALS, and some other disabilities.
Data shows that in 2018, Medicare provided almost 60 million individuals with healthcare in the US, over 51 million of which were older than 65.
The Medicare program is divided into four parts:
- Part A – which covers hospitals, skilled nursing and hospice services.
- Part B – covers outpatient services, including some providers’ services while inpatient at a hospital, outpatient hospital charges
- Part C – is an alternative called Managed Medicare, which permits patients to select health plans with at least the same service coverage as Part A and B, often the benefits of Part D, and an annual out of pocket spend limit which A and B lack. To sign in this part, one must sign in Part A and B fist.
- Part D – covers mostly self-administered prescription drugs.
Medicaid is a federal and state program that helps people with limited income and resources to cover medical costs, while covering benefits normally not covered by Medicare, as nursing home care and personal care services.
It is the largest source of funding for medical and health-related services for people with low income in the United States. Data shows that the US provided health insurance to 71 million people with low income or disabilities, which is 23% of the total of the US’ population.
Children’s Health Insurance Program
Formerly known as the State Children’s Health Insurance Program (SCHIP), this is a program that covers with health insurance children of families with modest income, that are not low enough to qualify for Medicaid.
The Affordable Care Act – Obamacare
The Patient Protection and Affordable Care Act is a federal statute signed into law by President Obama, which made it mandatory for every citizen to have health insurance or be penalized. The Act subsidies for low-income families, by taxing healthcare providers and high-income families, as it was designed to lower health care costs while providing better health care for Americans.
The Affordable Care Act allowed parents to ad their children up to the age of 26 to their policies, in a bid to have younger healthy people paying premiums. It also allowed poorer people to get treatment for chronic illnesses instead of using the emergency room.
US Private Health Insurance
There are about a thousand private health insurance providers in the US, with each of them offering different plans with different prices, which largely depend on a person’s medical history. However, while there are individual plans, covering only one person, there are also group plans targeting families in particular.
Usually, there are three types of health insurances in the United States:
- Traditional fee-for-service health insurance plans which plans are usually the most expensive, that those with an income lower than the average income in the US, have difficulties to purchase. However, these are the best plans as they offer you most flexibility.
- Health Maintenance Organizations (HMOs) which offers a limited choice of healthcare providers, yet it also offers lower co-payments and covers the costs of more preventative care. They are evaluated and accredited by the National Committee for Quality Assurance.
- Preferred Provider Organizations (PPOs) which just like HMOs offer lower co-payments, but they give you more flexibility when selecting a provider, as they give you a list of providers among which you can choose.
How to Choose a Good US Health Insurance Plan?
When looking up for a good health insurance plan make sure you ask questions like:
- Does that plan grant you with the right to go to any doctor, hospital, clinic or pharmacy you choose?
- Are specialists such as eye doctors and dentists covered?
- Does the plan cover special conditions or treatments such as pregnancy, psychiatric care and physical therapy?
- Does the plan cover home care or nursing home care and medications a physician might prescribe?
- What are the deductibles? Are there any co-payments?
- What is the most you will have to pay out of my own pocket to cover expenses?
Make sure you also understand how a dispute about a bill or service is handled by your provider, as in some plans, you may be required to have a third party decide how to settle the problem. We recommend the GeoBlue Xplorer plan for foreigners in the United States.
Health Insurance Requirements for Foreign Visitors in the US
Though the United States Authorities have not made health insurance mandatory for short-term travelers to the country, as B-1/B-2 visa holders, it is highly recommended for every traveler to get insurance before their trip to the country.
The main reason why you should get insurance is that healthcare in the US is extremely expensive and even a check-up for a simple headache will cost you hundreds of dollars, while a broken limb will cost you thousands.
Health incidents are never foreseen, therefore it is best to be prepared for it and get insurance, so in case of need you save yourself money.
Health Insurance Options for Legal Immigrants
Immigrants that are lawfully present in the United States are eligible to get private health insurance in the US. In addition, lawful immigrants may also eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income, as follows:
- Those with annual income 400% of the federal poverty level or below may be eligible for premium tax credits and other savings on Marketplace insurance.
- Whereas those with annual household income is below 100% federal poverty level that are not otherwise eligible for Medicaid are eligible for premium tax credits and other savings on Marketplace insurance, given that they meet all other eligibility requirements.
Most of the time, “qualified non-citizens” are eligible for coverage through Medicaid and Children’s Health Insurance Program (CHIP), given that they meet the income and residency rules of the state where they are based.
“Qualified non-citizens” are considered the following:
- Lawful permanent residents
- Asylees, refugees, battered non-citizens & spouses, children, or parents, victims of trafficking and his or her spouse, child, sibling, or parent or individuals with a pending application for a victim of trafficking visa
- Cuban/Haitian entrants,
- Those paroled into the US for at least one year
- Conditional entrant granted before 1980
- those granted withholding of deportation and members of a federally recognized Indian Tribe or American Indian born in Canada.
However, most of them will need to wait for 5 years in the US in order to get Medicaid and CHIP coverage in the US, after they get qualified. Refugees and asylees are exempt from the waiting period.
In addition, states have the option to abolish the 5-year waiting period for children and pregnant women so they can be covered by Medicare and CHIP.
Health Insurance Options for Illegal Immigrants
Illegal Immigrants in the US can get health coverage only from private providers, as the US government funded health insurance does not cover them.
Community centers can provide medical help to undocumented immigrants in the US, which is termed Safety Net Providers, if the healthcare seeker can participate in fee for service medical assistance.